E-health intervention for co-occurring at-risk alcohol use and depressive symptoms: Reach, adherence, and two-year effects of a randomized controlled trial

Abstract

Background

This randomized controlled trial explored reach, adherence, and two-year effects of a proactive e-health intervention for co-occurring at-risk alcohol use and depressive symptoms (ITE).

Methods

German medical care patients were screened for at-risk alcohol use and subthreshold depression. Over 6 months, ITE participants received 6 individualized feedback letters and weekly text messages. Primary outcome was change in a composite measure including problematic alcohol use (Alcohol Use Disorders Identification Test consumption questions) and depressive symptoms (two subscales of the Patient-Health-Questionnaire-8) from baseline to 6, 12, and 24 months. Analyses were adjusted for education, setting, major depression, and baseline differences.

Results

Among eligible patients invited, 51 % agreed to participate; 40 % completed the baseline interview and were randomized to ITE (n = 64) or assessment only (n = 68). Within ITE participants, 73 % received all intervention components. A latent change model revealed a small, insignificant impact of study group on the composite measure at 6 (d = −0.49, β = −0.41, p = 0.06) and 12 months (d = −0.26, β = −0.22, p = 0.35), diminishing at 24 months (d = −0.06, β = −0.04, p = 0.88). Secondary analyses showed a non-significant trend at 6 months, suggesting possible effect modification by baseline major depression (β = 0.80, p = 0.098), with larger effects in those without major depression.

Limitations

Self-reported outcomes; psychotherapy status unknown.

Discussion

ITE showed high adherence and overall small, although non-significant, intervention effects up to month 12. The potential effect moderation warrants further investigation in larger samples.