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Cited by 271Digital Mental Health InterventionsMental Health Treatment and AccessTelemedicine and Telehealth Implementation

Internet-based mental health programs: A powerful tool in the rural medical kit

Open access
Griffiths, Kathleen M., Christensen, Helen·2007·Australian Journal of Rural Health
DOI 10.1111/j.1440-1584.2007.00859.x
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Abstract

Objective: To discuss, using two case examples, the potential utility of Internet-based depression information and automated therapy programs in rural regions. Design: Systematic review of evaluations of two Australian web-based mental health programs: MoodGYM and BluePages Depression Information. Setting: Community, school, university. Participants: A total of 12 papers and reports derived from nine separate studies of MoodGYM and BluePages involving sample sizes ranging from 78 to 19 607 people. Outcome measures: Depressive symptoms, anxiety symptoms, dysfunctional thoughts, depression literacy, stigma, help seeking and cost-effectiveness. Results: Internet-based applications were effectivein reducing depressive symptoms and stigmatising attitudes to depression and in improving depression literacy. School-based programs also showed promise in decreasing depressive symptoms. Conclusions: Depression self-help and information programs can be delivered effectively by means of the Internet. As accessibility of face-to-face mental health services in rural areas is poor and as there is a strong culture of self-reliance and preference for self-managing health problems among rural residents, the Internet might offer an important platform for the delivery of help for depression in rural regions. Consideration should be given to developing programs tailored to rural settings and future research should evaluate the efficacy and effectiveness of such programs in rural settings. © 2007 The Authors; Journal Compilation © 2007 National Rural Health Alliance Inc.

Integrity signals

Registry

Crossref · 10.1111/j.1440-1584.2007.00859.x

Cites

27 of 27 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

10 of 38 cited sources checked · 8 supported · 0 flagged · accuracy not yet measured

  • Premisecitation
    § Introduction · p. 1

    Rural areas have a prevalence of mental health problems at least as high as metropolitan areas.

    “There is evidence that the prevalence of mental health problems in rural areas is at least as high as among metropolitan residents 1,2”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [1] source
    • cites [2] source

      The Abstract reports a higher prevalence of diagnosable mental health disorders among rural GP attendees than among attendees at a regional urban practice. It does not compare rural residents with metropolitan residents generally, and it cautions that earlier rural–urban studies had mixed findings. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Findingcitation
    § Depression literacy, stigma and dysfunctional thoughts and help seeking · p. 3

    MoodGYM, unlike BluePages, reduced dysfunctional thoughts.

    “MoodGYM but not BluePages reduced dysfunctional thoughts. 20”
    Quote in the paperNot a substantial claim1 of 1 sources checked
  • Findingcitation
    § Depressive and anxiety symptoms · p. 3

    The first MoodGYM evaluation, an uncontrolled study of users in the site's first six months, found that online anxiety and depression scores fell systematically as users moved through the five modules.

    “The first evaluation of the effectiveness of MoodGYM was an uncontrolled study of users who visited the site in the initial six months after its release. 19 The study found a systematic decrease in users' online anxiety and depression scores as they progressed through the five modules of the application.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
  • Findingcitation
    § Depressive and anxiety symptoms · p. 3

    The pattern of results across modules did not differ between spontaneous MoodGYM visitors and BlueMood participants.

    “There was no difference in the pattern of findings across modules for spontaneous and BlueMood users. 24”
    Quote in the paperSubstantial claim1 of 1 sources checked
  • Findingown data
    § Results · p. 3

    The review found 12 papers and reports from nine separate studies of MoodGYM and BluePages.

    “A total of 12 papers and reports derived from nine separate studies of MoodGYM and BluePages were identified (Table 1).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 20
  • Classified as probably not a substantial claim. 10
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingcitation
    § Depressive and anxiety symptoms · p. 3

    In the BlueMood randomized trial, intention-to-treat analysis found that both MoodGYM and BluePages lowered depressive and anxiety symptoms compared with control right after the program ended.

    “An intent-to-treat analysis demonstrated that both the MoodGYM and the BluePages interventions were associated with a reduction in depressive and anxiety symptoms relative to the control condition immediately after completion of the program. 20”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [20] source

      The Symptoms of depression and mental health literacy section states that, in the intention-to-treat analysis, both BluePages and MoodGYM reduced depressive symptoms; the Procedures section says post-intervention questionnaires were administered at six weeks. Our copy does not report a reduction in anxiety symptoms for either intervention, so that part of the claim is unsupported (searched: anxiety). Page numbers were not available in the indexed passages. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Introduction · p. 1

    Rural residents tend to be more stoic and self-reliant and to prefer managing their own health problems.

