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Cited by 35Digital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and Access

Internet-delivered treatment: its potential as a low-intensity community intervention for adults with symptoms of depression: protocol for a randomized controlled trial

Open access
Richards, Derek, Timulak, Ladislav, Doherty, Gavin, Sharry, John, Colla, Amy, Joyce, Ciara, Hayes, Claire·2014·BMC Psychiatry
DOI 10.1186/1471-244x-14-147PMC PMC4036670
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Abstract

BACKGROUND: Depression is a high prevalence disorder, displaying high rates of lifetime incidence, early age onset, high chronicity, and role impairment. In Ireland 12-month prevalence of depression has been reported to be 10.3%. A large percentage of affected individuals have no medical diagnosis nor seek treatment. Cognitive Behavior Therapy (CBT) has established itself as an option for the treatment of depression. Many Irish adults with depression find it difficult to access evidence-based CBT, this is due to several factors, like stigma and costs. However, systematic factors including the shortage of trained professionals and the relative underdevelopment of services also make access difficult.Stepped-care can increase access to evidence-based CBT. One option is tailored internet-delivered treatment programs. Preliminary research from Ireland needs now to include large-scale studies on effectiveness. Thus the current study seeks to examine the potential of an internet-delivered low-intensity treatment for symptoms of depression in an Irish adult community sample. METHOD/DESIGN: The study is a randomized controlled trial of an online CBT (iCBT) program for the treatment of adults with depressive symptoms. The trial will include an active treatment group and a waiting-list control group. The active condition will consist of 8 weekly modules of iCBT, with post-session feedback support. Participants in the waiting list will receive access to the treatment at week 8. Participants will complete the Beck Depression Inventory (BDI-II) and eligibility criteria will also apply. Primary outcomes are depressive symptoms. Secondary outcomes include quality of life indicators, significant events and satisfaction with online treatment. Data will be collected at baseline and at post-treatment, week 8, and at follow-up week 20 (3-months) and week 32 (6-months). Analysis will be conducted on the intention-to-treat basis. DISCUSSION: The study seeks to evaluate the effectiveness of an online delivered treatment for depression in a community sample of Irish adults with symptoms of depression. The study will be a first contribution and depending on the sample recruited the results may be generalizable to people with similar difficulties in Ireland and may therefore give insight into the potential of low-intensity interventions for Irish people with depressive symptoms. TRIAL REGISTRATION NUMBER: Current Controlled Trials ISRCTN03704676. DOI: 10.1186/ISRCTN03704676.

AI snapshot

Written from the paper’s full text.

TL;DR

This is a protocol for a randomized controlled trial evaluating an internet-delivered CBT program (Mind Balance on SilverCloud) with asynchronous supporter feedback for Irish adults with mild-to-moderate depressive symptoms. It reports no trial outcomes; it describes the design, measures, planned analyses, and hypotheses.

Key findings

  • The trial aims to test whether an online treatment for depressive symptoms can be effective as a low-intensity community-based intervention for adult users of the Aware charity, and to examine helpful/hindering aspects, satisfaction, and dropout reasons.
  • The authors hypothesize that participants in the trial will show significant decreases in depressive symptoms post-intervention and corresponding increases in quality-of-life indicators, based on prior supported online treatments for depression.
  • The primary outcome is depressive symptoms measured by BDI-II; secondary outcomes include GAD-7, WSAS, EQ-5D, satisfaction with treatment, and helpful/hindering aspects of treatment.
  • Power calculation using G-Power with power 0.80 and alpha 0.05 indicated 60 subjects per arm to observe a moderate post-treatment difference (d = .50); prior studies cited had post-treatment effect sizes averaging 1.29 and follow-up effects averaging 1.42.

Methods

  • Design: randomized controlled trial with an active internet-delivered intervention plus support versus a waiting-list control group; waiting-list participants receive access to the program at week 8.
  • Sample and eligibility: adult Aware service users aged 18+ with mild-to-moderate depressive symptoms (BDI-II 14–29); exclusions include suicidal intent/ideation (BDI-II question 9 score >2), psychotic illness, current psychological treatment for depression, medication for less than 1 month, alcohol or drug misuse, previous organic mental health disorder diagnosis, and depression preceding or coinciding with a diagnosed medical condition.
  • Intervention and assessment: the active condition is described as 8 weekly modules of iCBT in the abstract, while the Mind Balance program is described as a seven-module online CBT-based intervention; assessments occur at baseline, post-treatment/week 8, and follow-up at week 20 (3 months) and week 32 (6 months). Analysis is planned on an intention-to-treat basis using SPSS, repeated measures ANOVAs, Cohen’s d, remission/recovery criteria, and qualitative analysis of helpful/hindering and dropout data.

