A controlled trial of a school-based Internet program for reducing depressive symptoms in adolescent girls
Open accessAbstract
BACKGROUND: This study evaluates the benefits of a self-directed Internet intervention for depression (MoodGYM) delivered as a part of the high school curriculum. METHOD: One hundred and fifty-seven girls, aged 15 and 16 years, were allocated to undertake either MoodGYM or their usual curriculum. MoodGYM's impact on depressive symptoms, risk of depression, attributional style, depression literacy and attitudes toward depression was examined using random effect regression. RESULTS: MoodGYM produced a significantly faster rate of decline in depressive symptoms over the trial period than the control condition. The effect size for MoodGYM was not significant immediately after the intervention (Cohen's d=.19, 95% CI -.18-.56) but was moderate and significant 20 weeks after the intervention (d=.46, 95% CI .10-.82). Girls with high depression scores before intervention showed the strongest benefits on self-reported depression at follow-up (d=.92, 95% CI .10-1.38). There were no significant intervention effects on depression status, attributional style, depression literacy, and attitudes. Approximately 70% of girls in the MoodGYM group completed less than three of its modules and completion of fewer modules was related to high depression score before intervention. CONCLUSIONS: The findings suggest that there are benefits from MoodGYM on self-reported depressive symptoms but has low rates of completion highlight problems in ensuring adherence to Internet programs for depression.
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An internet package, MoodGYM, used with adults has been evaluated in a general adolescent population but 70% of young people did not complete the programme.
“An internet package, MoodGYM, used with adults has been evaluated in a general adolescent population but 70% of young people did not complete the programme.15”
From Computerised cognitive behaviour therapy for depression in adolescents: Study protocol for a feasibility randomised controlled trial (2014) · cites this paper as [15]
The Introduction says MoodGYM had been used with adults, and the Abstract describes its evaluation in a school-curriculum trial. But the participants were girls aged 15–16, not a general adolescent population; the Abstract and Adherence section report that about 70% completed fewer than three modules, rather than measuring the percentage who did not complete the entire programme. Page numbers are unavailable in our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measuredA popular setting for prevention interventions is within school settings due to the advantages of access and ease of incorporation into the curriculum.
“Again, although beyond the scope of this review, a popular setting for prevention interventions is within school settings [74–77], due to the advantages of access and ease with which such programs can be incorporated into the curriculum.”
From eHealth interventions for the prevention of depression and anxiety in the general population: a systematic review and meta-analysis (2017) · cites this paper as [75]
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Telemental health and Web-based applications in children and adolescents
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Achieving Depression Literacy: The Adolescent Depression Knowledge Questionnaire (ADKQ)
Hart, S. R., Kastelic, E. A., Wilcox, H. C., Beaudry, M. B., Musci, R. J., Heley, K. M., Ruble, A. E., & Swartz, K. (2014) · School Mental Health · doi:10.1007/s12310-014-9120-1 · Cited by 54 · see citing works
Type 1 Diabetes eHealth Psychoeducation: Youth Recruitment, Participation, and Satisfaction
Whittemore, R., Jaser, S. S., Faulkner, M. S., Murphy, K., Delamater, A. M., & Grey, M. J. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2170 · Cited by 52 · see citing works
“In an eHealth program for depression, only 30% of youths completed 50% or more of the program modules [24].”
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Bernard, R., Sabariego, C., & Cieza, A. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.5442 · Cited by 43 · see citing works
“Many other Web-based treatment and intervention options are increasingly being explored for other mental disorders (eg, posttraumatic stress disorder, eating disorders) [11] and populations including children (eg, Project CATCH-IT, MoodGYM) [12,13] with positive results.”
Salazar de Pablo, G., De Micheli, A., Solmi, M., Oliver, D., Catalan, A., Verdino, V., Di Maggio, L., Bonoldi, I., Radua, J., Baccaredda Boy, O., et al. (2021) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000294 · Cited by 51 · see citing works
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Evidence Map of Prevention and Treatment Interventions for Depression in Young People
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“grams [68, 69].”
Bradley, K. L., Robinson, L. M., & Brannen, C. L. (2012) · International Journal of Mental Health Promotion · doi:10.1080/14623730.2012.665337 · Cited by 41 · see citing works
“An IBSHP, MoodGYM, has been extensively studied in Australian adolescents with mixed results (Calear, Christensen, Mackinnon, Griffiths, & O'Kearney, 2009 ; O'Kearney, Gibson, Christensen, & Griffiths, 2006 ; O'Kearney, Kang, Christensen, & Griffiths, 2009 ).”