    “It has also been argued that rural residents are more 'stoic and self-reliant' 13 and prefer to manage their own health problems. 14-16”
    Quote in the paperNot a substantial claim1 of 4 sources checked
    • cites [13] source
      Experimental — accuracy not yet measured
    • cites [14] source
    • cites [15] source
    • cites [16] source

  • May combine two claims.

    Findingcitation
    § Depression literacy, stigma and dysfunctional thoughts and help seeking · p. 3

    Both BluePages and MoodGYM improved depression literacy in adults.

    “As might be expected, BluePages improved depression literacy in adults 20,21 as did MoodGYM. 20”
    Quote in the paperNot a substantial claim2 of 2 sources checked

  • May combine two claims.

    Findingcitation
    § Depression literacy, stigma and dysfunctional thoughts and help seeking · p. 3

    Both programs lowered personal stigma in adults, but neither reduced perceived stigma in adults nor personal stigma in school students.

    “Both programs led to reduced personal stigma among adults 21 but were not helpful in reducing perceived stigma in adults 21 or in decreasing personal stigma among school students. 27”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [21] source
    • cites [27] source

  • May combine two claims.

    Findingcitation
    § Depression literacy, stigma and dysfunctional thoughts and help seeking · p. 3

    Some evidence indicated MoodGYM increased use of certain evidence-based treatments, while BluePages reduced help seeking from non-professional sources like family and friends.

    “There was some evidence that MoodGYMincreased the use of selected evidence-based treatments and that BluePages reduced help seeking from non-professional sources such as family and friends. 23”
    Quote in the paperNot a substantial claim1 of 1 sources checked

  • May combine two claims.

    Findingcitation
    § Depressive and anxiety symptoms · p. 3

    A trial randomizing spontaneous visitors to different MoodGYM module combinations found that one online CBT module did not work, while extended CBT with or without behaviour strategies reduced depression.

    “A trial of spontaneous visitors to the site who agreed to be randomised to one of a number of combinations of MoodGYM modules demonstrated that a single module of online CBT was not effective but extended CBT with or without behaviour strategies reduced depression. 25”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data
    § Results · p. 3

    Among the nine studies, five were with community adults, one with university students, and three with secondary students in school programs.

    “Of the nine studies identified, five were concerned with adult members of the community, one involved university students and three involved programs delivered as part of the school curriculum to secondary school students.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingcitation
    § Depressive and anxiety symptoms · p. 3

    In a Norwegian randomized trial, university students with elevated depressive symptoms who completed questionnaires after using Norwegian MoodGYM and BluePages together had significantly less depression and anxiety than no-treatment controls.

    “The students who completed the post-intervention questionnaires showed a significantly lower level of depression and anxiety than the control group. 26”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingown data
    § Abstract · p. 1

    Internet-based applications reduced depressive symptoms and stigmatising attitudes to depression and improved depression literacy.

    “Internet-based applications were effective in reducing depressive symptoms and stigmatising attitudes to depression and in improving depression literacy.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § Discussion · p. 6

    The review indicates that MoodGYM and BluePages are linked to better mental health and to improved knowledge and attitudes about depression.

    “This review of MoodGYM and BluePages evaluations suggests that these programs are associated with improvements in mental health and knowledge and attitudes to depression.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given
    § Discussion · p. 6

    Among all MoodGYM users, 18.6% say a health practitioner referred them.

    “Indeed, 18.6% of all MoodGYM users report that they are referred by a health practitioner.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Discussion · p. 6

    Many schools in the YouthMood study were rural, and registration data show 20.5% of spontaneous MoodGYM users worldwide come from rural or remote areas.

    “However, a substantial percentage of the YouthMood study of MoodGYM in schools involved rural schools and according to data collected at registration, 20.5% of spontaneous MoodGYM users worldwide are from rural or remote areas.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Findingnone given
    § Discussion · p. 6

    MoodGYM's examples are not tailored specifically for rural users.

    “Moreover, the examples are not specifically tailored for a rural user.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning
    § Depressive and anxiety symptoms · p. 3

    That study supported MoodGYM's usefulness and was the first to show that a simple online educational program might improve depression outcomes.

