Calear, A. L., Christensen, H., Mackinnon, A., Griffiths, K. M., & O'Kearney, R. (2009). The YouthMood Project: a cluster randomized controlled trial of an online cognitive behavioral program with adolescents. Journal of Consulting and Clinical Psychology, 77(6), 1021–1032. https://doi.org/10.1037/a0017391

Type of Study: Randomized controlled trial
Number of Participants: 1,477

Population:

• Age — MoodGym: Mean=14.56 years; WL Control: Mean=14.20 years
• Race/Ethnicity — Not specified
• Gender — MoodGym: 63% Female and 37% Male; WL Control: 52% Female and 49% Male
• Status — Participants were adolescent students.

Location/Institution: Metropolitan and rural schools in Australia

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to investigate the effectiveness of an online, self-directed cognitive–behavioral therapy program (MoodGYM) in preventing and reducing the symptoms of anxiety and depression in an adolescent school-based population. Participant schools were randomized to either MoodGYM or to a waitlist-control condition. Measures utilized include the Revised Children’s Manifest Anxiety Scale (RCMAS), the Center for Epidemiological Studies Depression Scale (CES-D), attendance records, and study-developed questionnaires. Results indicate that at postintervention and 6-month follow-up, MoodGYM participants had significantly lower levels of anxiety than did participants in the wait-list control condition. The effects of the MoodGYM program on depressive symptoms were less strong, with only male participants in the MoodGYM condition exhibiting significant reductions in depressive symptoms at postintervention and 6-month follow-up. Limitations include that the instrument used to assess anxiety may not specifically measure anxiety symptoms, but rather may measure negative feelings in general, including depression; demand characteristics, such as the presence of the classroom teacher, may have affected participant responses to the questionnaire; the inability to collect complete data from some participants in the current trial due to absence or school relocation; the use of a wait-list control condition in that it is unclear whether the effects obtained were due to the intervention or to other factors; and reliance on self-report measures.

Length of controlled postintervention follow-up: 6 months.

Calear, A. L., Christensen, H., Mackinnon, A., & Griffiths, K. M. (2013). Adherence to the MoodGYM program: Outcomes and predictors for an adolescent school-based population. Journal of Affective Disorders, 147(1-3), 338–344. https://doi.org/10.1016/j.jad.2012.11.036

Type of Study: Randomized controlled trial
Number of Participants: 1,477

Population:

• Age — MoodGym: Mean=14.56 years; WL Control: Mean=14.20 years
• Race/Ethnicity — Not specified
• Gender — MoodGym: 63% Female and 37% Male; WL Control: 52% Female and 49% Male
• Status — Participants were adolescent students.

Location/Institution: Metropolitan and rural schools in Australia

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Calear et al. (2009). The purpose of the study was to investigate adolescent adherence to an internet-based depression prevention program in schools to identify the effect of adherence on outcomes and to ascertain the predictors of program adherence. Participant schools were randomized to either MoodGYM or to a waitlist-control condition. Two groups were created to distinguish high and low adherence; high adherence was defined as the completion of at least 20 exercises, whereas the completion of 19 or fewer exercises was categorized as low adherence. Measures utilized include the Revised Children’s Manifest Anxiety Scale (RCMAS), the Center for Epidemiological Studies Depression Scale (CES-D), Children’s Attributional Style Questionnaire-Revised (CASQ-R), Alcohol Use Disorders Identification Test (AUDIT), Rosenberg’s 10-item Self-Esteem Scale (RSES), Personal Depression Stigma Scale (DSS-Personal), and attendance records. Results indicate that when compared to the waitlist-control condition, participants in the high adherence group reported stronger intervention effects at post-intervention and 6-month follow-up than participants in the low adherence group for anxiety and male and female depression. No significant intervention effects were identified between the high and low adherence groups. Being in Year 9, living in a rural location, and having higher pre-intervention levels of depressive symptoms or self-esteem were predictive of greater adherence to the MoodGYM program. Limitations include a lack of controlled postintervention follow-up, reliance on self-report measures, and that the program trialed is internet-based and therefore the predictors of adherence identified may not generalize to face-to-face interventions.

Length of controlled postintervention follow-up: None.

