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Cited by 89Digital Mental Health InterventionsWorkplace Health and Well-beingMental Health Treatment and Access

Long-Term Results of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Randomized Controlled Trial

Open access
Geraedts, Anna S, Kleiboer, Annet M, Twisk, Jos, Wiezer, Noortje M, van Mechelen, Willem, Cuijpers, Pim·2014·Journal of Medical Internet Research
DOI 10.2196/jmir.3539PMC PMC4115257
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Abstract

BACKGROUND: Depressive disorders are highly prevalent in the working population and are associated with excessive costs. The evidence for effective worker-directed interventions for employees with depressive symptoms is limited. Treating employees with depressive symptoms via the Internet before they report sick from work could be beneficial and cost saving. OBJECTIVE: In this study, we tested the effectiveness over the period of 1 year of a Web-based guided self-help intervention, called Happy@Work, for employees with depressive symptoms who were not on sick leave. METHODS: A two-arm randomized controlled trial comparing a worker-directed, Web-based, guided self-help intervention to care as usual (CAU) was carried out. We recruited employees from 6 companies via the company's Intranet and by putting up posters. The inclusion criteria were elevated depressive symptoms as measured by a score ≥16 on the Center for Epidemiologic Studies Depression scale (CES-D) and not being on sick leave. The intervention contained 6 lessons and consisted of problem-solving treatment and cognitive therapy. Participants were asked to submit weekly assignments via the website after completion of a lesson and they received feedback from a coach via the website. Self-report questionnaires on depressive symptoms (CES-D; primary outcome), burnout (Maslach Burnout Inventory, MBI), work performance (Health and Work Performance Questionnaire, HPQ), duration of absenteeism, and anxiety (Hospital Anxiety and Depression Scale, HADS; secondary outcomes), were completed at baseline, posttreatment, and at 6-, and 12-month follow-up. Several subgroup and per-protocol analyses were performed. RESULTS: A total of 231 employees were randomized to either the intervention group (n=116) or to CAU (n=115). Completion of assessments varied between 54%-74%. Improvement in depressive symptoms between baseline and posttreatment was shown in all participants and these effects sustained over time. However, there were no differences between the 2 groups (adjusted regression coefficient=0.46, 95% CI -2.11 to 3.03, P=.72; Cohen's d=0.05). Differences between groups were also not significant for the secondary outcomes. No subgroups were identified to show differences between the groups, nor did we find a between-group effect in the per-protocol analyses. CONCLUSIONS: This study showed that a worker-directed, Web-based, guided self-help intervention was not more effective than CAU in reducing depressive symptoms among employees with depressive symptoms who were not on sick leave over the period of 1 year. An intervention for this specific target group might not be necessary because the recovery in the CAU group was comparable to the intervention group and sustained over a 12-month period. TRIAL REGISTRATION: Nederlands Trial Register (NTR): NTR2993; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2993 (Archived by WebCite at http://www.webcitation.org/6PL9pFC0n).

AI snapshot

Written from the paper’s full text.

TL;DR

In a two-arm RCT of 231 non-sick-listed employees with elevated depressive symptoms, a Web-based guided self-help intervention (Happy@Work) was not more effective than care as usual over 12 months. Both groups improved substantially and sustained improvements, but between-group differences were nonsignificant across primary and secondary outcomes.

Key findings

  • No between-group difference on the primary outcome, depressive symptoms (CES-D), over 1 year: adjusted regression coefficient=0.46, 95% CI –2.11 to 3.03, P=.72; Cohen’s d=0.05.
  • Both groups improved from baseline to posttreatment and sustained gains: CES-D intervention 25.7 to 15.8 posttreatment and 13.8 at 12 months; CAU 26.1 to 18.3 posttreatment and 16.2 at 12 months.
  • Secondary outcomes (burnout, work performance, absenteeism, anxiety) also showed no significant between-group differences; e.g., HADS adjusted coefficient=0.60, 95% CI –0.19 to 1.38, P=.13, d=0.15.
  • No subgroup or per-protocol effects were found; for treatment completers vs CAU, the primary CES-D unadjusted coefficient was –0.48, 95% CI –4.28 to 3.33, P=.80. Adherence was low: 57.8% (67/116) completed ≥3 lessons.

