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Cited by 140Digital Mental Health InterventionsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and Access

Internet-Based CBT for Depression with and without Telephone Tracking in a National Helpline: Randomised Controlled Trial

Open access
Farrer, Louise, Christensen, Helen, Griffiths, Kathleen M., Mackinnon, Andrew·2011·PLoS ONE
DOI 10.1371/journal.pone.0028099PMC PMC3227639
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Abstract

BACKGROUND: Telephone helplines are frequently and repeatedly used by individuals with chronic mental health problems and web interventions may be an effective tool for reducing depression in this population. AIM: To evaluate the effectiveness of a 6 week, web-based cognitive behaviour therapy (CBT) intervention with and without proactive weekly telephone tracking in the reduction of depression in callers to a helpline service. METHOD: 155 callers to a national helpline service with moderate to high psychological distress were recruited and randomised to receive either Internet CBT plus weekly telephone follow-up; Internet CBT only; weekly telephone follow-up only; or treatment as usual. RESULTS: Depression was lower in participants in the web intervention conditions both with and without telephone tracking compared to the treatment as usual condition both at post intervention and at 6 month follow-up. Telephone tracking provided by a lay telephone counsellor did not confer any additional advantage in terms of symptom reduction or adherence. CONCLUSIONS: A web-based CBT program is effective both with and without telephone tracking for reducing depression in callers to a national helpline. TRIAL REGISTRATION: Controlled-Trials.comISRCTN93903959.

AI snapshot

Written from the paper’s full text.

TL;DR

In a national helpline RCT, a 6-week web CBT program (BluePages + MoodGYM) reduced depression more than treatment as usual at post-intervention and 6-month follow-up, with large effect sizes. Adding weekly telephone tracking by a lay counsellor did not improve symptom reduction or adherence, and tracking alone was not effective.

Key findings

  • Among 155 callers randomised, web CBT conditions showed greater decline in CES-D depression than control at post-intervention and 6 months. Effect sizes were large: web only vs control g = 0.76 post-intervention and 1.19 at 6 months; web with tracking vs control g = 1.04 post-intervention and 1.26 at 6 months.
  • Tracking alone did not differ significantly from control at post-intervention or 6 months, and telephone tracking did not confer additional benefit over web CBT alone for symptom reduction or adherence.
  • At 6-month follow-up, clinical caseness on the CES-D was 43.5% in web only, 50.0% in web with tracking, and 90.9% in control. NNT was 6.03 for web only and 4.43 for web with tracking.
  • Adherence did not differ significantly between web conditions: average MoodGYM modules completed were 1.5 (SD = 1.89) for web only and 2.0 (SD = 1.88) for web with tracking; 15.8% and 17.8%, respectively, completed all five modules.

Methods

  • Randomised controlled trial recruiting callers to Lifeline’s 24-hour telephone counselling service in four major Australian cities; eligibility included age ≥18, English, Internet access, and K10 score ≥22.
  • Participants were randomised to web only, web with tracking, tracking only, or treatment as usual; the web intervention combined BluePages psychoeducation in Week 1 with five MoodGYM CBT modules over Weeks 2–6, and tracking consisted of weekly 10-minute calls from a telephone counsellor.
  • Primary outcome was CES-D depression, analysed on an intention-to-treat basis using mixed models repeated measures ANOVA with planned contrasts; effect sizes used Hedges’ g, and logistic/linear regressions examined dropout and caseness.

Limitations

  • Stated: intervention completion rates were lower than in some other web-based depression trials; symptom severity remained high post-intervention; greater dropout in the web with tracking condition may have inflated effects in that condition; two outliers were excluded from primary analyses; and depression caseness was estimated by CES-D cutoff rather than diagnostic interview.
  • Stated: the trial was a true effectiveness trial using a volunteer workforce, which may contribute to recruitment and adherence issues relative to efficacy studies.
  • Evident from the text: the achieved sample of 155 was below the original target of 400, although the authors state it maintained above 80% power to detect differences of less than 0.5 SD units in planned comparisons between individual treatment arms.

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

Integrity signals

Registry

Crossref · 10.1371/journal.pone.0028099

Cites

57 of 57 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 33 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Depression was lower in participants in the web intervention conditions both with and without telephone tracking compared to the treatment as usual condition both at post intervention and at 6 month follow-up.