Sethi, S. (2013). Treating youth depression and anxiety: A randomised controlled trial examining the efficacy of computerised versus face‐to‐face cognitive behaviour therapy. Australian Psychologist, 48(4), 249–57. https://doi.org/10.1111/ap.12006

Type of Study: Randomized controlled trial
Number of Participants: 89

Population:

• Age — MoodGYM: Mean=20.78 years; F2F: Mean=20.33 years; In-conjunction: Mean=19.63 years; Control: Mean=19.47 years
• Race/Ethnicity — 44 Australian, 17 Middle Eastern, 16 Asian, 9 Indian, 6 Other, 5 New Zealand, and 1 Sri Lankan
• Gender — 60 Female and 29 Male
• Status — Participants were young adults from youth community centers.

Location/Institution: North and Inner West regions of Sydney, Australia

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the efficacy of a computerized-based self-help program (MoodGYM) delivered in conjunction with face-to-face cognitive behavioral therapy (CBT) to expand the delivery avenues of psychological treatment for young adults. Participants were randomly allocated to a non-treatment control group or to one of three experimental groups: Face-to-face CBT (F2F), MoodGYM, or treatment in-conjunction (face-to-face CBT and MoodGYM). Measures utilized include the Kessler Psychological Distress Scale and Depression Anxiety Stress Scale (DASS 21). Results indicate that while MoodGYM did not significantly decrease depression in comparison to the control group, significant decreases were found for anxiety. MoodGYM delivered in-conjunction with face-to-face CBT is more effective in treating symptoms of depression and anxiety compared with standalone face-to-face or MoodGYM. Limitations include a lack of controlled postintervention follow-up and reliance on self-report measures.

Length of controlled postintervention follow-up: None.

Lillevoll, K. R., Vangberg, H. C. B., Griffiths, K. M., Waterloo, K., & Eisemann, M. R. (2014). Uptake and adherence of a self-directed internet-based mental health intervention with tailored e-mail reminders in senior high schools in Norway. BMC Psychiatry, 14, Article 14. https://doi.org/10.1186/1471-244X-14-14

Type of Study: Randomized controlled trial
Number of Participants: 707

Population:

• Age — Control: Mean=16.78 years; Intervention: Mean=16.80 years
• Race/Ethnicity — Not specified
• Gender — Intervention: 57% Female; Control: 42% Female
• Status — Participants were adolescent high-school students.

Location/Institution: Norway

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the feasibility and efficacy of disseminating a self-directed internet-based mental health intervention (MoodGYM) in senior high schools. It also sought to investigate possible effects of tailored weekly e-mail reminders on initial uptake and adherence to the intervention. Participants were randomized to one of four conditions: 1) waitlist control group, 2) MoodGYM without email reminders, 3) MoodGYM with standard reminders, and 4) MoodGYM with individually tailored reminders. Measures utilized include the Norwegian version of the Centre for Epidemiologic Studies Depression Scale (CES-D), Norwegian version of the General Self-Efficacy Scale (GSE), Norwegian version of the Rosenberg Self-Esteem Scale (RSES), and study-developed questionnaires. Results indicate that there was substantial nonparticipation from the intervention, with only 8.5% (45/527) of participants logging on to MoodGYM, and few proceeding beyond the first part of the program. No significant effect on depression or self-esteem was found among the sample as a whole or among participants with elevated depression scores at baseline. Having a higher average grade in senior high school predicted initial uptake of the intervention, but tailored e-mail and self-reported current need of help did not. Weekly e-mail prompts did not predict adherence. The main reasons for non-use reported were lack of time/forgetting about it and doubt about the usefulness of the program. Limitations include reliance on self-report measures, high attrition rate, lack of controlled postintervention follow-up, and lack of significant treatment effects.

Length of controlled postintervention follow-up: None.

Guille, C., Zhao, Z., Krystal, J., Nichols, B., Brady, K., & Sen, S. (2015). Web-based cognitive behavioral therapy intervention for the prevention of suicidal ideation in medical interns: A randomized clinical trial. JAMA Psychiatry, 72(12), 1192–1198. https://doi.org/10.1001/jamapsychiatry.2015.1880

Type of Study: Randomized controlled trial
Number of Participants: 199

Population:

• Age — Mean=25.2 years
• Race/Ethnicity — 49% White, 29% Asian, and 22% Other
• Gender — 49% Female
• Status — Participants were entering 1st year medical interns in traditional and primary care internal medicine, general surgery, pediatrics, obstetrics/gynecology, emergency medicine, combined medicine and pediatrics, and psychiatry residency.