Methods

  • Two-arm randomized controlled trial in 6 Netherlands companies; 231 employees with CES-D ≥16 and not on sick leave were randomized to Happy@Work (n=116) or care as usual (n=115).
  • Happy@Work consisted of 6 weekly Web-based lessons using problem-solving treatment and cognitive therapy, with coach feedback; CAU participants were advised to consult their physician or psychologist if they wanted treatment, and both groups could seek additional care.
  • Outcomes were assessed at baseline, posttreatment (8 weeks), 6 months, and 12 months; primary outcome was CES-D, with secondary outcomes including MBI burnout, HPQ work performance, absenteeism, and HADS anxiety. Linear mixed modeling was intention-to-treat with multiple imputation, plus subgroup, per-protocol, and sensitivity analyses.

Limitations

  • The paper states high attrition (26% at posttreatment, 32% at 6 months, 46% at 12 months), though it notes this was equal to or lower than several similar Web-based depression trials; multiple imputation was used, and sensitivity analyses without imputation were comparable.
  • The paper states the sample was primarily Dutch white-collar workers with high educational level (63.6% high education), limiting generalizability; subgroup analyses on education were underpowered.
  • The paper states the power analysis was based on a posttreatment effect, so follow-up analyses lacked power; adherence was low (57.8% completed ≥3 lessons), and per-protocol analyses were underpowered because they included only 42.2% of the intervention group. The text also makes evident that absenteeism used different recall periods across assessments, so only between-group differences, not increases or decreases over time, could be examined.

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

Integrity signals

Registry

Crossref · 10.2196/jmir.3539

Cites

90 of 90 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 58 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Differences between groups were not significant for the secondary outcomes.

    “Differences between groups were also not significant for the secondary outcomes.”
    Quote in the paperNot a substantial claim
  • Findingown data

    No subgroups benefited from the treatment compared to CAU.

    “We were not able to identify any subgroups that benefited from the treatment compared to CAU.”
    • Also stated in: § Subgroup Analyses · plain
      “There were no significant differences in depressive symptoms between the groups over time in any of the subgroups.”
    Quote in the paperSubstantial claim
  • Findingown data

    A total of 67 participants (57.8%) were treatment completers because they completed 3 or more lessons of the intervention.

    “A total of 67 participants (57.8%) were seen as treatment completers because they completed 3 or more lessons of the intervention.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Per-protocol analyses comparing treatment completers to the CAU group did not reveal any significant results on the primary outcome depressive symptoms and all secondary outcomes.

    “The per-protocol analyses, in which the group of treatment completers was compared to the CAU group, did not reveal any significant results on the primary outcome depressive symptoms (unadjusted regression coefficient=–0.48, 95% CI –4.28 to 3.33, P=.80) and all secondary outcomes.”
    Quote in the paperSubstantial claim
  • Findingown data

    There were no significant differences between the intervention and CAU groups on any outcome measures over long-term follow-up.

    “This study did not affirm evidence for the long-term effectiveness of the Web-based intervention compared to CAU for any of the outcome measures.”
    • Also stated in: § Principal Results · plain
      “However, no difference between the 2 conditions in the course of symptoms was found on any of the outcome measures.”
    Quote in the paperSubstantial claim
  • May combine two claims. 29
  • Classified as probably not a substantial claim. 25
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    The Cohen's ds assessed at each time point, based on observed data, were close to the overall effect size of Richards and Richardson, but they were not significant and the effect size over time was small (d=0.05).

    “The Cohen’s ds that were assessed at each time point, based on the observed data, showed effect sizes that were close to the overall effect size of Richards and Richardson, but they were not significant and the effect size over time was small (d=0.05).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Richards and Richardson

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    Findingown data

    Participants improved on work-related outcomes of burnout symptoms and work performance between baseline and posttreatment, with sustainable effects up to 12 months.

    “This was also true for the work-related outcomes of burnout symptoms and work performance as participants improved between baseline and posttreatment with sustainable effects up to 12 months.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Findingown data

    A total of 231 employees were randomized to either the intervention group (n=116) or to CAU (n=115).

    “A total of 231 employees were randomized to either the intervention group (n=116) or to CAU (n=115).”
    • Also stated in: § Procedure · plain
      “A total of 231 participants were randomized to the Happy@Work intervention (n=116) or the CAU group (n=115).”
    Quote in the paperSubstantial claim

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

    Findingown data

    Completion of assessments varied between 54%-74%.

    “Completion of assessments varied between 54%-74%.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants improved substantially on the primary outcome depressive symptoms between baseline and posttreatment assessment, and these improvements sustained over 1 year.

