IMPORTANCE Self-guided internet-based cognitive behavioral therapy (iCBT) has the potential to increase access and availability of evidence-based therapy and reduce the cost of depression treatment.OBJECTIVES To estimate the effect of self-guided iCBT in treating adults with depressive symptoms compared with controls and evaluate the moderating effects of treatment outcome and response.DATA SOURCES A total of 13 384 abstracts were retrieved through a systematic literature search in PubMed, Embase, PsycINFO, and Cochrane Library from database inception to January 1, 2016.STUDY SELECTION Randomized clinical trials in which self-guided iCBT was compared with a control (usual care, waiting list, or attention control) in individuals with symptoms of depression. DATA EXTRACTION AND SYNTHESISPrimary authors provided individual participant data from 3876 participants from 13 of 16 eligible studies. Missing data were handled using multiple imputations. Mixed-effects models with participants nested within studies were used to examine treatment outcomes and moderators. MAIN OUTCOMES AND MEASURESOutcomes included the Beck Depression Inventory, Center for Epidemiological Studies-Depression Scale, and 9-item Patient Health Questionnaire scores. Scales were standardized across the pool of the included studies. RESULTSOf the 3876 study participants, the mean (SD) age was 42.0 (11.7) years, 2531 (66.0%) of 3832 were female, 1368 (53.1%) of 2574 completed secondary education, and 2262 (71.9%) of 3146 were employed. Self-guided iCBT was significantly more effective than controls on depressive symptoms severity (β = −0.21; Hedges g = 0.27) and treatment response (β = 0.53; odds ratio, 1.95; 95% CI, 1.52-2.50; number needed to treat, 8). Adherence to treatment was associated with lower depressive symptoms (β = −0.19; P = .001) and greater response to treatment (β = 0.90; P < .001). None of the examined participant and study-level variables moderated treatment outcomes.CONCLUSIONS AND RELEVANCE Self-guided iCBT is effective in treating depressive symptoms. The use of meta-analyses of individual participant data provides substantial evidence for clinical and policy decision making because self-guided iCBT can be considered as an evidence-based first-step approach in treating symptoms of depression. Several limitations of the iCBT should be addressed before it can be disseminated into routine care. M any studies [1][2][3][4] have found that depressive symptoms can be effectively treated with psychotherapy, pharmacotherapy, or both. Nevertheless, many people with depressive symptoms do not seek help, and even well-resourced health care systems find it difficult to marshal enough qualified therapists to offer psychological interventions. Access barriers to psychotherapy include limited availability of trained clinicians, high cost of treatment, and fear of stigmatization.5-8 As a consequence, a significant number of individuals with depressive symptoms remain untreated.9,10Self-guided internet-based cognitive behavioral therapy (iCBT) wi...

Brief CBT-based interventions are not as effective as extended interventions. However, longer programs are associated with higher rates of dropout.

Recent climate change has been especially pronounced in the High Arctic, however, the responses of aquatic biota, such as diatoms, can be modified by site-specific environmental characteristics. To assess if climate-mediated ice cover changes affect the diatom response to climate, we used paleolimnological techniques to examine shifts in diatom assemblages from ten High Arctic lakes and ponds from Ellesmere Island and nearby Pim Island (Nunavut, Canada). The sites were divided a priori into four groups (“warm”, “cool”, “cold”, and “oasis”) based on local elevation and microclimatic differences that result in differing lengths of the ice-free season, as well as about three decades of personal observations. We characterized the species changes as a shift from Condition 1 (i.e. a generally low diversity, predominantly epipelic and epilithic diatom assemblage) to Condition 2 (i.e. a typically more diverse and ecologically complex assemblage with an increasing proportion of epiphytic species). This shift from Condition 1 to Condition 2 was a consistent pattern recorded across the sites that experienced a change in ice cover with warming. The “warm” sites are amongst the first to lose their ice covers in summer and recorded the earliest and highest magnitude changes. The “cool” sites also exhibited a shift from Condition 1 to Condition 2, but, as predicted, the timing of the response lagged the “warm” sites. Meanwhile some of the “cold” sites, which until recently still retained an ice raft in summer, only exhibited this shift in the upper-most sediments. The warmer “oasis” ponds likely supported aquatic vegetation throughout their records. Consequently, the diatoms of the “oasis” sites were characterized as high-diversity, Condition 2 assemblages throughout the record. Our results support the hypothesis that the length of the ice-free season is the principal driver of diatom assemblage responses to climate in the High Arctic, largely driven by the establishment of new aquatic habitats, resulting in increased diversity and the emergence of novel growth forms and epiphytic species.

