Effectiveness of a web-based solution-focused brief chat treatment for depressed adolescents and young adults: randomized controlled trial
Open accessAbstract
BACKGROUND: Up to 9% of young people suffer from depression. Unfortunately, many in need of help remain untreated. The Internet offers anonymous ways to help depressed youth, especially those who are reluctant to search for help because of fear of stigma. OBJECTIVE: Our goal was to evaluate the effectiveness of an individual chat treatment based on Solution-Focused Brief Therapy (SFBT) to young individuals aged 12-22 years with depressive symptoms by comparing it to a waiting list control group. METHODS: For this study, 263 young people with depressive symptoms were randomized to the Web-based SFBT intervention, PratenOnline, or to a waiting list control condition. The chat treatment was delivered by trained professionals. Groups were compared on depressive complaints as measured by the Center for Epidemiologic Studies Depression Scale (CES-D) after 9 weeks and 4.5 months. For the chat group only, changes in depressive symptoms at 7.5 months after baseline were explored. RESULTS: The experimental SFBT condition (n=131) showed significantly greater improvement than the waiting list condition (n=132) in depressive symptoms at 9 weeks and 4.5 months on the CES-D, with a small between group effect size at 9 weeks (d=0.18, 95% CI -0.10 to 0.47) and a large effect size at 4.5 months (d=0.79, 95% CI 0.45-1.08). The percentage of participants showing a reliable and clinically significant change in depression was significantly larger for the SFBT intervention at 4.5 months only (28.2% vs 11.4% for the waiting list, P<.001, number needed to treat=6). At 7.5 months, the SFBT group showed further improvements. However, results have to be considered carefully because of high attrition rates. CONCLUSIONS: The Web-based SFBT chat intervention of PratenOnline was more effective than a waiting list control group in reducing depressive symptoms, and effects were larger at follow-up then at post-treatment. More studies are needed to find out if outcomes will be replicated, especially for those younger than 18 year old. TRIAL REGISTRATION: Netherlands Trial Register: NTR 1696; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1696 (Archived by WebCite at http://www.webcitation.org/6DspeYWrJ).
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Higher pre-test scores in depression, a longer history of mood disorders, or low scores in anxiety at pre-test predicted greater adherence.
“Mental health also played a role, with higher pre-test scores in depression (57), a longer history of mood disorders (51), or low scores in anxiety at pre-test (70) predicting greater adherence.”
From What Works and What Doesn’t Work? A Systematic Review of Digital Mental Health Interventions for Depression and Anxiety in Young People (2019) · cites this paper as [51]
Citation (51) is attached to the longer-history claim. In Results > Attrition (page unavailable), participants with a longer history of mood problems were more likely to be non-completers of the first follow-up questionnaire—the opposite direction for questionnaire completion. The passage does not establish that a longer history predicted greater chat-treatment adherence. (LLM, conf=0.84)
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Experimental — accuracy not yet measuredGender was a consistent predictor of adherence, with females being more likely to complete compared to males.
“Gender was also a consistent predictor of adherence, with females being more likely to complete compared to males (51, 57, 70).”
From What Works and What Doesn’t Work? A Systematic Review of Digital Mental Health Interventions for Depression and Anxiety in Young People (2019) · cites this paper as [51]
The Results > Attrition section (page unavailable) reports that males were more likely to miss the first follow-up questionnaire, supporting the direction of the completion difference. It does not establish gender as a consistent predictor across follow-ups or of adherence to the chat treatment; the later follow-up comparisons identify other factors. (LLM, conf=0.86)
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- Authors
- Kramer, J., Conijn, B., Oijevaar, P., & Riper, H.
- Affiliations
- Trimbos Institute (NL)
- Leuphana University of Lüneburg (DE)
- Corresponding author
- Kramer, Jeannet
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2014-05-29
- Volume
- 16
- Issue
- 5
- Pages
- e141
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC4062279
- OpenAlex
- W2138643659
- Cited by
- 69
- References
- 48
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 9 · 2023: 6 · 2022: 6 · 2021: 12 · 2020: 5 · 2019: 7 · 2018: 4 · 2017: 5 · 2016: 3 · 2015: 2 · 2014: 2
- FWCI
- 6.22
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Multilingual Matters (Channel View Publications) (publishedVersion, cc-by)
- VU Research Portal (publishedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Pure Amsterdam UMC (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- ZonMw
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- adolescent depression, young adult depression, solution-focused therapy, online therapy, depressive symptoms, treatment effectiveness, attrition, help-seeking barriers, stigma, waitlist control, number needed to treat, follow-up outcomes, Germany
- MeSH terms
- Adolescent, Depression, Female, Humans, Male, Psychotherapy, Brief, Waiting Lists, Telemedicine, Internet, Young Adult
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