    “Overall, participants improved substantially on the primary outcome depressive symptoms between baseline and posttreatment assessment and these improvements sustained over the period of 1 year.”
    • Also stated in: § Implications and Future Research · plain
      “Overall, participants improved substantially between baseline and posttreatment assessment on depressive symptoms and these improvements sustained over time.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    The overall estimated mean difference between the groups over time for absenteeism was not significant.

    “The overall estimated mean difference between the groups over time was not significant (see Table 3).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Improvement in depressive symptoms between baseline and posttreatment was shown in all participants and these effects sustained over time.

    “Improvement in depressive symptoms between baseline and posttreatment was shown in all participants and these effects sustained over time.”
    • Also stated in: § Effectiveness · plain
      “All participants improved between baseline and posttreatment on the primary outcome depressive symptoms and this improvement sustained over time (see Table 2).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The Cohen's d per assessment for depressive symptoms were all small to moderate and nonsignificant (t1: d=0.26, 95% CI -0.04 to 0.56; t2: d=-0.12, 95% CI -0.43 to 0.20; t3: d=0.24, 95% CI -0.12 to 0.59).

    “The Cohen’s d per assessment were all small to moderate effect sizes and nonsignificant (t1: d=0.26, 95% CI –0.04 to 0.56; t2: d=–0.12, 95% CI –0.43 to 0.20; t3: d=0.24 95% CI –0.12 to 0.59).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    For the secondary outcomes, improvements between baseline and posttreatment sustained over time, but there were no significant differences between the groups over time.

    “There were improvements between baseline and posttreatment assessment on the secondary outcomes and these improvements sustained over time (see Table 2), but there were no significant differences between the groups over time.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants also improved on the secondary outcomes, which sustained over time.

    “Participants also improved on the secondary outcomes, which sustained over time.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The natural recovery in the CAU group was comparable to the intervention group and sustainable over a 12-month period.

    “Based on the results of this study, we can conclude that an intervention for employees with mild to moderate depressive symptoms who are not on sick leave might not be necessary because the natural recovery in the CAU group was comparable to the intervention group and sustainable over a 12-month period.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    No further improvements on the cynicism and reduced professional efficacy dimensions occurred at follow-up, but the small improvements between baseline and posttreatment assessment sustained during follow-up.

    “Apparently, this was not the case because no further improvements on the cynicism and reduced professional efficacy dimensions occurred at follow-up, but the small improvements between baseline and posttreatment assessment sustained during follow-up.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    The large reduction in depressive symptoms in the CAU group between baseline and posttreatment was unforeseen and sustained at the follow-up assessments.

    “The large reduction in depressive symptoms in the CAU group between baseline and posttreatment was unforeseen and sustained at the follow-up assessments [34,67,68].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [34] source

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    • cites [67] source

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    Premisecitation

    Richards and Richardson reported the results of 14 studies that included a long-term follow-up, primarily up to 6 months with few studies reporting outcomes up to 12 months.

    “Richards and Richardson [21] reported the results of 14 studies that included a long-term follow-up, primarily up to 6 months with few studies reporting outcomes up to 12 months.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [21] source

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  • Classified as probably not a substantial claim.

    Premisecitation

    There is increasing evidence for the effectiveness of treatments for depression delivered via the Internet.

    “there is increasing evidence for the effectiveness of treatments that are delivered via the Internet [19-23]”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [19] source

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    • cites [20] Van't Hof, E, 2009, CNS Spectr

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    • cites [21] source

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    • cites [22] source

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    • cites [23] source

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    Premisecitation

    Studies on the effectiveness of Web-based interventions for the treatment of depressive symptoms show positive short-term effects.

    “studies on the effectiveness of Web-based interventions for the treatment of depressive symptoms show positive short-term effects [21]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [21] source

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

    Premisecitation

    Richards and Richardson showed a small but significant effect of computer cognitive behavior therapy on depression (d=0.20).

    “They showed a small but significant effect of CCBT on depression (d=0.20)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] source

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    Premisecitation

    Depression can be treated effectively with different forms of psychotherapies.

    “depression can be treated effectively with different forms of psychotherapies [13-18]”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [13] Churchill, R, 2001, Health Technol Assess

      Not checked in the free run.

    • cites [14] source

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    • cites [15] source

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    • cites [16] source

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    • cites [17] Dobson, KS, 1989, J Consult Clin Psychol source

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    • cites [18] source

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  • May combine two claims.