Attwood, M., Meadows, S., Stallard, P. N., & Richardson, T. H. (2011) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2011.00627.x · Cited by 45 · see citing works
Computers and psychosocial treatment for child anxiety: recent advances and ongoing efforts
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Hickie, I., Davenport, T., Luscombe, G., Moore, M., Griffiths, K., & Christensen, H. (2010) · Medical Journal of Australia · doi:10.5694/j.1326-5377.2010.tb03690.x · Cited by 50 · see citing works
Self-citationInternet-Based Depression Prevention over the Life Course: A Call for Behavioral Vaccines
Voorhees, B. W. V., Mahoney, N., Mazo, R., Barrera, A. Z., Siemer, C. P., Gladstone, T. R. G., & Muñoz, R. F. (2011) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2010.11.002 · Cited by 42 · see citing works
“In 3 MoodGYM studies, support was given in the school environment by a supervising professional (teacher).(30,32,33) In CYL, supervision was provided by a trained coach.”
Cynthia Logsdon, M., Myers, J., Rushton, J., Gregg, J. L., Josephson, A. M., Davis, D. W., Brothers, K., Baisch, K., Carabello, A., Vogt, K., et al. (2018) · Archives of Women's Mental Health · doi:10.1007/s00737-017-0804-z · Cited by 40 · see citing works
“Feedback on the intervention indicated that the amount of material, the age-appropriateness of the themes and examples, and time available for access to the intervention were problematic (O'Kearney et al. 2009).”
Anttila, M., Sittichai, R., Katajisto, J., & Valimaki, M. A. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16142473 · Cited by 41 · see citing works
Myers, K., & Comer, J. S. (2016) · Journal of Child and Adolescent Psychopharmacology · doi:10.1089/cap.2015.0055 · Cited by 37 · see citing works
“…adolescents, ‘‘Mood Gymn’’ has demonstrated variable success in reducing depressive symptoms in high school students with low levels of depressive symptoms (O’Kearney et al. 2009), whereas Project CATCH-IT has shown potential to prevent depression in youth treated in primary care (Van Voorhees et…”
Berg, M., Rozental, A., de Brun Mangs, J., Näsman, M., Strömberg, K., Viberg, L., Wallner, E., Åhman, H., Silfvernagel, K., Zetterqvist, M., et al. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00503 · Cited by 35 · see citing works
Results from a trial of an unsupported internet intervention for depressive symptoms
Leykin, Y., Muñoz, R. F., Contreras, O., & Latham, M. D. (2014) · Internet Interventions · doi:10.1016/j.invent.2014.09.002 · Cited by 34 · see citing works
“…have used financial incentives (Clarke et al., 2005; Clarke et al., 2002) or phone interviews (Berger et al., 2011; Christensen et al., 2004a; Spek et al., 2007; Vernmark et al., 2010), or were administered in a structured setting such as a school (O'Kearney et al., 2006; O'Kearney et al., 2009).”
BackgroundMethodDavidson, T. M., Soltis, K. E., Albia, C. M., de Arellano, M. A., & Ruggiero, K. J. (2014) · Psychological Services · doi:10.1037/a0037686 · Cited by 32 · see citing works
“First, similar to other web-based, depressionfocused interventions for adolescents (O'Kearny et al., 2009), when first accessing the site, users are presented with a disclaimer that explains terms of use, privacy notice, and the PI's contact information.”
BackgroundMohammadi, A. S., Panahi, S., Sayarifard, A., & Ashouri, A. (2020) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_623_20 · Cited by 33 · see citing works
Lattie, E. G., Ho, J., Sargent, E., Tomasino, K. N., Smith, J. D., Brown, C. H., & Mohr, D. C. (2017) · Internet Interventions · doi:10.1016/j.invent.2017.02.003 · Cited by 31 · see citing works
“…mental health clinicians (Rice et al., 2016), most studies of internet-based mental health interventions focused on prevention with adolescents have been conducted through school systems (Calear et al., 2009, 2013; O'Kearney et al., 2006, 2009; Attwood et al., 2012;Werner-Seidler et al., 2017).”