    “Thus, the study confirmed the utility of MoodGYM and provided the first (and to date only) demonstration that a simple web-based educational program might also be associated with improved depression outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation
    § Introduction · p. 1

    Rural residents often do not know which agencies provide mental health services; in one rural study only 40% knew where to get help.

    “knowledge of agencies providing mental health services is poor among rural residents with only 40% of respondents in one study of a rural population being aware of where they could receive help for a mental health problem. 11”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] source

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationreasoning
    § Abstract · p. 1

    Because rural residents have limited access to in-person mental health care and tend to value independence and managing their own health, the Internet may be an important way to deliver depression help in rural regions.

    “As accessibility of face-to-face mental health services in rural areas is poor and as there is a strong culture of self-reliance and preference for selfmanaging health problems among rural residents, the Internet might offer an important platform for the delivery of help for depression in rural regions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § Introduction · p. 1

    Rural GPs say the greatest need for mental health services is CBT groups and patient education about depression.

    “According to rural GPs the greatest need for mental health services relates to the provision of cognitive behavioural therapy (CBT) groups and patient education about depression. 10”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] source

  • May combine two claims.

    Premisecitation
    § Introduction · p. 1

    About two-thirds of practitioners say they need substantial CBT support, and half say they need patient education.

    “Indeed two-thirds of practitioners report a high or extreme need for CBT support and half report such a need for 'patient education'. 10”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] source

  • May combine two claims.

    Interpretationown data
    § Depressive and anxiety symptoms · p. 3

    Both groups showed a systematic drop in anxiety and depression scores across modules, which supports MoodGYM working without interviewer monitoring.

    “Both showed a systematic decrease in anxiety and depression scores across modules consistent with the suggestion that MoodGYM is effective even in the absence of tracking by an interviewer.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning
    § Depressive and anxiety symptoms · p. 3

    Despite having no control group, that first study was the first indication that a website could deliver effective depression therapy.

    “Although lacking a control group, this was the first demonstration that a website might be capable of delivering effective therapy for depression.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § What is already known on this subject : · p. 2

    Qualitative evidence suggests farming communities may view expressing negative feelings as inappropriate and favour solving problems over talking about them.

    “there is some qualitative evidence that expressing negative feelings or thoughts is considered inappropriate within farming communities and that a person should seek to solve, rather than talk about, their problems. 4”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] source

  • Classified as probably not a substantial claim.

    Interpretationreasoning
    § What is already known on this subject : · p. 2

    A self-reliant culture may make self-help methods for mental health problems more acceptable.

    “In particular, a culture of self-reliance might be conducive to the use of self-help methods for addressing mental health problems.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given
    § Discussion · p. 6

    MoodGYM does not suit every user, especially those with lower literacy.

    “MoodGYM is not suitable for all users, particularly those with lower literacy levels.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given
    § Discussion · p. 6

    Some rural residents may find CBT's learning style incompatible with how they prefer to learn.

    “It is possible that some rural residents in particular will find the learning style involved in CBT inconsistent with their preferred mode of learning.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning
    § Discussion · p. 6

    These programs can be used alone or alongside treatment from a busy rural GP.

    “Such programs can be used without input from a clinician, or as an adjunct to treatment by the busy rural GP.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning
    § Discussion · p. 6

    MoodGYM and BluePages may help rural consumers who are psychologically inclined and have elevated depressive symptoms.

    “Meanwhile, MoodGYM and BluePages might prove useful for psychologically inclined rural consumers with elevated depressive symptoms.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § Discussion · p. 6

    ABS data show 51% of non-metropolitan residents have home Internet access, compared with 59% in metropolitan areas, which suggests considerable rural use of Internet technology.

    “Australian Bureau of Statistics figures indicate that 51% of people outside metropolitan areas have access to the Internet from home, a figure that although lower than access rates for metropolitan areas (59%), nevertheless suggests a substantial degree of engagement of rural residents with Internet technology. 29”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [29]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

27 of 27

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • iCBT allows breast cancer survivors and their carers access to the programme at a time and place convenient to them regardless of their location, and may reduce concerns about stigma and privacy.

    “It would allow breast cancer survivors and their carers access to the programme at a time and place convenient to them regardless of their location; furthermore, it may reduce concerns about stigma and privacy”

    From A randomised controlled trial comparing internet-delivered cognitive behavioural therapy (iCBT) with and without main carer access versus treatment-as-usual for depression and anxiety among breast cancer survivors: Study protocol (2021) · cites this paper as Griffiths and Christensen, 2007

    The Discussion (p. 6) says the internet-based services are anonymous, fit around rural work schedules, and avoid lengthy travel, supporting the proposed convenience and privacy benefits. The paper discusses rural consumers with depressive symptoms, not breast cancer survivors or their carers, and does not establish that these groups would have reduced concerns about stigma. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Lack of availability of alternative services, greater motivation of supervising staff members, or a preference for health self-management in rural participants are potential explanations for the mixed adherence findings.

