TY  - JOUR
AU  - Nakagami, Yukako
AU  - Uwatoko, Teruhisa
AU  - Shimamoto, Tomonari
AU  - Sakata, Masatsugu
AU  - Toyomoto, Rie
AU  - Yoshida, Kazufumi
AU  - Luo, Yan
AU  - Shiraishi, Nao
AU  - Tajika, Aran
AU  - Sahker, Ethan
AU  - Horikoshi, Masaru
AU  - Noma, Hisashi
AU  - Iwami, Taku
AU  - Furukawa, Toshi A
PY  - 2024
DA  - 2024/9/24
TI  - Long-Term Effects of Internet-Based Cognitive Behavioral Therapy on Depression Prevention Among University Students: Randomized Controlled Factorial Trial
JO  - JMIR Ment Health
SP  - e56691
VL  - 11
KW  - iCBT
KW  - depression prevention
KW  - student mental health
KW  - factorial randomized controlled trial
KW  - mobile phone
AB  - Background: Internet-based cognitive behavioral therapy (iCBT) shows promise in the prevention of depression. However, the specific iCBT components that contribute to its effectiveness remain unclear. Objective: We aim to evaluate the effects of iCBT components in preventing depression among university students. Methods: Using a smartphone cognitive behavioral therapy (CBT) app, we randomly allocated university students to the presence or absence of 5 different iCBT components: self-monitoring, behavioral activation, cognitive restructuring, assertiveness training, and problem-solving. The active intervention lasted 8 weeks but the app remained accessible through the follow-up. The primary outcome was the onset of a major depressive episode (MDE) between baseline and the follow-up after 52 weeks, as assessed with the computerized World Health Organization Composite International Diagnostic Interview. Secondary outcomes included changes in the 9-item Patient Health Questionnaire, 7-item General Anxiety Disorder, and CBT Skills Scale. Results: During the 12-month follow-up, 133 of 1301 (10.22%) participants reported the onset of an MDE. There were no significant differences in the incidence of MDEs between the groups with or without each component (hazard ratios ranged from 0.85, 95% CI 0.60‐1.20, for assertiveness training to 1.26, 95% CI 0.88‐1.79, for self-monitoring). Furthermore, there were no significant differences in the changes on the 9-item Patient Health Questionnaire, 7-item General Anxiety Disorder, or for CBT Skills Scale between component allocation groups. However, significant reductions in depression and anxiety symptoms were observed among all participants at the 52-week follow-up. Conclusions: In this study, we could not identify any specific iCBT components that were effective in preventing depression or the acquisition of CBT skills over the 12-month follow-up period, but all participants with and without intervention of each iCBT component demonstrated significant improvements in depressive and anxiety symptoms. Further research is needed to explore the potential impact of frequency of psychological assessments, nonspecific intervention effects, natural change in the mental state, and the baseline depression level. Trial Registration: UMINCTR UMIN000031307; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000035735 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2719-z 
SN  - 2368-7959
UR  - https://mental.jmir.org/2024/1/e56691
UR  - https://doi.org/10.2196/56691
DO  - 10.2196/56691
ID  - info:doi/10.2196/56691
ER  -