BackgroundInfluentialKahl, B. L., Miller, H. M., Cairns, K., Giniunas, H., & Nicholas, M. (2020) · JMIR Mental Health · doi:10.2196/21280 · Cited by 31 · see citing works
“There is also increasing evidence of the effectiveness of web-based counseling, therapies, and mobile self-monitoring tools in improving mental health outcomes and help-seeking [27-33].”
Psychological Treatments for Depression in Adolescents: More Than Three Decades Later
Méndez, X., Sánchez-Hernández, Ó., Garber, J., Espada, J. P., & Orgilés, M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18094600 · Cited by 33 · see citing works
“[49] CBT MoodGYM Internet Program Usual curriculum Universal prevention: All year 10 girls attending a single sex school”
BackgroundYouth work service providers' attitudes towards computerized CBT for adolescents
Fleming, T., & Merry, S. (2013) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465812000306 · Cited by 37 · see citing works
Promoting Youth Mental Health through Computer-Mediated Communication
Rickwood, D. (2010) · International Journal of Mental Health Promotion · doi:10.1080/14623730.2010.9721817 · Cited by 30 · see citing works
A review of web-based support systems for students in higher education
Παπαδάτου-Παστού, Μ., Goozée, R., Payne, E., Barrable, A., & Tzotzoli, P. (2017) · International Journal of Mental Health Systems · doi:10.1186/s13033-017-0165-z · Cited by 30 · see citing works
“However, 20 weeks later the effect size was moderate and significant [58].”
BackgroundMartínez, V., Espinosa-Duque, D., Jiménez-Molina, Á., Rojas, G., Vöhringer, P. A., Fernández-Arcila, M., Luttges, C., Irarrázaval, M., Bauer, S., & Moessner, M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18189628 · Cited by 27 · see citing works
School-based prevention of depression and anxiety in Australia: Current state and future directions
Nehmy, T. J. (2010) · Clinical Psychologist · doi:10.1080/13284207.2010.524884 · Cited by 28 · see citing works
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Technology at the Service of Pediatric Mental Health: Review and Assessment
Aboujaoude, E. N., & Salame, W. O. (2015) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2015.12.009 · Cited by 26 · see citing works
Crawford, E. A., Salloum, A., Lewin, A. B., Andel, R., Murphy, T. K., & Storch, E. A. (2013) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.27.3.221 · Cited by 26 · see citing works
Baldofski, S., Kohls, E., Bauer, S., Becker, K., Bilić, S., Eschenbeck, H., Kaess, M., Moessner, M., Salize, H. J., Diestelkamp, S., et al. (2019) · Trials · doi:10.1186/s13063-018-3156-8 · Cited by 25 · see citing works
“Another self-directed Internet-based intervention for depression was delivered as part of the high school curriculum and resulted in a reduction of depressive symptoms in adolescent girls [26].”
BackgroundMarsac, M. L., Winston, F. K., Hildenbrand, A. K., Kohser, K. L., March, S., Kenardy, J. A., & Kassam‐Adams, N. (2014) · Clinical Practice in Pediatric Psychology · doi:10.1037/cpp0000080 · Cited by 24 · see citing works
“…treat mood and anxiety symptoms in children and teens (Cohen & Mannarino, 2008; Kenardy, McCafferty, & Rosa, 2006; March, Spence, & Donovan, 2009; O’Kearney, Kang, Christensen, & Griffiths, 2009), evidence has yet to be translated into widely accessible interventions to prevent negative…”
Price, M., Yuen, E. K., Davidson, T. M., Hubel, G. S., & Ruggiero, K. J. (2015) · Psychological Services · doi:10.1037/ser0000017 · Cited by 23 · see citing works
Hedemann, E. R., & Frazier, S. L. (2016) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-016-0758-x · Cited by 25 · see citing works
“Many prevention programs have been designed for schools (e.g., Barrett et al. 2006; O’Kearney et al. 2009), but competing priorities (e.g., academic instruction, standardized test preparation) and limited resources (e.g., time for teacher training) make it difficult to integrate such programs into…”
Internet-Based Cognitive Behavior Therapy
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Richards, D., Duffy, D. J., Burke, J., Anderson, M., Connell, S., & Timulák, L. (2018) · JMIR Mental Health · doi:10.2196/10204 · Cited by 23 · see citing works