Limitations

  • The paper states that the study will not include an official diagnosis of participants, and that generalizability may depend on the sample recruited.
  • The paper states dropout is a continued cause of concern for online treatments, especially self-administered ones, and that session time estimation is imperfect because users may be interrupted, take breaks, or not formally log out.
  • Evident from the text: this is a protocol only, so no outcome data are available; the abstract says 8 weekly modules while the program description says seven modules, and the trial status indicates materials were still being prepared for a January 2014 launch.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/1471-244x-14-147

Cites

74 of 74 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 53 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    Stepped-care can increase access to evidence-based CBT.

    “Stepped-care can increase access to evidence-based CBT.”
    • Also stated in: § Stepped care models of treatment · plain
      “Such a program is recommended as best-practice by the National Institute for Health and Clinical Excellence [13] and also advocated by the Irish health service [30].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [13] National Institute for Health and Clinical Excellence: Computerised Cognitive Behaviour Therapy for Depression and Anxiety. Technology Appraisal 97. 2006, London: National Institute for Health and Clinical Excellence

      Not checked in the free run.

    • cites [30] Health Service Executive: Advancing the Shared Care Approach between Primary care and Specialist Mental Health Services. 2012, Dublin: Health Service Executive, 27-

      Not checked in the free run.

  • Premisecitation

    Cognitive vulnerability increases the risk for first episode and recurrences of depression.

    “Research has provided compelling support for cognitive-vulnerability as theorized by Beck [17] and demonstrates that cognitive-vulnerability increases the risk for first episode and recurrences of depression [18].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Abramson LY, Alloy LB, Hankin BL, Haeffel GJ, MacCoon DG, Gibb BE: Cognitive Vulnerability-Stress Model of Depression in a Self-Regulatory and Psychobiological Context. Handbook of Depression. Edited by: Gotlib IH, Hammen CL. 2002, New York: Guilford, 268-294.

      Not checked in the free run.

  • Premisecitation

    Low-intensity internet-delivered treatments for depression have established a sound base supporting their effectiveness and efficacy.

    “More precisely, low-intensity internet-delivered treatments for depression have established a sound base supporting their effectiveness and efficacy [34].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [34] Richards D, Richardson T: Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev. 2012, 32: 329-342. 10.1016/j.cpr.2012.02.004. source

      Not checked in the free run.

  • Premisecitation

    In Ireland, less than 20% of patients presenting with mental health difficulties at general practitioners are in receipt of secondary specialist services.

    “More recent reports also corroborate the state of affairs where less than 20% of patients presenting with mental health difficulties at Irish general practitioners are in receipt of secondary specialist services [27,28].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [27] Hughes M, Byrne M, Synnott J: Prevalence of psychological distress in general practitioner adult attendees. Clin Psychol Forum. 2010, 206: 33-38. source

      Not checked in the free run.

    • cites [28] Tedstone-Doherty D, Moran R, Kartalova-O’Doherty Y: Psychological Distress, Mental Health Problems and use of Health Services in Ireland. Health Research Board (HRB) Research Series 5. 2008, Dublin: HRB

      Not checked in the free run.

  • Premisecitation

    Internet-delivered depression treatments that provide human support yield enhanced results compared to those with no support.

    “In addition, such studies for depression treatment that provide human support yield enhanced results compared to those with no support [34,35].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [34] Richards D, Richardson T: Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev. 2012, 32: 329-342. 10.1016/j.cpr.2012.02.004. source

      Not checked in the free run.

    • cites [35] Andersson G, Cuijpers P: Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn Behav Ther. 2009, 38: 196-205. 10.1080/16506070903318960. source

      Not checked in the free run.

  • May combine two claims. 14
  • Classified as probably not a substantial claim. 27

  • May combine two claims.

    Premisecitation

    In Ireland, less than one third of GPs have postgraduate training in psychological therapies and 85% referred less than 5% of their service users with mental health difficulties to specialists.