    Premisecitation

    At posttreatment, the intervention group improved substantially on depressive symptoms, but the CAU control group improved considerably as well and there was no significant difference between both groups.

    “The intervention group improved substantially on the primary outcome of depressive symptoms, but the CAU control group improved considerably as well and there was no significant difference between both groups [41].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] source

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

    Study design and conductnone given

    Block randomization was used with random blocks containing 4, 6, or 8 allocations.

    “Block randomization was used with random blocks containing 4, 6, or 8 allocations.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    There were no changes to the content, bugs, or periods with downtime during the trial.

    “There were no changes to the content, bugs, or periods with downtime during the trial.”
    Quote in the paperNot a substantial claim

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

    Study design and conductcitation

    The HADS has shown good homogeneity and reliability in different normal and clinical Dutch samples.

    “The HADS has shown good homogeneity and reliability in different normal and clinical Dutch samples [58].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [58] Spinhoven, P, 1997, Psychol Med source

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

    Study design and conductcitation

    The CES-D has been tested for validity in different populations.

    “Its validity has been tested in different populations [48-50].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [48] Furukawa, T, 1997, J Affect Disord source

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    • cites [49] source

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    • cites [50] source

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

    Study design and conductnone given

    We performed several a priori subgroup analyses on the primary outcome depressive symptoms.

    “We performed several a priori subgroup analyses on the primary outcome depressive symptoms.”
    Quote in the paperNot a substantial claim

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

    Study design and conductreasoning

    The absenteeism outcome was expressed in duration of absenteeism during the time period between 2 assessments, so it is not possible to study whether there was an increase or decrease of absenteeism duration over time, but only differences between the groups on absenteeism duration can be examined.

    “The absenteeism outcome was expressed in duration of absenteeism during the time period between 2 assessments. Therefore, it is not possible to study whether there was an increase or decrease of absenteeism duration over time, but only the differences between the groups on absenteeism duration can be examined.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    Randomization took place at an individual level after completion of the baseline measurement, with stratification at 2 levels (use of antidepressants and receiving treatment from a psychologist or psychiatrist at study entry).

    “Randomization took place at an individual level after completion of the baseline measurement (questionnaire and clinical interview). We used stratification at 2 levels: (1) use of antidepressants and (2) receiving treatment from a psychologist or psychiatrist at study entry.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The attrition rates for the study sample were 26% at posttreatment, 32% at the 6-month follow-up, and 46% at the 12-month follow-up.

    “The attrition rates for the study sample were 26% at posttreatment assessment, 32% at the 6-month follow-up assessment, and 46% at the 12-month follow-up assessment.”
    Quote in the paperNot a substantial claim

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

    Study design and conductcitation

    We also performed all analyses on the data for 100 imputations and performed the LMM analyses without multiple imputations.

    “We also performed all analyses on the data for 100 imputations. Because there is a current debate whether it is necessary to perform multiple imputations in combination with mixed-model analyses in longitudinal studies [65], we also performed the LMM analyses without multiple imputations.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [65] source

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

    Study design and conductcitation

    The process evaluation of this study revealed that the intervention was conducted according to protocol and seemed feasible for further implementation.

    “A process evaluation of this study (submitted paper) revealed that the intervention was conducted according to protocol and seemed feasible for further implementation.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites submitted paper

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

    Study design and conductnone given

    An independent researcher made the allocation schedule with a computerized random number generator and the investigators had no knowledge of the schedule.

    “An independent researcher made the allocation schedule with a computerized random number generator and the investigators had no knowledge of the schedule.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Two important differences between the studies in the meta-analysis and this study are that the meta-analysis studies generally examined a target group with more severe depressive symptoms and/or depressive disorders at baseline, and none were tested in a workplace context.

    “There are 2 important differences between the studies analyzed in the meta-analysis and our study which make the results of the meta-analysis more difficult to compare to this study: (1) in general, the studies in the meta-analysis examined a target group with more severe depressive symptoms and/or depressive disorders at baseline compared to this study, and (2) none of the studies in the meta-ana”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Richards and Richardson [21] source

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  • Classified as probably not a substantial claim.

    Study design and conductnone given

    All analyses were performed according to the intention-to-treat (ITT) principle.

    “All analyses were performed according to the intention-to-treat (ITT) principle.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Missing data were handled by multiple imputation via data augmentation.