    “Depression was lower in participants in the web intervention conditions both with and without telephone tracking compared to the treatment as usual condition both at post intervention and at 6 month follow-up.”
    Quote in the paperSubstantial claim
  • Findingown data

    At 6 month follow-up, those who completed more MoodGYM modules also had reduced odds of missingness (odds ratio 0.56, 95% CI: 0.41 to 0.75, p<.001).

    “At 6 month follow-up, those who completed more MoodGYM modules also had reduced odds of missingness (odds ratio 0.56, 95% CI: 0.41 to 0.75, p<.001).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Those who completed more MoodGYM modules had reduced odds of missingness at post intervention (odds ratio 0.49, 95% CI: 0.35 to 0.69, p<.001).

    “Those who completed more MoodGYM modules had reduced odds of missingness at post intervention (odds ratio 0.49, 95% CI: 0.35 to 0.69, p<.001).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Telephone tracking provided by a lay telephone counsellor did not confer any additional advantage in terms of symptom reduction or adherence.

    “Telephone tracking provided by a lay telephone counsellor did not confer any additional advantage in terms of symptom reduction or adherence.”
    Quote in the paperSubstantial claim
  • Findingown data

    The odds of missingness at post intervention were greater for participants in the Internet plus tracking condition, relative to participants in the control condition (odds ratio 6.46, 95% CI: 2.01 to 20.77, p = .002).

    “The odds of missingness at post intervention were greater for participants in the Internet plus tracking condition, relative to participants in the control condition (odds ratio 6.46, 95% CI: 2.01 to 20.77, p = .002).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 29
  • Classified as probably not a substantial claim. 22

  • May combine two claims.

    Findingown data

    A significant occasion by condition interaction was found for depression symptoms, F(6,100.5) = 2.97, p = .01, indicating different patterns of change between conditions across measurement occasion.

    “A significant occasion by condition interaction was found for depression symptoms, F(6,100.5) = 2.97, p = .01), indicating different patterns of change between conditions across measurement occasion.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Trial condition and number of MoodGYM modules completed were significant predictors of missingness at post intervention.

    “Trial condition and number of MoodGYM modules completed were significant predictors of missingness (failure to complete a questionnaire) at post intervention.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Pre intervention psychological distress, sex, age, pre intervention depression symptoms, pre intervention anxiety symptoms and whether participants received their preferred trial condition did not predict missingness at post intervention or 6 month follow-up.

    “Pre intervention psychological distress, sex, age, pre intervention depression symptoms, pre intervention anxiety symptoms and whether participants received their “preferred” trial condition did not predict missingness at post intervention or 6 month follow-up.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    With outliers included, at 6 months, comparable outcomes were (t(107.7) = −1.72, p = .089) and (t(107.7) = −2.83, p = 0.006) respectively.

    “At 6 months, comparable outcomes were (t(107.7) = −1.72, p = .089) and (t(107.7) = −2.83, p = 0.006) respectively.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Neither trial condition nor symptom severity predicted dropout at 6-month follow-up.

    “Neither trial condition nor symptom severity predicted dropout at 6 month follow up.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Post-intervention, the number needed to treat (NNT) under the web only intervention was 6.03 (95% CI 2.72 - ∞ - NNH 27.15) and for the web with tracking intervention 4.43 (95% CI 2.22-265.75).

    “Post intervention, the number needed to be treated (NNT) under the web only intervention was estimated to be 6.03 (95% CI: 2.72 – ∞ – NNH 27.15) and for the web with tracking intervention 4.43 (95% CI: 2.22–265.75).”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The CES-D cutoff used adequately identifies clinical caseness of depression.

  • May combine two claims.

    Findingcitation

    In the conservative analysis, the NNTs were 6.09 (95% CI 3.07 - ∞ - NNH 90.15) and 3.63 (95% CI 2.23-12.29) respectively.

    “This yields NNTs of 6.09 (95% CI: 3.07 – ∞ – NNH 90.15) and 3.63 (95% CI: 2.23–12.29) [33] respectively.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [33] DG Altman, 1998, Confidence intervals for the number needed to treat., BMJ source

      Not checked in the free run.

    • Rests on an assumption: The CES-D cutoff used adequately identifies clinical caseness of depression.

  • May combine two claims.

    Findingown data

    At 6-month follow-up, the odds of meeting caseness criteria were lower in the web with tracking condition (OR 0.10, 95% CI 0.02 to 0.56, p = .009) and the web only condition (OR 0.08, 95% CI 0.01 to 0.41, p = .003) compared with control.