    “Many Irish present their psychological difficulties, initially, to their primary care phsician however, one survey reported that less than one third of GPs have postgraduate training in psychological therapies and 85% referred less than 5% of their service users with mental health difficulties to specialists [26].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Copty M: Mental Health in Primary Care. 2004, Dublin: Irish College of General Practitioners/South Western Area Health Board

      Not checked in the free run.

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

    Premisecitation

    The majority of research investigating possible links in depression consistently finds a link between the experience of a stressful life event and the onset of depression.

    “The majority of research investigating possible links in depression consistently find a link between the experience of a stressful life event and the onset of depression [20].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Ingram RE, Luxton DD: Vulnerability-Stress Models. Development of Psychopathology: A Vulnerability-Stress Perspective. Edited by: Hankin BL, Abela JRZ. 2005, California: Sage

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Worldwide, a large percentage of affected individuals have no medical diagnosis nor seek treatment.

    “Worldwide, a large percentage of affected individuals have no medical diagnosis nor seek treatment [21].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [21] Andrews G, Sanderson K, Slade T, Issakidis C: Why Does the Burden of Disease Persist? Relating the Burden of Anxiety and Depression to Effectiveness of Treatment. Bulletin World Health Organisation, vol. 78. 2000, Geneva: World Health Organisation, 446-454.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Many Irish adults with depression find it difficult to access appropriate and evidence-based CBT due to factors including stigma, costs, shortage of trained professionals, and underdevelopment of services.

    “Many Irish adults with depression find it difficult to access evidence-based CBT, this is due to several factors, like stigma and costs. However, systematic factors including the shortage of trained professionals and the relative underdevelopment of services also make access difficult.”
    • Also stated in: § Access to treatment · plain
      “Many in Ireland with depression find it difficult to access appropriate and evidence-based CBT, this is due to several factors, some of which were mentioned earlier as barriers, but particularly in Irelands case, the shortage of trained professionals alongside the relative underdevelopment of services makes it difficult to access treatments [25].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Department of Health and Children: Avision for Change: Report of the Expert Group on Mental Health Policy. 2006, Dublin: Stationary office

      Not checked in the free run.

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

    Premisecitation

    The worldwide treatment gap in depression is estimated at 56.3%.

    “One study estimated the worldwide treatment gap in depression at 56.3% [22].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] Kohn R, Saxena S, Levav I, Saraceno B: The treatment gap in mental health care. Bull World Health Organ. 2004, 82: 858-866.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    CBT has established itself as an option for the treatment of depression, for post-treatment gains and for maintaining gains and preventing future relapses and recurrences.

    “CBT has established itself as an option for the treatment of depression, for post-treatment gains and also for maintaining gains and preventing future relapses and recurrences [14].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] Hollon SD, DeRubeis RJ: Effectiveness of Treatment for Depression. Contemporary Cognitive Therapy: Theory, Research, and Practice. Edited by: Leahy RL. 2006, New York: Guildford Press, 45-61.

      Not checked in the free run.

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

    Premisecitation

    The 21-item Beck Depression Inventory - Second Edition (BDI-II) is a widely used questionnaire developed for the assessment of depressive symptoms that correspond to the criteria for depressive disorder diagnosis as outlined in DSM-IV.

    “The 21-item Beck Depression Inventory – Second Edition (BDI-II) is a widely used questionnaire developed for the assessment of depressive symptoms that correspond to the criteria for depressive disorder diagnosis as outlined in The American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition (DSM-IV) [51].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [51] American Psychiatric Association [APA]: Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 2000, Washington D.C: American Psychiatric Association, 4

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Despite the barriers that exist for Irish people, both personal and systemic, what is considered best-practice has not evolved in Ireland.

    “Yet, despite the barriers that exist for Irish people, both personal and systemic, what is considered best-practice has not evolved in Ireland.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    The randomization procedure will be managed by a person independent of the research group.

    “The randomization procedure will be managed by a person independent of the research group (Figure 1).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    A stepped-care program with low-intensity interventions is recommended as best-practice by the National Institute for Health and Clinical Excellence and advocated by the Irish health service.

    “Such a program is recommended as best-practice by the National Institute for Health and Clinical Excellence [13] and also advocated by the Irish health service [30].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [13] National Institute for Health and Clinical Excellence: Computerised Cognitive Behaviour Therapy for Depression and Anxiety. Technology Appraisal 97. 2006, London: National Institute for Health and Clinical Excellence

      Not checked in the free run.