    “Missing data were handled by multiple imputation via data augmentation.”
    Quote in the paperSubstantial claim

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

    Study design and conductreasoning

    To ensure treatment fidelity, all feedback was reviewed by a supervisor before it was placed on the website.

    “To ensure treatment fidelity, all feedback was reviewed by a supervisor (AG) before it was placed on the website.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    The baseline Cronbach alpha for the HADS anxiety subscale in this study was .76.

    “The baseline Cronbach alpha in this study was .76.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    The sample size was determined at 200 participants, based on a power of .80, an alpha of .05, and an expected dropout percentage of 30% to show a posttreatment effect size Cohen's d of 0.50.

    “The sample size was determined at 200 participants, based on a power of .80, an alpha of .05, and an expected dropout percentage of 30% to show a posttreatment effect size Cohen’s d of 0.50.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    An intervention for this specific target group might not be necessary because the recovery in the CAU group was comparable to the intervention group and sustained over a 12-month period.

    “An intervention for this specific target group might not be necessary because the recovery in the CAU group was comparable to the intervention group and sustained over a 12-month period.”
    Quote in the paperSubstantial claim

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

    Study design and conductown data

    The baseline Cronbach alpha for the CES-D in this study was .82.

    “The baseline Cronbach alpha in this study was .82.”
    Quote in the paperNot a substantial claim

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

    Study design and conductown data

    The baseline Cronbach alphas for the MBI dimensions in this study were .83 for exhaustion, .83 for cynicism, and .79 for reduced professional efficacy.

    “The baseline Cronbach alphas for the different dimensions in this study were .83 for exhaustion, .83 for cynicism, and .79 for reduced professional efficacy.”
    Quote in the paperNot a substantial claim

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

    Study design and conductcitation

    The CES-D cut-off score of 16 has shown good sensitivity (0.95), specificity (0.85), and positive predictive value of major depression (0.11) in a sample of employees.

    “This cut-off score is used frequently in studies and has shown to have good sensitivity (0.95), specificity (0.85), and positive predictive value of major depression (0.11) in a sample of employees [50].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] source

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  • May combine two claims.

    Study design and conductown data

    The per-protocol analyses did not show significant differences either, but had a lack of power because the analyses were only based on 42.2% of the intervention group.

    “The per-protocol analyses did not show significant differences either, but had a lack of power because the analyses were only based on 42.2% of the intervention group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The power analysis was based on a posttreatment effect, and therefore the analyses on follow-up assessments have a lack of power.

    “Third, the power-analysis was based on a posttreatment effect and, therefore, the analyses on follow-up assessments have a lack of power.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Mixed-model analysis without multiple imputations was also performed, and the results were comparable, indicating that data were robust and multiple imputations may not have been needed.

    “Because of the current debate on the necessity of multiple imputations in combination with mixed-model analysis in longitudinal studies [65], we also performed mixed-model analysis without multiple imputations. The results were comparable, indicating that data were robust and multiple imputations may not have been needed.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [65] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Two published studies on Web-based interventions in a workplace context with long-term follow-up and comparable target group of non-sick-listed employees with mild to moderate depressive symptoms both tested unguided interventions and did not report significant effects in favor of the intervention at follow-up (3 or 6 months).

    “Both studies did not report significant effects in favor of the intervention at follow-up (either 3 or 6 months) and showed the same pattern of improvement as was found in this study: substantial improvements between baseline and posttreatment which sustained at follow-up in both groups.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [28] source

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    • cites [66] source

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  • May combine two claims.

    Study design and conductown data

    Adherence to the intervention was low and only 57.8% completed at least 3 lessons of the intervention.

    “Finally, as stated previously, adherence to the intervention was low and only 57.8% completed at least 3 lessons of the intervention.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The subgroup analyses had a lack of power and only 36.4% of the study population had a low or middle educational level.

    “Although our subgroup analysis on educational level did not show significant differences, the subgroup analyses had a lack of power and only 36.4% of the study population had a low or middle educational level.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premiseown data

    When posttreatment effects on burnout symptoms were examined, small but significant differences in favor of the intervention group were found for emotional exhaustion but not on cynicism and reduced professional efficacy.

    “When we examined the posttreatment effects of the Web-based guided self-help intervention on burnout symptoms [41], we found small but significant differences in favor of the intervention group for emotional exhaustion but not on the other 2 dimensions, cynicism and reduced professional efficacy.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [41] source

      Not checked in the free run.

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  • The paper relies on this without support.

    No studies have been published on the effectiveness of Web-based worker-directed interventions for employees with depressive symptoms who are not on sick leave.

