An Internet-Based Intervention to Promote Mental Fitness for Mildly Depressed Adults: Randomized Controlled Trial

Abstract

BackgroundDepression is a worldwide problem warranting global solutions to tackle it. Enhancing well-being has benefits in its own right and could be a good strategy for preventing depression. Providing well-being interventions via the Internet may have synergetic effects.ObjectivePsyfit (“mental fitness online”) is a fully automated self-help intervention to improve well-being based on positive psychology. This study examines the clinical effects of this intervention.MethodsWe conducted a 2-armed randomized controlled trial that compared the effects of access to Psyfit for 2 months (n=143) to a waiting-list control condition (n=141). Mild to moderately depressed adults in the general population seeking self-help were recruited. Primary outcome was well-being measured by Mental Health Continuum-Short Form (MHC-SF) and WHO Well-being Index (WHO-5); secondary outcomes were depressive symptoms, anxiety, vitality, and general health measured by Center for Epidemiological Studies Depression Scale (CES-D), Hospital Anxiety and Depression Scale Anxiety subscale (HADS-A), and Medical Outcomes Study-Short Form (MOS-SF) vitality and general health subscales, respectively. Online measurements were taken at baseline, 2 months, and 6 months after baseline.ResultsThe dropout rate was 37.8% in the Psyfit group and 22.7% in the control group. At 2-month follow-up, Psyfit tended to be more effective in enhancing well-being (nonsignificantly for MHC-SF: Cohen’s d=0.27, P=.06; significantly for WHO-5: Cohen’s d=0.31, P=.01), compared to the waiting-list control group. For the secondary outcomes, small but significant effects were found for general health (Cohen’s d=0.14, P=.01), vitality (d=0.22, P=.02), anxiety symptoms (Cohen’s d=0.32, P=.001), and depressive symptoms (Cohen’s d=0.36, P=.02). At 6-month follow-up, there were no significant effects on well-being (MHC-SF: Cohen’s d=0.01, P=.90; WHO-5: Cohen’s d=0.26, P=.11), whereas depressive symptoms (Cohen’s d=0.35, P=.02) and anxiety symptoms (Cohen’s d=0.35, P=.001) were still significantly reduced compared to the control group. There was no clear dose–response relationship between adherence and effectiveness, although some significant differences appeared across most outcomes in favor of those completing at least 1 lesson in the intervention.ConclusionsThis study shows that an online well-being intervention can effectively enhance well-being (at least in the short-term and for 1 well-being measure) and can help to reduce anxiety and depression symptoms. Further research should focus on increasing adherence and motivation, reaching and serving lower-educated people, and widening the target group to include people with different levels of depressive symptoms.Trial RegistrationNetherlands Trial Register (NTR) number: NTR2126; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2126 (archived by WebCite at http://www.webcitation.org/6IIiVrLcO).

Feasibility of an online well-being intervention for people with spinal cord injury: a pilot study

“…7,8,12 Still, the amount of participants not completing one module was considerable in this study, despite the intensive telephone support. Different factors may influence adherence to this type of treatment, such as disease severity 13 and the ability to reflect on one's thoughts and feelings that such programmes require.…”

“…8 Each module is to be completed in 4 weeks. In each week, a specific topic is addressed, including general information, psycho-education and a practical exercise.…”

“…With a self-test at the start and the end of each module, the participant can monitor his own improvement. In the original study, 8 participants were advised to do at least 1 module. Each module is an intervention on its own and can have benefits.…”

“…So far, the results of online positive psychological interventions do not compare positively with the results of traditional or telephone-based cognitive behavioural therapy of depression in persons with SCI. 15,16 In the original evaluation of Psyfit, Bolier et al 8 reported significant small to moderate effects in persons in the general population, and these effects were larger. It is unclear why in our study, after encouraging short-term results, the longer-term (3 months post intervention) results were disappointing.…”

“…8 Psyfit is based on positive psychology, mindfulness, cognitive behavioural therapy and problem-solving therapy and aims to strengthen personal resources and qualities in order to, primarily, enhance mental well-being and, secondarily, reduce symptoms of depression and anxiety. 8 It is available at a very low cost of about €30 per year, and several health insurance companies have made it available for free for their clients. If applicable in people with SCI, Psyfit would therefore be an attractive option for people with SCI who experience mild depressive symptoms before they should consider more intensive treatment modalities.…”