    • cites [30] Health Service Executive: Advancing the Shared Care Approach between Primary care and Specialist Mental Health Services. 2012, Dublin: Health Service Executive, 27-

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Analysis will be conducted on the intention-to-treat basis.

    “Analysis will be conducted on the intention-to-treat basis.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    The structure and content of the Mind Balance program modules follow evidence-based CBT principles.

    “The structure and content of the program modules follow evidence-based CBT principles.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The internet offers the possibility of delivering a treatment intervention at low cost and perhaps overcoming some of the barriers to access.

    “The internet offers the possibility of delivering a treatment intervention at low cost and perhaps overcoming some of the barriers to access mentioned earlier.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    Some studies report variables for dropout from online treatments such as difficulties using the computer, negative features of the program, perceived as too demanding, poor clinical progress, receiving alternative treatment, feeling better, lack of time, and problems understanding the computer program.

    “Some studies have report variables such as difficulties using the computer, negative features of the program, perceived as too demanding, poor clinical progress, receiving alternative treatment, feeling better, lack of time, and problems understanding the computer program [34,41].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [34] Richards D, Richardson T: Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev. 2012, 32: 329-342. 10.1016/j.cpr.2012.02.004. source

      Not checked in the free run.

    • cites [41] Warmerdam L, Van Straten A, Twisk J, Riper H, Cuijpers P: Internet-based treatment for adults with depressive symptoms: randomized controlled trial. J Med Internet Res. 2008, 10: e44-10.2196/jmir.1094. source

      Not checked in the free run.

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

    Interpretationnone given

    The internet can deliver treatment incrementally and in an engaging way.

    “The internet can deliver treatment incrementally and in an engaging way.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    The BDI-II manual states that a cut score of 17 has yielded 93% specificity and 18% sensitivity for the presence of major depression.

    “The BDI-II manual states that a cut score of 17 has yielded a 93% specificity and 18% sensitivity for the presence of major depression (Beck et al., [50]).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] Beck AT, Steer RA, Brown GK: Manual for the BDI-II. 1996, San Antonio, TX: Psychological Corporation

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The primary outcome measure (BDI-II) that will assess depressive symptoms is a well established measure and has been used in other trials of internet-delivered treatments.

    “The primary outcome measure (BDI-II) that will assess depressive symptoms is a well established measure and has been used in other trials of internet-delivered treatments.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] Beck AT, Steer RA, Brown GK: Manual for the BDI-II. 1996, San Antonio, TX: Psychological Corporation

      Not checked in the free run.

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

    Premisecitation

    The WSAS is a simple, reliable and valid measure of impaired functioning.

    “The WSAS is a simple, reliable and valid measure of impaired functioning.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59] Mundt JC, Marks IM, Shear MK, Greist JM: The work and social adjustment scale: a simple measure of impairment in functioning. Br J Psychiatry. 2002, 180: 461-464. 10.1192/bjp.180.5.461. source

      Not checked in the free run.

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

    Premisecitation

    The SAT measure is based on a Net Promoter Score, a management tool that can be used to gauge the loyalty of a firm's customer relationships.

    “The measure is based on a Net Promotoer Score: which is a management tool that can be used to gauge the loyalty of a firm’s customer relationships.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Richards D, Timulak L, Hevey D: A comparison of two online cognitive-behavioural interventions for symptoms of depression in a student population: the role of therapist responsiveness. Couns Psychother Res. 2012, 13: 1-10.

      Not checked in the free run.

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

    Premisecitation

    The GAD-7 is increasingly used in large-scale studies as a generic measure of changes in anxiety symptomatology, using a cut-off score of 8.

    “The GAD-7 is increasingly used in large-scale studies as a generic measure of changes in anxiety symptomatology, using a cut-off score of 8 [31,58].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [31] Clark DM, Layard R, Smithies R, Richards DA, Suckling R, Wright B: Improving access to psychological therapy: initial evaluation of two UK demonstration sites. Behav Res Ther. 2009, 47: 910-920. 10.1016/j.brat.2009.07.010. source

      Not checked in the free run.

    • cites [58] Richards DA, Suckling R: Improving access to psychological therapies: phase IV prospective cohort study. Br J Clin Psychol. 2009, 48: 377-396. 10.1348/014466509X405178. source

      Not checked in the free run.