    “Lack of availability of alternative services, greater motivation of supervising staff members, or a preference for health self-management in rural participants are potential explanations for this [38,43,48].”

    From Computerized cognitive behavior therapy for anxiety and depression in rural areas:a systematic review (2015) · cites this paper as [48]

    The Introduction (p. 1) says rural mental health services are less accessible than those in major cities, and p. 2 reports a preference among rural respondents for self-help over formal help. These passages support two proposed explanations, but the paper does not identify greater motivation among supervising staff or connect these factors to mixed adherence findings. Its discussion of non-completion (p. 3) does not offer those explanations. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Online delivery may be a relatively inexpensive means of delivering treatments to a wide range of people, particularly for rural residents whose access to in-person interventions may be limited.

    “In addition, online delivery may be a relatively inexpensive means of delivering treatments to a wide range of people [53], particularly for rural residents [54] whose access to in-person interventions may be limited.”

    From A systematic review of help-seeking interventions for depression, anxiety and general psychological distress (2012) · cites this paper as [54]

  • The review by Griffiths and Christensen included studies reporting the efficacy of CCBT for both children/young people and adults, none of their included studies disaggregated the data by location.

    “Furthermore, while the review by Griffiths and Christensen included studies reporting the efficacy of CCBT for both children/young people and adults, none of their included studies disaggregated the data by location [48].”

    From Computerized cognitive behavior therapy for anxiety and depression in rural areas:a systematic review (2015) · cites this paper as [48]

  • The included systematic review found that, of spontaneous users of the CCBT program MoodGYM worldwide, 20.5% were from rural and remote areas.

    “The included systematic review [48] found that, of spontaneous users of the CCBT program MoodGYM worldwide, 20.5% were from rural and remote areas.”

    From Computerized cognitive behavior therapy for anxiety and depression in rural areas:a systematic review (2015) · cites this paper as [48]

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. Australian Institute of Health and Welfare., 2005, Rural, Regional and Remote Health: Indicators of Health.
  2. Lowe S, 2004, National Allied Health Workforce Report.
  3. Christensen H, 2004, MoodGYM Training Program: Clinician's Manual
  4. GriffithsK ChristensenH ClarkeG. Depression interventions panel. Mednet 2006: 11th World Conference on Internet in Medicine. Toronto 2006.

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Related

Authors
Griffiths, K. M., & Christensen, H.
Affiliations
Australian National University (AU)
Corresponding author
Griffiths, Kathleen M.
ORCID
Venue
Australian Journal of Rural Health
Publisher
Wiley
Published
2007-04
Volume
15
Issue
2
Pages
81-87
ISSN
  • 1038-5282 (ISSN-L)
  • 1440-1584
DOI
10.1111/j.1440-1584.2007.00859.x
OpenAlex
W1999735089
Semantic Scholar
b4f481a36c49e356d5d8e9543bbcdbd62057764a
Cited by
270
References
26
Citations by year
2025: 6 · 2024: 7 · 2023: 7 · 2022: 10 · 2021: 21 · 2020: 20 · 2019: 17 · 2018: 20 · 2017: 14 · 2016: 25 · 2015: 18 · 2014: 15 · 2013: 21 · 2012: 16
FWCI
2.36
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 16 d)
Locations
  • Australian Journal of Rural Health (publishedVersion)
  • PubMed (publishedVersion)
  • ANU Open Research (Australian National University) (submittedVersion)
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
Keywords
depression, rural mental health, MoodGYM, self-help, school-based intervention, depression literacy, stigma, help-seeking, cost-effectiveness
MeSH terms
Australia, Computer-Assisted Instruction, Cost-Benefit Analysis, Depressive Disorder, Health Services Accessibility, Health Services Research, Humans, Mental Health Services, Patient Acceptance of Health Care, Patient Education as Topic, Research Design, Self Care, Self Concept, Stereotyping, Therapy, Computer-Assisted, Program Evaluation, Cognitive Behavioral Therapy, Outcome Assessment, Health Care, Rural Health Services, Evidence-Based Medicine, Internet

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