    “To our knowledge, no studies have been published on the effectiveness of Web-based worker-directed interventions for employees with depressive symptoms who are not on sick leave.”

  • The paper relies on this without support.

    The improvements in the CAU group represent natural recovery rather than effects of the intervention or other factors.

    “Based on the results of this study, we can conclude that an intervention for employees with mild to moderate depressive symptoms who are not on sick leave might not be necessary because the natural recovery in the CAU group was comparable to the intervention group and sustainable over a 12-month period.”
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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.

  • Per-protocol sample percentage is reversed

    Minor

    The paper states that 67 of 116 intervention participants completed at least three lessons. That is 57.8%, not the 42.2% stated for the per-protocol analyses; 42.2% is the noncompleter percentage.

    Reported 42.2 · recomputed 57.758621

  • Adjusted absenteeism effect size has the wrong sign

    Minor

    The methods define the overall effect size as the regression coefficient divided by a standard deviation. Table 3 gives a negative adjusted absenteeism coefficient but a positive effect size, unlike its other rows with negative coefficients.

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Cites

Flagged first, then by citations

Research works printed but not linked: 11

  1. de Graaf, R, 2011, Verzuim door psychische en somatische aandoeningen bij werkenden. Resultaten van de ‘Netherlands Mental Health Survey and Incidence Study-2’ (NEMESIS-2) [Absenteeism due to psychological or somatic disorders in workers. Results of the ‘Netherlands Mental Health Survey and Incidence Study-2’ (NEMESIS-2)]
  2. Smit, F, 2006, J Ment Health Policy Econ, 9, 193
  3. Churchill, R, 2001, Health Technol Assess, 5, 1
  4. Van't Hof, E, 2009, CNS Spectr, 14, 34
  5. Franck, E, 2004, Handleiding Preventie Leidraad [Manual for Prevention Guideline]
  6. Franck, E, 2004, Ervaringen met de Preventie Leidraad [Experiences with the Prevention Guideline]
  7. Bouma, J, 1995, Het meten van symptomen van depressie met de CES-D; een handleiding [Assessment of Symptoms of Depression by Means of the CES-D: A Manual]
  8. Schaufeli, WB, 2000, UBOS: Utrechtse Burnout Schaal [UBOS: Utrecht Burnout Scale]
  9. Hakkaart-van Roijen, L, 2002, Manual Trimbos/iMTA Questionnaire for Costs Associated with Psychiatric Illness (TIC-P)
  10. 1990, Composite International Diagnostic Interview (version 2.1)
  11. 2000, Diagnostic and Statistical Manual of Mental Disorders (Text Revision)

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Authors
Geraedts, A. S., Kleiboer, A. M., Twisk, J., Wiezer, N. M., van Mechelen, W., & Cuijpers, P.
Affiliations
  • Vrije Universiteit Amsterdam (NL)
  • Amsterdam Public Health (NL)
  • Netherlands Organisation for Applied Scientific Research (NL)
Corresponding author
Geraedts, Anna S
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2014-07-09
Volume
16
Issue
7
Pages
e168
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/jmir.3539
PMC
PMC4115257
OpenAlex
W2137928281
Cited by
89
References
89
Citations by year
2026: 1 · 2025: 7 · 2024: 4 · 2023: 6 · 2022: 8 · 2021: 14 · 2020: 4 · 2019: 7 · 2018: 9 · 2017: 13 · 2016: 7 · 2015: 4 · 2014: 5
FWCI
14.96
Type
journal article
Language
en
Open access
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)
  • Pure Amsterdam UMC (publishedVersion)
  • Multilingual Matters (Channel View Publications) (publishedVersion, cc-by)
  • TNO Repository (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • VU Research Portal (submittedVersion, other-oa)
  • Repository hosted by TU Delft Library (TU Delft) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
  • Vanderbilt University Medical Center
  • Vrije Universiteit Amsterdam
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
depressive symptoms, workers, workplace mental health, problem-solving therapy, cognitive therapy, burnout, employee performance, absenteeism, anxiety, long-term outcomes, online intervention, cost reduction, sick leave prevention, employee well-being, return to work
MeSH terms
Absenteeism, Adult, Depression, Female, Humans, Male, Middle Aged, Problem Solving, Psychiatric Status Rating Scales, Surveys and Questionnaires, Self Care, Cognitive Behavioral Therapy, Treatment Outcome, 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.

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