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

    Study design and conductcitation

    The process of qualitative analysis is organic, involving constant reference to the source data.

    “The process is organic, involving constant reference to the source data [67].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [67] Richards D, Timulak L: Client-identified helpful and hindering events in therapist-delivered vs. self-administered online cognitive-behavioural treatments for depression in college students. Couns Psychol Q. 2012, 25: 251-262. 10.1080/09515070.2012.703129. source

      Not checked in the free run.

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

    Study design and conductnone given

    Informed consent will be obtained from each participant before randomization.

    “Informed consent will be obtained from each participant before randomization.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationnone given

    Depending on the sample recruited, the results may be generalizable to people with mild to moderate symptoms of depression in Ireland and may give insight into the potential of low-intensity interventions for Irish people with depressive symptoms.

    “Depending on the sample recruited the results may be generalizable to people with mild to moderate symptoms of depression in Ireland and may therefore give insight into the potential of low-intensity interventions for Irish people with depressive symptoms.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    The GAD-7 has good internal consistency (.89) and good convergent validity with other anxiety scales.

    “The GAD-7 has good internal consistency (.89) and good convergent validity with other anxiety scales [56].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] Kroenke K, Spitzer RL, Williams JBW, Löwe B: The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry. 2010, 32: 345-359. 10.1016/j.genhosppsych.2010.03.006. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The study will not include an official diagnosis of participants.

    “While the study will not include an official diagnosis of participants, it does include established measures that will gather valuable data on participants that can allow us to begin to build a picture of the relevance of iCBT treatments for depression in Ireland.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    The EQ-5D is a generic instrument of health-related quality of life.

    “EuroQol 5D (EQ-5D)[60]. Is a generic instrument of health-related quality of life:”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [60] Rabin R, Oemar M, Oppe M: EQ-5D-3L User Guide: Basic Information on how to use the EQ-5D-3L Instrument. 2011, Rotterdam: The Netherlands: EuroQol Group, 40

      Not checked in the free run.

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

    Premisecitation

    The HAT is an instrument that assesses the most helpful and hindering events in therapy.

    “Helpful Aspects of Therapy Form (HAT) [61,62] is an instrument that assesses the most helpful and hindering events in the therapy.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [61] Elliott R, Slatick E, Urman M: Qualitative Change Process Research on Psychotherapy: Alternative Strategies. Qualitative Psychotherapy Research: Methods and Methodology. Edited by: Frommer J, Rennie DL. 2001, Lengerich, Germany: Pabst Science Publishers, 69-111.

      Not checked in the free run.

    • cites [62] Llewelyn SP, Elliott R, Shapiro DA, Hardy G, Firth-Cozens J: Client perceptions of significant events in prescriptive and exploratory periods of individual therapy. Br J Clin Psychol. 1988, 27: 105-114. 10.1111/j.2044-8260.1988.tb00758.x. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The analyses will be based on the intention-to-treat principle, including those who began treatment and provided follow-up data irrespective of treatment compliance.

    “The analyses will be based on the intention-to-treat principle, including those who began treatment and provided follow-up data irrespective of treatment compliance.”
    Quote in the paperSubstantial claim

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

    Study design and conductreasoning

    Session time estimation will always be an imperfect calculation, as users may be interrupted or take breaks within a session, and may not formally log out of the system.

    “Session time estimation will always be an imperfect calculation, as users may be interrupted or take breaks within a session, and may not formally log out of the system.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    For Cohen's d, an effect size of 0.2 to 0.3 can be considered small, around 0.5 medium, and 0.8 upwards large.

    “For Cohen’s d an effect size of 0.2 to 0.3 can be considered a small effect, around 0.5 a medium effect and 0.8 upwards, a large effect [64].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [64] Cohen J: Statistical power analysis for the behavioral sciences. 1988, Hillsdale, NJ: Lawrence Earlbaum Associates, 2

      Not checked in the free run.

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

    Premisecitation

    The BDI-II has demonstrated good convergent validity with other measures of depression among clinical and nonclinical adult samples.

    “The BDI-II has demonstrated good convergent validity with other measures of depression among clinical and nonclinical adult samples [54].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Beck AT, Steer RA, Garbin MG: Psychometric properties of the beck depression inventory: twenty-five years of evaluation. Clin Psychol Rev. 1988, 8: 77-100. 10.1016/0272-7358(88)90050-5. source

      Not checked in the free run.