These findings suggest the need for multiple modes of delivering mental health information. While many people feel that information delivered face-to-face is likely to be helpful, websites and other tools that maintain anonymity may be preferred by those who choose to or find themselves dealing with mental illness alone.

Visitors to the MoodGYM site are likely to have better psychological outcomes if they complete more of the site material. Compulsory completion of core sections increases assessment completion. There is a need to examine further the significance of attrition from online interventions, to develop methods of handling missing data, and to investigate strategies to improve visitor dropout.

Subject-specific search facilities on health sites are usually built using manual inclusion and exclusion rules. These can be expensive to maintain and often provide incomplete coverage of Web resources. On the other hand, health information obtained through whole-of-Web search may not be scientifically based and can be potentially harmful.To address problems of cost, coverage and quality, we built a focused crawler for the mental health topic of depression, which was able to selectively fetch higher quality relevant information. We found that the relevance of unfetched pages can be predicted based on link anchor context, but the quality cannot. We therefore estimated quality of the entire linking page, using a learned IR-style query of weighted single words and word pairs, and used this to predict the quality of its links. The overall crawler priority was determined by the product of link relevance and source quality.We evaluated our crawler against baseline crawls using both relevance judgments and objective site quality scores obtained using an evidence-based rating scale. Both a relevance focused crawler and the quality focused crawler retrieved twice as many relevant pages as a breadth-first control. The quality focused crawler was quite effective in reducing the amount of low quality material fetched while crawling more high quality content, relative to the relevance focused crawler.Analysis suggests that quality of content might be improved by post-filtering a very big breadth-first crawl, at the cost of substantially increased network traffic.

IMPORTANCE Although 13% to 20% of American adolescents experience a depressive episode annually, no scalable primary care model for adolescent depression prevention is currently available.OBJECTIVE To study whether competent adulthood transition with cognitive behavioral humanistic and interpersonal training (CATCH-IT) lowers the hazard for depression in at-risk adolescents identified in primary care, as compared with a general health education (HE) attention control. DESIGN, SETTING, AND PARTICIPANTSThis multicenter, randomized clinical trial, a phase 3 singleblind study, compares CATCH-IT with HE. Participants were enrolled from 2012 to 2016 and assessed at 2, 6, 12, 18, and 24 months postrandomization in a primary care setting. Eligible adolescents were aged 13 to 18 years with subsyndromal depression and/or history of depression and no current depression diagnosis or treatment. Of 2250 adolescents screened for eligibility, 446 participants completed the baseline interview, and 369 were randomized into CATCH-IT (n = 193) and HE (n = 176). INTERVENTIONS The internet-based intervention, CATCH-IT, is a 20-module (15 adolescent modules and 5 parent modules) online psychoeducation course that includes a parent program, supported by 3 motivational interviews. MAIN OUTCOMES AND MEASURES Time to event for depressive episode; depressive symptoms at 6 months. RESULTS Of 369 participants (mean [SD] age, 15.4 [1.5] years; 251 women [68%]) included in this trial, 193 were randomized into CATCH-IT and 176 into HE. Among these participants, 28% had both a past episode and subsyndromal depression; 12% had a past episode only, 59% had subsyndromal depression only, and 1% had borderline subsyndromal depression. The outcome of time to event favored CATCH-IT but was not significant with intention-to-treat analyses (unadjusted hazard ratio [HR], 0.59; 95% CI, 0.27-1.29; P = .18; adjusted HR, 0.53; 95% CI, 0.23-1.23; P = .14). Adolescents with higher baseline Center for Epidemiologic Studies Depression scale (CES-D 10 ) scores showed a significantly stronger effect of CATCH-IT on time to event relative to those with lower baseline scores (HR 0.82; 95% CI, 0.67-0.99; P = .04). For example, the hazard ratio for a CES-D 10 score of 15 was 0.20 (95% CI, 0.05-0.77), compared with a hazard ratio of 1.44 (95% CI, 0.41-5.03) for a CES-D 10 (continued) Key Points Questions Does an internet-based depression prevention program (competent adulthood transition with cognitive behavioral humanistic and interpersonal training) lower the hazard for depression in at-risk adolescents relative to health education attention control? Findings In this randomized clinical trial of adolescents with subsyndromal depression or history of depression randomized to receive internet-based behavioral humanistic interpersonal training or an internet-based general health education control, those who received the CATCH-IT intervention did not evidence fewer episodes of depression in the full intention-to-treat sample, but adolescents with subsyndromal depression may...

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