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Does Internet-based cognitive behavioral therapy (iCBT) prevent major depressive episode for workers? A 12-month follow-up of a randomized controlled trial

Published online by Cambridge University Press:  07 January 2015

K. Imamura
Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
N. Kawakami*
Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
T. A. Furukawa
Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
Y. Matsuyama
Department of Biostatistics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
A. Shimazu
Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
R. Umanodan
Kyoto office, Health Wave Co., Ltd, Kyoto, Japan
S. Kawakami
Nippon University College of the Arts, Tokyo, Japan
K. Kasai
Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
*Address for correspondence: Dr N. Kawakami, Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan (Email:



In this study we investigated whether an Internet-based computerized cognitive behavioral therapy (iCBT) program can decrease the risk of DSM-IV-TR major depressive episodes (MDE) during a 12-month follow-up of a randomized controlled trial of Japanese workers.


Participants were recruited from one company and three departments of another company. Those participants who did not experience MDE in the past month were randomly allocated to intervention or control groups (n = 381 for each). A 6-week, six-lesson iCBT program was provided to the intervention group. While the control group only received the usual preventive mental health service for the first 6 months, the control group was given a chance to undertake the iCBT program after a 6-month follow-up. The primary outcome was a new onset of DSM-IV-TR MDE during the 12-month follow-up, as assessed by means of the web version of the WHO Composite International Diagnostic Interview (CIDI), version 3.0 depression section.


The intervention group had a significantly lower incidence of MDE at the 12-month follow-up than the control group (Log-rank χ2 = 7.04, p < 0.01). The hazard ratio for the intervention group was 0.22 (95% confidence interval 0.06–0.75), when estimated by the Cox proportional hazard model.


The present study demonstrates that an iCBT program is effective in preventing MDE in the working population. However, it should be noted that MDE was measured by self-report, while the CIDI can measure the episodes more strictly following DSM-IV criteria.

Original Articles
Copyright © Cambridge University Press 2014 

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