Pilot Study Evaluates Online Intervention for Elevated Depressive Symptoms

The use of an online intervention targeting adults with depression warrants further large-scale studies after a pilot study showed high acceptance among participants, according to a study published in Journal of Affective Disorders.¹

The 2-phase pilot study evaluated MARIGOLD (Mobile Affect Regulation Intervention With the Goal of Lowering Depression), a web-based, self-guided intervention based on Stress and Coping² and Broaden-and-Build³ theories of positive emotion. Its aim is to teach individuals positive emotion skills for handling elevated depressive symptoms defined as a Patient Health Questionnaire-8 score >5. Skills include noticing and amplifying positive events, gratitude, activation, mindfulness, positive reappraisal, strengths, and acts of kindness.

In phase 1, participants (n=58) were randomly assigned to a MARIGOLD group, an active control group participating in daily emotion reporting during the intervention period, or to a waitlist control group. All participants were assessed at baseline, at postintervention, and at 1- and 3-month follow-ups. In phase 2, participants (n=79) were randomly assigned to receive MARIGOLD plus 1 of 3 enhancements: an online discussion board, virtual badges for accomplishing goals (eg, logging into the website for 7 consecutive days), or facilitator contact, which consisted of 5-minute weekly telephone check-ins during the intervention period. Investigators interviewed participants postintervention to assess acceptability and used intention-to-treat analyses to assess retention, adherence, and efficacy.

Analyses showed that in both phases of the study, groups did not differ in retention, adherence, or efficacy. However, MARIGOLD was highly acceptable to participants. In phase 1, the MARIGOLD and active control groups showed similar findings in stable depressive symptoms, increased positive emotion, and decreased negative emotion and stress, but the waitlist group showed increases in depressive mood. Most phase 2 within-group analyses demonstrated decreases in Patient Health Questionnaire-8 scores and negative emotion as well as increases in positive emotion. In the online discussion board and facilitator contact phase 2 groups, perceived stress remained stable over time. Depressive symptomatology also remained stable in the facilitator contact group.

The current phase studies were limited by their small sizes and the preponderance of female participants.

“The larger sample (n=600) planned for phase 3 of the MARIGOLD study will facilitate further investigation of home practice adherence and acceptability, differences in home practice associated with receipt of varying enhancements, and relationships between home practice and efficacy of MARIGOLD for improving key outcomes such as depression and positive affect,” investigators concluded.

References

1. Addington EL, Cheung EO, Bassett SM, et al. The MARIGOLD study: Feasibility and enhancement of an online intervention to improve emotion regulation in people with elevated depressive symptoms. J Affect Disord. 2019;257:352-364.
2. Folkman S. Positive psychological states and coping with severe stress. Soc Sci Med. 1997;45(8):1207-1221.
3. Fredrickson BL. What good are positive emotions? Rev Gen Psychol. 1998;2(3):300-319.