Internet cognitive behavioural therapy (iCBT) for depression in older individuals with comorbid depression and cardiovascular disease

INTERVENTION: All intervention participants will separately complete 6 lessons of Internet based treatment about the management of symptoms of depression. One lesson will be completed every 7 to 14 days (it will become available after the preceding lesson has been completed, with a minimum of 7 days between lessons and a maximum of 14 days). Each lesson will take about 15 minutes to complete. Group 1 participants will have access to summaries of each lesson, homework exercises, extra resources, weekly reminder emails, and one‐on‐one contact with the Clinician (Clinical Psychologist) by telephone or email in the first 2 weeks, then as required. The participant receives a template email from the clinician twice in the first two weeks congratulating the participant on their progress. The participant is also able to email or phone the clinician at any point during the trial as required. The participant completes a measure of psychological distress before each lesson and if their scores increase by one or more standard deviations the clinician is automatically alerted and contact with the participant either by phone or email is initiated. We’ve found that people who get the most out of our programs spend about 3‐4 hours a week completing the homework tasks and applying the new skills they’re learning on a daily basis. The treatment materials are based on cognitive behavioural techniques. Strategies used to improved adherence to intervention protocols and procedures for monitoring adherence include: automated email reminders, monitoring the downloading of homework, collection of data on how long participants spent reading lessons and practising skills CONDITION: Depression Heart failure PRIMARY OUTCOME: Reductions in the Patient Health Questionnaire – 9‐Item (PHQ‐9) SECONDARY OUTCOME: Improvements in adherence to CVD treatment as measured by the Medical Outcomes Study Measures of Patient Adherence Scale Improvements in biomarkers of CVD: pro‐inflammatory proteins: CRP, TNF, IL‐8, MIC‐1, as well fasting glucose and cholesterol will be determine via collection of blood samples Improvements in cognitive and emotional representations of illness according to The Brief Illness Perception Questionnaire ; Improvements in physical activity as measured by the Physical Activity Scale Improvements in psychological distress according to the Kessler 10 Reductions in anxiety according to the Generalized Anxiety Disorder 7‐Item (GAD‐7) Reductions in disability according to the World Health Organisation Disability Assessment Schedule (WHODAS‐II) Reductions in disability and impairment according to the Sheehan Disability Scale Reductions in risky drinking as measured by the Alcohol Use Disorders Identification Test—Consumption (AUDIT‐C) INCLUSION CRITERIA: A diagnosis of Major Depressive Disorder (MDD) according to the Mini International Neuropsychiatric Interview Version 5.0.0; self‐reported heart failure confirmed by a clinician at St Vincent's Heart and Lung Outpatients Clinic; aged over 50; prepared to provide name, phone number and address, and to provide the name and address of a local general practitioner, and to provide written informed consent; English language skills equivalent to a School Certificate level; access to a phone and a computer with internet and a printer.