“However, the complexities associated with delivering a successful internet-delivered intervention for this population are naturally more challenging, with some studies suggesting that severely depressed individuals participate less in iCBT [23] and sometimes demonstrate less improvement than the mild to moderately dep…”
Promoting youth mental health: priorities for policy from an Australian perspective
Rickwood, D. (2011) · Early Intervention in Psychiatry · doi:10.1111/j.1751-7893.2010.00239.x · Cited by 22 · see citing works
“MoodGYM, an online CBT-based intervention that has recently been adapted for youth, and for which evidence is accumulating.(20,21) There is a rapidly growing array of ICT-based interventions for mental health, often targeted at youth because of their high”
MethodMarsac, M. L., Kohser, K. L., Winston, F. K., Kenardy, J. A., March, S., & Kassam‐Adams, N. (2013) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v4i0.21311 · Cited by 21 · see citing works
Francis, J., Vella‐Brodrick, D., & Chin, T. (2021) · International Journal of Wellbeing · doi:10.5502/ijw.v11i4.1465 · Cited by 20 · see citing works
Li, S. H., Achilles, M. R., Werner‐Seidler, A., Beames, J. R., Subotic-Kerry, M., & O’Dea, B. (2022) · JMIR Mental Health · doi:10.2196/37640 · Cited by 20 · see citing works
“Number of modules or sessions Therapeutic modelDelivery formatDelivery modeTarget conditionIntervention nameStudy and year published 8 modulesCBTaSequentialWebAnxiety and depression UndisclosedBerg et al [47], 2020 UnclearCBT, IPTb, positive psychology, NonsequentialMultiplatform (web, app) DepressionMoodHwbBevan Jone…”
BackgroundMethodInfluentialA Comprehensive Evaluation of a Universal School-Based Depression Prevention Program for Adolescents
Tomyn, J. D., Fuller‐Tyszkiewicz, M., Richardson, B., & Colla, L. (2016) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-016-0136-x · Cited by 20 · see citing works
A Spirituality Teaching Program for Depression: A Randomized Controlled Trial
Rickhi, B., Moritz, S., Reesal, R. T., Xu, T. J., Paccagnan, P., Urbanska, B., Liu, M. F., Ewing, H., Toews, J., Gordon, J. S., et al. (2011) · The International Journal of Psychiatry in Medicine · doi:10.2190/pm.42.3.f · Cited by 20 · see citing works
“Other studies also show a high level of participation in home based depression programs and it has been suggested that this delivery format may be particularly suited for a depressed population with little energy and motivation to venture out [22-25].”
BackgroundWright, B., Tindall, L., Littlewood, E., Adamson, J., Allgar, V., Bennett, S., Gilbody, S., Verduyn, C., Alderson-Day, B., Dyson, L., et al. (2014) · BMJ Open · doi:10.1136/bmjopen-2014-006488 · Cited by 19 · see citing works
- Authors
- O'Kearney, R., Kang, K., Christensen, H., & Griffiths, K.
- Affiliations
- Australian National University (AU)
- ORCID
- Christensen, Helen
- Venue
- Depression and Anxiety
- Publisher
- Hindawi Limited
- Published
- 2009-01
- Volume
- 26
- Issue
- 1
- Pages
- 65-72
- ISSN
- 1091-4269 (ISSN-L)
- 1520-6394
- OpenAlex
- W2017051042
- Cited by
- 179
- References
- 32
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 7 · 2023: 9 · 2022: 10 · 2021: 13 · 2020: 8 · 2019: 6 · 2018: 9 · 2017: 9 · 2016: 15 · 2015: 19 · 2014: 19 · 2013: 15 · 2012: 10
- FWCI
- 11.25
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- ANU Open Research (Australian National University) (submittedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- MoodGYM, online intervention, adolescent depression, depressive symptoms, school-based intervention, self-guided intervention, depression literacy, attributional style, attitudes toward depression, intervention adherence, adolescent girls
- MeSH terms
- Adaptation, Psychological, Adolescent, Attitude to Health, Combined Modality Therapy, Curriculum, Depression, Female, Follow-Up Studies, Health Education, Humans, Internal-External Control, School Health Services, Therapy, Computer-Assisted, Cognitive Behavioral Therapy, Internet, Australian Capital Territory
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