Location/Institution: University hospitals at the University of Southern California and Yale University

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to assess the effectiveness of a Web-based cognitive behavioral therapy (wCBT) program, MoodGYM, delivered prior to the start of the internship year in the prevention of suicidal ideation in medical interns. Participants were randomly assigned to either wCBT or to an attention control condition (ACG) that received standard mental health information and available contacts for mental health services. Measures utilized include the Patient Health Questionnaire (PHQ-9) and NEO Personality Inventory. Results indicate that during at least onetime point over the course of the internship year, 12% of interns assigned to wCBT endorsed suicidal ideation, compared to 21% of interns assigned to ACG. After adjusting for covariates that have previously been shown to increase the risk for suicidal ideation, interns assigned to wCBT were 60% less likely to endorse suicidal ideation during the internship year compared to those assigned to the ACG. Limitations include lack of generalizability due to sample size, reliance on self-report measures, and only suicidal ideation being assessed and not suicide or suicidal behaviors.

Length of controlled postintervention follow-up: 6 weeks.

The following studies were not included in rating moodgym on the Scientific Rating Scale...

Donker, T., Batterham, P. J., Warmerdam, L., Bennett, K., Bennett, A., Cuijpers, P., Griffiths, K. M., & Christensen, H. (2013). Predictors and moderators of response to internet-delivered interpersonal psychotherapy and cognitive behavior therapy for depression. Journal of Affective Disorders, 151(1), 343–351. https://doi.org/10.1016/j.jad.2013.06.020

The study used the same sample as Donker et al. (2013). The purpose of the study was to identify which predictors and moderators lead to beneficial outcomes, and if accurate selection of the best initial treatment will have significant benefits for depressed individuals. Participants were randomized to either face-to-face interpersonal psychotherapy (IPT), face-to-face cognitive behavioral therapy (CBT), or to an online control – MoodGYM. Measures utilized include the Center for Epidemiological Studies Depression Scale, US National Comorbidity Survey, Quality of Life Survey (EUROHIS-QOL), Generalized Anxiety Disorder Scale (GAD-7), and a survey measuring medication use. Results indicate that female gender, lower mastery, and lower dysfunctional attitudes predicted better outcome at post-test and/or follow-up regardless of intervention. No overall differential effects for condition on depression as a function of outcome were found. However, based on time-specific estimates, a significant interaction effect of age was found. For younger people, internet-delivered IPT may be the preferred treatment choice, whereas older participants derive more benefits from internet-delivered CBT programs. Limitations include a large percentage of the sample size were above the age of 25 years, reliance on self-report measures, and although the sample of participants was large, power to detect moderator effects was still lacking. Note: This article was not used in the rating process since a large percentage of the sample was over the age of 25 years.

Donker, T., Bennett, K., Bennett, A., Mackinnon, A., van Straten, A., Cuijpers, P., Christensen, H. & Griffiths, K. M. (2013). Internet-Delivered interpersonal psychotherapy versus internet-delivered cognitive behavioral therapy for adults with depressive symptoms: Randomized controlled noninferiority trial. Journal of Medical Internet Research, 15(5), Article e82. https://doi.org/10.2196/jmir.2307

The purpose of the study was to examine whether interpersonal psychotherapy (IPT) is effective, noninferior to, and as feasible as Cognitive behavioral therapy (CBT) when delivered online (MoodGYM) to spontaneous visitors of an online therapy website. Participants were randomized to either face-to-face IPT, face-to-face CBT, or to an online control – MoodGYM. Measures utilized include the Center for Epidemiological Studies Depression Scale, Client Satisfaction Questionnaire (CSQ-8), and study-developed surveys. Results indicate that there was a significant reduction in depressive symptoms at posttest and follow-up for both CBT and IPT, and they were noninferior to MoodGYM. Within-group effect sizes were medium to large for all groups. There were no differences in clinically significant changes between the programs. Reliable change was shown at posttest and follow-up for all programs, with consistently higher rates for CBT. Participants allocated to IPT showed significantly lower treatment satisfaction compared to CBT and MoodGYM. There was a dropout rate of 70% at posttest, highest for MoodGYM. Limitations include a large percentage of the sample were above the age of 25 years, and reliance on self-report measures. Note: This article was not used in the rating process since a large percentage of the sample was over the age of 25 years.