    “The odds of meeting caseness criteria were lower in the web with tracking (odds ratio 0.10, 95% CI: 0.02 to 0.56, p = .009) and web only (odds ratio 0.08, 95% CI: 0.01 to 0.41, p = .003) conditions, compared with the control condition.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The CES-D cutoff used adequately identifies clinical caseness of depression.

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

    Findingnone given

    In the context of the current trial, callers were willing to forgo anonymity to receive the intervention.

    “It was of interest, however, that in the context of the current trial, callers were willing to forgo anonymity to receive the intervention.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    With outliers included, pre-to-post intervention change remained significantly different comparing web with tracking to control (t(112.6) = −2.09, p = .039) and nearly so for web only compared to control (t(109.0) = −1.98, p = .051).

    “pre to post intervention change remained significantly different comparing web with tracking to control (t(112.6) = −2.09, p = .039) and nearly so for web only condition compared to the control condition (t(109.0) = −1.98, p = .051).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Of those for whom post-intervention data were available, 92.6% in the control condition continued to meet clinical caseness, compared to 70.4% in the web only and 66.7% in the web with tracking condition.

    “Of those for whom post intervention data were available, 92.6% of those in the control condition continued to meet clinical caseness, compared to 70.4% in the web only and 66.7% in the web with tracking condition.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The CES-D cutoff used adequately identifies clinical caseness of depression.

  • May combine two claims.

    Findingown data

    There were no significant differences between web only and web with tracking conditions in average number of BluePages visits or average visit duration.

    “No significant differences were found in average number of BluePages visits (t(81) = 0.388, p = .70) or average visit duration (t(81) = 0.728, p = .47) between participants in the web only and web with tracking conditions”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Half of participants in the web only condition (50.0%) and approximately one third of participants in the web with tracking condition (31.1%) did not complete any modules of the MoodGYM program.

    “Half of participants in the web only condition (50.0%) and approximately one third of participants in the web with tracking condition (31.1%) did not complete any modules of the program.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Compared to the control condition, decline in depression symptoms from baseline to post intervention was greater for participants in the web only and web with tracking conditions.

    “Compared to the control condition, decline in depression symptoms from baseline to post intervention was greater for participants in the web only and web with tracking conditions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the conservative analysis, at 6 months, the odds of achieving caseness were lower in the web only condition (OR 0.17, 95% CI 0.04 to 0.67, p = .010) and the web with tracking condition (OR 0.28, 95% CI 0.07 to 11.1, p = .072) compared to control.

    “as the odds of achieving caseness status were lower in participants in the web only (odds ratio 0.17, 95% CI: 0.04 to 0.67, p = .010) and web with tracking conditions (odds ratio 0.28, 95% CI: 0.07 to 11.1, p = .072), compared to the control condition.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The CES-D cutoff used adequately identifies clinical caseness of depression.

  • May combine two claims.

    Findingown data

    Despite the strong effect sizes associated with the intervention, symptom severity remained quite high at post-intervention.

    “Despite the strong effect sizes associated with the intervention, symptom severity remained quite high at post intervention.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    31.6% of participants in the web only condition and 37.7% of participants in the web with tracking condition completed 3 or more MoodGYM modules.

    “31.6% of participants in the web only and 37.7% of participants in the web with tracking conditions completed 3 or more MoodGYM modules.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Symptoms for participants in the tracking only condition fell between the control and the web only conditions, and did not differ significantly from either.

    “Symptoms for participants in the tracking only condition fell between the control and the web only conditions, and did not differ significantly from either.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At 6-month follow-up, 43.5% in the web only condition and 50.0% in the web plus tracking condition met clinical caseness compared with 90.9% in the control condition.

    “At 6 month follow up, 43.5% in the web only condition and 50.0% in the web plus tracking condition met clinical caseness compared with 90.9% in the control condition.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The CES-D cutoff used adequately identifies clinical caseness of depression.

  • Classified as probably not a substantial claim.

    Premisecitation

    Web-based CBT applications have reduced depression in general practice environments.

    “A range of software applications available on the web have also delivered effective CBT to depressed samples [11], reduced depression in school settings [12] and in general practice environments [13], [14], either with or without support from mental health professionals, paraprofessionals or teachers [11].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13], [14]

      Not checked in the free run.

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

    Premisecitation

    Web-based CBT applications have reduced depression in school settings.

