Abstract
BACKGROUND: Symptom reduction occurring early in depression treatment is associated with favourable post-treatment outcome, but it is not known how early reduction in specific depression symptoms affect treatment outcome. We aimed to determine the impact of symptom-specific change from pre-treatment to week four during internet-delivered CBT (ICBT) on overall and symptom-specific depression severity at post-treatment. We hypothesized that change in mood and emotional involvement would be most strongly associated with later overall depression severity.
METHODS: 1300 participants with Major Depressive Disorder were followed over 12 weeks of ICBT using the self-report Montgomery-Åsberg Depression Rating Scale gauging nine symptoms. Linear models, informed by causal inference and cross-lagged network analysis methods, were used to estimate associations between early symptom-specific change and post-treatment depression severity, controlling for register-based and self-reported pre-treatment confounders.
RESULTS: Early reduction in all symptoms was associated with lower overall and symptom-specific depression severity post-ICBT. Seven symptoms showed similar associations between early change and overall depression severity post-treatment: mood (standardized beta [β] = 0.44), feelings of unease (β = 0.39), ability to concentrate (β = 0.46), initiative (β = 0.43), emotional involvement (β = 0.42), pessimism (β = 0.44), and zest for life (β = 0.42). Change in sleep (β = 0.27) and appetite (β = 0.27) had weaker associations with overall depression severity at post-treatment and were the only symptoms showing the hypothesized difference compared with mood and emotional involvement.
CONCLUSIONS: The impact of early symptom-specific reduction on post-treatment depression severity in ICBT for MDD may be similar across most symptoms, but less for the sleep and appetite symptoms, although causal interpretations rests on several assumptions.
Original language | English |
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Pages (from-to) | 420-428 |
Number of pages | 9 |
Journal | Journal of Affective Disorders |
Volume | 368 |
Early online date | 2024 Sept 16 |
DOIs | |
Publication status | Published - 2025 |
Subject classification (UKÄ)
- Psychiatry
- Psychology (excluding Applied Psychology)
Free keywords
- Depression
- Network analysis
- Internet-delivered CBT
- Early symptom change