Early change in specific depression symptoms and later outcome in internet-delivered psychotherapy for depression : A cohort study and cross-lagged network analysis
(2025) In Journal of Affective Disorders 368. p.420-428- 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.... (More)
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.
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- author
- Johansson, Fred ; Flygare, Oskar ; Bäckman, Julia ; Fondberg, Robin ; Axelsson, Erland ; Forsell, Erik ; Cervin, Matti LU ; Kaldo, Viktor ; Rück, Christian and Wallert, John
- organization
- publishing date
- 2025
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Depression, Network analysis, Internet-delivered CBT, Early symptom change
- in
- Journal of Affective Disorders
- volume
- 368
- pages
- 9 pages
- publisher
- Elsevier
- external identifiers
-
- scopus:85204408351
- pmid:39293595
- ISSN
- 0165-0327
- DOI
- 10.1016/j.jad.2024.09.092
- language
- English
- LU publication?
- yes
- id
- 12b5efc0-948a-4a77-ad30-ab1be9ec90fb
- date added to LUP
- 2024-11-06 13:58:55
- date last changed
- 2025-07-04 00:26:13
@article{12b5efc0-948a-4a77-ad30-ab1be9ec90fb,
abstract = {{<p>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.</p><p>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.</p><p>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.</p><p>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.</p>}},
author = {{Johansson, Fred and Flygare, Oskar and Bäckman, Julia and Fondberg, Robin and Axelsson, Erland and Forsell, Erik and Cervin, Matti and Kaldo, Viktor and Rück, Christian and Wallert, John}},
issn = {{0165-0327}},
keywords = {{Depression; Network analysis; Internet-delivered CBT; Early symptom change}},
language = {{eng}},
pages = {{420--428}},
publisher = {{Elsevier}},
series = {{Journal of Affective Disorders}},
title = {{Early change in specific depression symptoms and later outcome in internet-delivered psychotherapy for depression : A cohort study and cross-lagged network analysis}},
url = {{http://dx.doi.org/10.1016/j.jad.2024.09.092}},
doi = {{10.1016/j.jad.2024.09.092}},
volume = {{368}},
year = {{2025}},
}