    “A range of software applications available on the web have also delivered effective CBT to depressed samples [11], reduced depression in school settings [12] and in general practice environments [13], [14], either with or without support from mental health professionals, paraprofessionals or teachers [11].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] AL Calear, 2009, The YouthMood Project: A cluster randomized controlled trial of an online cognitive behavioral program with adolescents., Journal of Consulting and Clinical Psychology source

      Not checked in the free run.

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

    Study design and conductnone given

    A block randomisation procedure with stratification based on sex, site of recruitment and severity of psychological distress at screening was used.

    “A block randomisation procedure with stratification based on sex, site of recruitment and severity of psychological distress at screening was used.”
    Quote in the paperNot a substantial claim

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

    Premisecitation

    78% of callers to telephone helplines experience depressive symptoms.

    “Over 40% of callers phone the service 20 times or more, 78% of callers experience depressive symptoms, and the prevalence of anxiety in this group is between 2 to 6 times that of the population [2], [3], [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2], [3], [4]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Web-based CBT applications have been effective either with or without support from mental health professionals, paraprofessionals or teachers.

    “A range of software applications available on the web have also delivered effective CBT to depressed samples [11], reduced depression in school settings [12] and in general practice environments [13], [14], either with or without support from mental health professionals, paraprofessionals or teachers [11].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] KM Griffiths, 2010, The efficacy of internet interventions for depression and anxiety disorders: a review of randomised controlled trials., Med J Aust source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    A web-based CBT program is effective both with and without telephone tracking for reducing depression in callers to a national helpline.

    “A web-based CBT program is effective both with and without telephone tracking for reducing depression in callers to a national helpline.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    Provision of support or tracking has been proposed to increase adherence to treatment.

    “Based on reviews of the evidence, the provision of support or tracking (ongoing contact with users during an intervention) has been proposed to increase adherence to treatment, prevent dropout, and improve efficacy [6].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] V Spek, 2007, Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis., Psychol Med source

      Not checked in the free run.

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

    Premisecitation

    Over 40% of callers to telephone helplines phone the service 20 times or more.

    “Over 40% of callers phone the service 20 times or more, 78% of callers experience depressive symptoms, and the prevalence of anxiety in this group is between 2 to 6 times that of the population [2], [3], [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2], [3], [4]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Provision of support or tracking has been proposed to prevent dropout.

    “Based on reviews of the evidence, the provision of support or tracking (ongoing contact with users during an intervention) has been proposed to increase adherence to treatment, prevent dropout, and improve efficacy [6].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] V Spek, 2007, Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis., Psychol Med source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Provision of support or tracking has been proposed to improve efficacy.

    “Based on reviews of the evidence, the provision of support or tracking (ongoing contact with users during an intervention) has been proposed to increase adherence to treatment, prevent dropout, and improve efficacy [6].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] V Spek, 2007, Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis., Psychol Med source

      Not checked in the free run.

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

    Premisecitation

    Both BluePages and MoodGYM have been shown to reduce depressive symptoms in community users.

    “Both BluePages and MoodGYM have been shown to reduce depressive symptoms in community users [15].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] H Christensen, 2004, Delivering interventions for depression by using the internet: randomised controlled trial., British Medical Journal source

      Not checked in the free run.

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

    Study design and conductnone given

    Allocation of participants to trial conditions was conducted independently by a research assistant not otherwise involved with the trial.

    “Allocation of participants to trial conditions was conducted independently by a research assistant not otherwise involved with the trial.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    A range of software applications available on the web have delivered effective CBT to depressed samples.

    “A range of software applications available on the web have also delivered effective CBT to depressed samples [11], reduced depression in school settings [12] and in general practice environments [13], [14], either with or without support from mental health professionals, paraprofessionals or teachers [11].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] KM Griffiths, 2010, The efficacy of internet interventions for depression and anxiety disorders: a review of randomised controlled trials., Med J Aust source

      Not checked in the free run.

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

    Premisecitation

    The prevalence of anxiety in telephone helpline callers is between 2 to 6 times that of the population.

    “Over 40% of callers phone the service 20 times or more, 78% of callers experience depressive symptoms, and the prevalence of anxiety in this group is between 2 to 6 times that of the population [2], [3], [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2], [3], [4]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Treatments supported by professionals and non-professionals are equally effective in the treatment of depression.

    “Evidence from Titov and colleagues suggests that treatments supported by professionals and non-professionals are equally effective in the treatment of depression [18].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] N Titov, 2010, Internet treatment for depression: a randomized controlled trial comparing clinician vs. technician assistance., PLoS One source

      Not checked in the free run.

