Open Access Highly Accessed Study protocol

Internet-based treatment for older adults with depression and co-morbid cardiovascular disease: protocol for a randomised, double-blind, placebo controlled trial

Nicole L Cockayne1, Nick Glozier12*, Sharon L Naismith1, Helen Christensen3, Bruce Neal4 and Ian B Hickie1

Author Affiliations

1 Brain & Mind Research Institute, The University of Sydney, 100 Mallet Street, Camperdown NSW 2050, Australia

2 Disciplines of Psychiatry and Sleep Medicine, Sydney Medical School, The University of Sydney NSW 2006, Australia

3 Centre for Mental Health Research, The Australian National University, Canberra ACT 0200, Australia

4 The George Institute for Global Health, PO Box M201 Missenden Road, Sydney NSW 2050, Australia

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BMC Psychiatry 2011, 11:10  doi:10.1186/1471-244X-11-10

Published: 14 January 2011



Depression, cardiovascular disease (CVD) risk factors and cognitive impairment are important causes of disability and poor health outcomes. In combination they lead to an even worse prognosis. Internet or web-based interventions have been shown to deliver efficacious psychological intervention programs for depression on a large scale, yet no published studies have evaluated their impact among patients with co-existing physical conditions. The aims of this randomised controlled trial are to determine the effects of an evidence-based internet intervention program for depression on depressive mood symptoms, cognitive function and treatment adherence in patients at risk of CVD.


This study is an internet-based, double-blind, parallel group randomised controlled trial. The trial will compare the effectiveness of online cognitive behavioural therapy with an online attention control placebo. The trial will consist of a 12-week intervention phase with a 40-week follow-up. It will be conducted in urban and rural New South Wales, Australia and will recruit a community-based sample of adults aged 45 to 75 years. Recruitment, intervention, cognitive testing and follow-up data collection will all be internet-based and automated. The primary outcome is a change in severity of depressive symptoms from baseline to three-months. Secondary outcomes are changes in cognitive function and adherence to treatment for CVD from baseline to three, six and 12-months.


Prior studies of depression amongst patients with CVD have targeted those with previous vascular events and major depression. The potential for intervening earlier in these disease states appears to have significant potential and has yet to be tested. Scalable psychological programs using web-based interventions could deliver care to large numbers in a cost effective way if efficacy were proved. This study will determine the effects of a web-based intervention on depressive symptoms and adherence to treatment among patients at risk of CVD. In addition it will also precisely and reliably define the effects of the intervention upon aspects of cognitive function that are likely to be affected early in at risk individuals, using sensitive and responsive measures.

Trial registration

Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12610000085077