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

    Premisecitation

    Increasing GAD-7 scores indicate greater severity of symptoms.

    “Increasing scores indicating greater severity of symptoms [57].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W, Herzberg PY: Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care. 2008, 46: 266-274. 10.1097/MLR.0b013e318160d093. source

      Not checked in the free run.

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

    Study design and conductreasoning

    On its own, the log-based total time calculation will yield a result vulnerable to overestimation of session time.

    “On its own, this will yield a result vulnerable to overestimation of session time.”
    Quote in the paperNot a substantial claim
33 of 33

  • The paper relies on this without support.

    There is a need to develop larger community-based projects to assess the feasibility, efficacy, effectiveness and scalability of low-intensity interventions for Ireland.

    “There is now a need to develop larger community based projects like those that have occurred throughout Europe to assess the feasibility, efficacy effectiveness and scalability of such low-intensity interventions for Ireland.”

  • The paper relies on this without support.

    Information to date on reasons for dropout from online treatments is limited.

    “Information to date on reasons for dropout is limited.”

  • The paper relies on this without support.

    Given the continued growth in high prevalence disorders, there is a real need to increase access to treatment.

    “Given the continued growth in high prevalence disorders (depression and anxiety) there is a real need to increase access.”
3 of 3

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?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • BDI-II eligibility range includes a score classified as severe

    Minor

    The inclusion criterion labels scores of 14-29 as mild to moderate, while the paper's severity scale classifies a score of 29 as severe.

  • Treatment is described as both eight and seven modules

    Minor

    The abstract says the active treatment consists of eight weekly modules, but the intervention description calls Mind Balance a seven-module program, and Table 1 lists seven modules.

2 of 2

Cites

Flagged first, then by citations

1 of the 75 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

  1. Department of Health and Children: Avision for Change: Report of the Expert Group on Mental Health Policy. 2006, Dublin: Stationary office
  2. Health Service Executive: Advancing the Shared Care Approach between Primary care and Specialist Mental Health Services. 2012, Dublin: Health Service Executive, 27-
  3. Low Intensity CBT Interventions. Edited by: Bennett-Levy J, Richards DA, Farrand P, Christensen H, Griffiths KM, Kavanagh DJ, Klein B, Lau MA, Proudfoot J, Ritterband L, White J, Williams C. 2010, Oxford: Oxford University Press
  4. Beck AT, Steer RA, Brown GK: Manual for the BDI-II. 1996, San Antonio, TX: Psychological Corporation
  5. Rabin R, Oemar M, Oppe M: EQ-5D-3L User Guide: Basic Information on how to use the EQ-5D-3L Instrument. 2011, Rotterdam: The Netherlands: EuroQol Group, 40

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Authors
Richards, D., Timulak, L., Doherty, G., Sharry, J., Colla, A., Joyce, C., & Hayes, C.
Affiliations
  • SilverCloud (Ireland) (IE)
  • Trinity College Dublin (IE)
  • Mater Misericordiae University Hospital (IE)
Corresponding author
Richards, Derek
ORCID
Venue
BMC Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2014-05-21
Volume
14
Issue
1
Pages
147-147
ISSN
1471-244X (ISSN-L)
DOI
10.1186/1471-244x-14-147
PMC
PMC4036670
OpenAlex
W2103835974
Semantic Scholar
b2e854e3d9d4ee290929839c24d99ae71cc448cc
Cited by
35
References
75
Citations by year
2026: 1 · 2024: 1 · 2023: 4 · 2022: 5 · 2021: 2 · 2020: 4 · 2019: 3 · 2018: 3 · 2017: 4 · 2016: 3 · 2015: 4 · 2014: 1
FWCI
6.22
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Psychiatry (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Arrow@dit (Dublin Institute of Technology) (submittedVersion, cc-by-nc-sa)
  • Lenus, The Irish Health Repository (Dr Steevens Hospital Library) (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
internet-based cognitive behavioral therapy, depressive symptoms, low-intensity intervention, stepped care, access to mental health care, community-based treatment, treatment effectiveness, quality of life, treatment satisfaction, Irish adults
MeSH terms
Depressive Disorder, Female, Humans, Male, Personality Inventory, Psychiatric Status Rating Scales, Quality of Life, Waiting Lists, Cognitive Behavioral Therapy, Treatment Outcome, Evidence-Based Medicine, Internet

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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