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

    Study design and conductown data

    Additional analyses were conducted with these cases included.

    “However, additional analyses were conducted with these cases included.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The primary outcome variable was analysed on an intention to treat basis using mixed models repeated measures ANOVA.

    “The primary outcome variable was analysed on an intention to treat (ITT) basis using mixed models repeated measures ANOVA, with measurement occasion as a within groups factor and intervention condition as a between groups factor.”
    Quote in the paperSubstantial claim

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

    Study design and conductcitation

    Depression symptoms were measured by the CES-D, a widely used, 16 item scale with strong reliability and validity.

    “Depression symptoms were measured by the Center for Epidemiologic Studies Depression Scale [20] (CES-D), a widely used, 16 item scale with strong reliability and validity [20], [21], [22], [23], [24], [25], with a range of scores of 0 to 60.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20], [21], [22], [23], [24], [25]

      Not checked in the free run.

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

    Study design and conductcitation

    Studies have estimated sensitivity of 84%-93% and specificity of 69%-74% for the CES-D using the cutoff of 16 or above.

    “Studies have estimated reasonable sensitivity (84%–93%) and specificity (69%–74%) of the CES-D using this cutoff [26], [27].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26], [27]

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    The telephone and the Internet have been used separately to effectively treat physical and mental health problems.

    “The telephone and the Internet have been used separately to effectively treat physical and mental health problems [6], [7], [8], [9].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6], [7], [8], [9]

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    The effect sizes associated with the web interventions were large, with effects at post-intervention and 6 months equal to those reported for face-to-face clinician-delivered CBT for depression and online CBT delivered by professionals.

    “The effect sizes associated with the web interventions were large, with effects at post intervention and at 6 months equal to those reported for face to face clinician delivered CBT programs for depression [36] and online CBT programs delivered by professionals [37].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [36] AC Butler, 2006, The empirical status of cognitive-behavioral therapy: a review of meta-analyses., Clin Psychol Rev source

      Not checked in the free run.

    • cites [37] G Andrews, 2010, Computer Therapy for the Anxiety and Depressive Disorders Is Effective, Acceptable and Practical Health Care: A Meta-Analysis., PLoS ONE source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    The current trial was a true effectiveness trial employing a volunteer workforce for recruitment and tracking, and hence would be expected to be associated with recruitment and adherence issues relative to the more controlled environment of an efficacy study.

    “The current trial was a true effectiveness trial employing a volunteer workforce for recruitment and tracking, and hence would be expected to be associated with recruitment and adherence issues relative to the more controlled environment of an efficacy study [49].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [49] BR Flay, 1986, Efficacy and effectiveness trials (and other phases of research) in the development of health promotion programs., Prev Med source

      Not checked in the free run.

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

    Interpretationnone given

    The intervention was short, delivered by non-health professionals, and may have constituted the only service received.

    “Moreover, the intervention was short, delivered by non-health professionals, and may have constituted the only service received.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Under the conservative assumption that all participants who discontinued retained their last assessed caseness status, post-intervention effects were attenuated, but 6-month follow-up effects retained or narrowly escaped significance.

    “Repeating these analyses under the conservative assumption that all participants who discontinued the trial (i.e. failed to complete a post intervention or follow-up questionnaire) retained their last assessed caseness status attenuated effects post intervention. However, 6 month follow-up effects retained, or only narrowly escaped, significance”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The CES-D cutoff used adequately identifies clinical caseness of depression.

  • May combine two claims.

    Study design and conductown data

    Secondary analyses with outliers included confirmed the direction of findings, although effect sizes were attenuated.

    “Secondary analyses with outliers included confirmed the direction of findings, although we acknowledge that effect sizes were attenuated.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    Intervention completion rates were lower in this study relative to some other trials of web-based treatments for depression but not of other telephone-based services.

    “Intervention completion rates were lower in our study relative to some other trials of web-based treatments for depression [47] but not of other telephone-based services [48].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [47] H Christensen, 2009, Adherence in Internet interventions for anxiety and depression: Systematic review., Journal of Medical Internet Research source

      Not checked in the free run.

    • cites [48] WK Rhee, 2005, Efficacy of brief telephone psychotherapy with callers to a suicide hotline., Suicide Life Threat Behav source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    With the two outlying cases included, the findings were consistent with the main analysis but resulted in slightly attenuated effect sizes and reduced or quasi-significant test results.

