Internet Based Treatment of Depressive Symptoms


On the Internet psycho education is as effective as cognitive behavior therapy in reducing symptoms of depression. The INTERNET is a useful tool in delivering interventions for depression. Cognitive behavior therapy was predicted to improve symptoms of depression and dysfunctional thoughts more than psycho education but depression literacy was found to be as effective as cognitive behavior therapy in reducing symptoms of depression.

Depression is a leading cause of disability worldwide and many individuals with depression do not receive adequate treatment. Large scale intervention programmes on the Internet can benefit these individuals and prevent the disabilities associated with this disease.

The researchers used participants recruited directly from the community to investigate this possibility by comparing the effects of a website for psycho education and a website offering cognitive behaviour therapy with a control intervention. One site provided depression literacy, offering evidence based information on depression and its treatment. The other site offered cognitive behaviour therapy for the prevention of depression. The control intervention used an “attention placebo,” which provided weekly contact with a lay interviewer to discuss lifestyle factors such as exercise, education, and health habits.

A questionnaire was send to 27 000 people aged 18-52 years in Canberra, Australia. They randomly selected participants from which 6122 people returned questionnaires.Of those participants 752 indicated a willingness to participate, had access to the internet, scored 22 or above on the Kessler psychological distress scale, and were not receiving clinical care from either a psychologist or psychiatrist. Of these, 525 (150 men, 375 women), aged 36.43 (SD = 9.4) years, completed the forms and were randomised to groups. These were not patients diagnosed with depression.

Lay interviewers contacted participants weekly by phone to direct their use of the websites. In the control group participants were phoned weekly by interviewers to discuss lifestyle and environmental factors that may have an influence on depression.

Effect sizes were some what smaller than brief cognitive therapy assisted by a therapist, self directed manualised computer therapy, and bibliotherapy, where pre-post effect sizes have ranged from about 0.70 to 1.20 standard deviation units for mixed or depressed samples. Computer assisted cognitive behavior therapy in general practice has produced even better pre-post effect sizes of approximately 1.20.

The cognitive behavioral group had a higher drop out rate. A follow-up study after 12 months will provide information about the sustainability of internet interventions.

Moreover this research used two reliable websites for the treatment of depression. In a review of 21 popular websites containing infor­mation about treating depression the quality of this information was poor. This review was published in the British Medical Journal in 2000: Quality of web based information on treatment of depression: cross sectional survey.

Currently popular criteria for evaluating the quality of websites were not indicators of content quality. These Silberberg criteria are: accountability standards (disclosure of authorship, own­ership, and currency of information). In this review the sites with higher quality information about depression and it’s treatment were sites with an editorial board and sites owned by organisations.

There is a need for better evidence based information about depression on the web, and a need to reconsider the role of accountability criteria as indicators of site quality and to develop simple valid indicators of quality.
Christensen, H. (2004). Delivering interventions for depression by using the internet: randomised controlled trial. BMJ, 328(7434), 265. DOI: 10.1136/bmj.37945.566632.EE