    “The findings were consistent with those reported above but resulted in slightly attenuated effect sizes and reduced or quasi significant test results.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The study demonstrated that a generic helpline could deliver a brief effective intervention within its current service model, and that users of the service were willing to give up their anonymity to participate in the program.

    “In addition, the study demonstrated that a generic helpline could deliver a brief effective intervention within its current service model, and that users of the service were willing to give up their anonymity to participate in the program.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    Call centres may be a particularly appropriate setting in which to place evidence-based web programs.

    “This suggests that call centres may be a particularly appropriate setting in which to place evidence-based web programs.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Helpline users prefer to treat themselves, manage their own health, and retain a greater sense of control over their treatment.
48 of 48

  • The authors state this as an assumption.

    Missingness is either completely at random or at random conditional on observed data.

    “Mixed modelling allows the use of all available data for each participant to yield unbiased estimates of effects under the assumption that missingness is either completely at random (MCAR) or at random conditional on observed data (MAR) [30].”

  • The paper relies on this without support.

    No studies have directly compared the relative efficacy of an Internet-based self-help treatment monitored by non-professionals with a non-guided treatment.

    “However, to-date, no studies have directly compared the relative efficacy of an Internet-based self-help treatment monitored by non-professionals (such as volunteer telephone counsellors) with a non-guided treatment.”

  • The paper relies on this without support.

    No trials have evaluated the effectiveness of web based interventions within existing helpline or call centre services.

    “To our knowledge, no trials have evaluated the effectiveness of web based interventions within existing helpline or call centre services.”

  • The paper relies on this without support.

    Mainstream mental health services are often difficult to access because of cost, structured consultation times, waiting list length, and location, and may not inspire trust.

    “However, mental health services are often difficult to access because of cost, structured consultation times, waiting list length, and location. In addition, mainstream mental health services may not inspire trust.”

  • The paper relies on this without support.

    Volunteer counsellors constitute a ready made workforce to refer and/or guide callers, making it possible to use the existing call centre structure to deliver immediate, cost-effective, evidence-based help.

    “Volunteer counsellors constitute a ready made workforce to refer and/or guide callers, making it possible to use the existing call centre structure to deliver immediate, cost-effective, evidence-based help.”

  • The paper relies on this without support.

    The CES-D cutoff used adequately identifies clinical caseness of depression.

    “depression caseness was estimated using a cutoff on the CES-D.”

  • The paper relies on this without support.

    Helpline users prefer to treat themselves, manage their own health, and retain a greater sense of control over their treatment.

    “Helpline users in particular may prefer to treat themselves, to manage their own health, and to retain a greater sense of control over their treatment.”

  • The paper relies on this without support.

    High baseline depression symptom levels enabled greater change in symptoms from pre- to post-intervention.

    “the high baseline depression symptom levels observed in this sample may have enabled greater change in symptoms from pre to post-intervention.”
8 of 8

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-help interventions have a small but significant effect size compared to a control condition.

    “the results so far indicate a small but significant effect size of these self-help interventions compared to a control condition [43–47].”

    From An Internet-based treatment for flying phobia (NO-FEAR Airlines): Study protocol for a randomized controlled trial (2016) · cites this paper as [46]

    The Results (Depression symptoms, Table 4; page not supplied) report significant differences from control, but explicitly describe the post-intervention effects as large, not small. They report g = 0.76 for web-only treatment and g = 1.04 for web treatment with tracking, with larger effects at six months. (LLM, conf=0.88)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

  • Two recent studies on unguided treatments showed medium-to-large effects when including a contact by telephone before treatment.

    “For example, two recent studies on unguided treatments showed medium-to-large effects when including a contact by telephone before treatment [16,17].”

    From Internet-based psychological treatments for depression (2012) · cites this paper as [17]

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • ConsistentF(6, 100.5) = 2.97reported p = .01 · recomputed p = .010

    “F(6,100.5) = 2.97, p = .01”

  • Consistentt(109.2) = -3.34reported p = 0 · recomputed p = .001

    “t(109.2) = −3.34, p = .00”

  • Consistentt(109.5) = -2.23reported p = .03 · recomputed p = .028

    “t(109.5) = −2.23, p = .03”

  • Consistentt(109.2) = 1.38reported p = .17 · recomputed p = .170

    “t(109.2) = 1.38, p = .17”

  • Consistentt(105.8) = -2.16reported p = .03 · recomputed p = .033

    “t(105.8) = −2.16, p = .03”

  • Consistentt(105.7) = -0.89reported p = .37 · recomputed p = .375

    “t(105.7) = −0.89, p = .37”

  • Consistentt(105.4) = -1.35reported p = .18 · recomputed p = .180

    “t(105.4) = −1.35, p = .18”

  • Consistentt(100.5) = -2.97reported p = 0 · recomputed p = .004

    “t(100.5) = −2.97, p = .00”

  • Consistentt(100.7) = -1.43reported p = .16 · recomputed p = .156

    “t(100.7) = −1.43, p = .16”

  • Consistentt(100) = -0.01reported p = 1 · recomputed p = .992

    “t(100.0) = −0.01, p = 1.00”

  • Consistentt(100.3) = -3.16reported p = 0 · recomputed p = .002

    “t(100.3) = −3.16, p = .00”

  • Consistentt(100.4) = -1.54reported p = .13 · recomputed p = .127

    “t(100.4) = −1.54, p = .13”

  • Consistentt(100.7) = -1.74reported p = .09 · recomputed p = .085

    “t(100.7) = −1.74, p = .09”

  • Consistentt(112.6) = -2.09reported p = .039 · recomputed p = .039

    “t(112.6) = −2.09, p = .039”

  • Consistentt(109) = -1.98reported p = .051 · recomputed p = .050

    “t(109.0) = −1.98, p = .051”

  • Consistentt(107.7) = -1.72reported p = .089 · recomputed p = .088

    “t(107.7) = −1.72, p = .089”

  • Consistentt(107.7) = -2.83reported p = .006 · recomputed p = .006

    “t(107.7) = −2.83, p = .006”

  • Consistentt(81) = 0.388reported p = .7 · recomputed p = .699

    “t(81) = 0.388, p = .70”

  • Consistentt(81) = 0.728reported p = .47 · recomputed p = .469

    “t(81) = 0.728, p = .47”

19 of 19

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.

  • Tracking-only never-married percentage does not match the group size

    Minor

    Table 1 reports 7 never-married participants among 37 in the tracking-only group. That is 18.92%, which rounds to 19%, not 18%.

    Reported 18 · recomputed 18.918919

  • Same comparison has two different effect sizes in Table 4

    Minor

    Table 4 labels two rows "Web with tracking vs control," but reports different effect sizes for that comparison at both time points. The fourth row appears to describe a different comparison.

2 of 2

Cites

Flagged first, then by citations

1 of the 58 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. 2003, National Review of Tele Counselling and Web Counsellling Services: Final Report
  2. AL Calear, 2009, The YouthMood Project: a cluster randomized controlled trial of an online cognitive behavioral program with adolescents., J Consult Clin Psychol, 77, 1021, 10.1037/a0017391 · DOI · Paper page

Cited by

Sorted by citations

Related

Authors
Farrer, L., Christensen, H., Griffiths, K. M., & Mackinnon, A.
Affiliations
  • Australian National University (AU)
  • The University of Melbourne (AU)
Corresponding author
Farrer, Louise
ORCID
Venue
PLoS ONE
Publisher
Public Library of Science (PLoS)
Published
2011-11-30
Volume
6
Issue
11
Pages
e28099
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0028099
PMC
PMC3227639
OpenAlex
W2038169816
Semantic Scholar
95651e02415cb99ae8dabe6dec5bcd2aaa8a2b11
Cited by
140
References
58
Citations by year
2026: 1 · 2025: 2 · 2024: 7 · 2023: 16 · 2022: 9 · 2021: 14 · 2020: 10 · 2019: 4 · 2018: 8 · 2017: 11 · 2016: 12 · 2015: 11 · 2014: 16 · 2013: 13 · 2012: 6
FWCI
14.97
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • ANU Open Research (Australian National University) (submittedVersion, cc-by)
Funders
  • Medical Research Council
  • Australian Research Council (LP0667970)
  • National Health and Medical Research Council (525413, 525411)
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, depression, telephone helpline, telephone counseling, online intervention, psychological distress, medication adherence
MeSH terms
Adult, Australia, Depression, Female, Follow-Up Studies, Humans, Male, Patient Compliance, Patient Dropouts, Patient Participation, Telephone, Cognitive Behavioral Therapy, Confidence Intervals, Internet

About these checks

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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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