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      Systematic Review on Internet Support Groups (ISGs) and Depression (1): Do ISGs Reduce Depressive Symptoms?

      research-article
      , PhD 1 , , , PhD 1 , , BA 1
      (Reviewer)
      Journal of Medical Internet Research
      Gunther Eysenbach
      Depression, consumer participation, Internet, self-help groups

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          Abstract

          Background

          Internet support groups (ISGs) enable individuals with specific health problems to readily communicate online. Peer support has been postulated to improve mental health, including depression, through the provision of social support. Given the growing role of ISGs for both users with depression and those with a physical disorder, there is a need to evaluate the evidence concerning the efficacy of ISGs in reducing depressive symptoms.

          Objective

          The objective was to systematically review the available evidence concerning the effect of ISGs on depressive symptoms.

          Method

          Three databases (PubMed, PsycINFO, Cochrane) were searched using over 150 search terms extracted from relevant papers, abstracts, and a thesaurus. Papers were included if they (1) employed an online peer-to-peer support group, (2) incorporated a depression outcome, and (3) reported quantitative data. Studies included both stand-alone ISGs and those used in the context of a complex multi-component intervention. All trials were coded for quality.

          Results

          Thirty-one papers (involving 28 trials) satisfied the inclusion criteria from an initial pool of 12,692 abstracts. Sixteen trials used either a single-component intervention, a design in which non-ISG components were controlled, or a cross-sectional analysis, of which 10 (62.5%) reported a positive effect of the ISG on depressive symptoms. However, only two (20%) of these studies employed a control group. Only two studies investigated the efficacy of a depression ISG and neither employed a control group. Studies with lower design quality tended to be associated with more positive outcomes ( P = .07). Overall, studies of breast cancer ISGs were more likely to report a reduction in depressive symptoms than studies of other ISG types (Fisher P = .02), but it is possible that this finding was due to confounding design factors rather than the nature of the ISG.

          Conclusions

          There is a paucity of high-quality evidence concerning the efficacy or effectiveness of ISGs for depression. There is an urgent need to conduct high-quality randomized controlled trials of the efficacy of depression ISGs to inform the practice of consumers, practitioners, policy makers, and other relevant users and providers of online support groups.

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          Most cited references67

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          Online communication, compulsive Internet use, and psychosocial well-being among adolescents: a longitudinal study.

          The present study investigated the relationships between adolescents' online communication and compulsive Internet use, depression, and loneliness. The study had a 2-wave longitudinal design with an interval of 6 months. The sample consisted of 663 students, 318 male and 345 female, ages 12 to 15 years. Questionnaires were administered in a classroom setting. The results showed that instant messenger use and chatting in chat rooms were positively related to compulsive Internet use 6 months later. Moreover, in agreement with the well-known HomeNet study (R. Kraut et al., 1998), instant messenger use was positively associated with depression 6 months later. Finally, loneliness was negatively related to instant messenger use 6 months later. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
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            Major depression after breast cancer: a review of epidemiology and treatment.

            While many breast cancer patients experience "normal" distress, there is a subset who experience clinically significant depression. We examined the current knowledge about the prevalence, impact and treatment of major depression in women with breast cancer. We reviewed the evidence for the prevalence of depression in women with breast cancer from the last 20 years and summarized the medical literature on the pharmacology and psychotherapy of depression in this population. Despite evidence that depression significantly impacts quality of life in breast cancer patients, few studies focus on the epidemiology and treatment of major depression. Treatment studies have focused on distress and mixed depressive states, with resulting lack of replicable studies showing treatment efficacy. Potential biological and psychosocial determinants of major depression following breast cancer are discussed in a proposed model. The need for further research on the epidemiology and treatment of major depression in this population is proposed. Major depression is a frequent but underrecognized and undertreated condition among breast cancer patients, which causes amplification of physical symptoms, increased functional impairment and poor treatment adherence. More research on the epidemiology and treatment of major depression in this population is needed.
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              Internet-based self-help for depression: randomised controlled trial.

              Major depression can be treated by means of cognitive-behavioural therapy, but as skilled therapists are in short supply there is a need for self-help approaches. Many individuals with depression use the internet for discussion of symptoms and to share their experience. To investigate the effects of an internet-administered self-help programme including participation in a monitored, web-based discussion group, compared with participation in web-based discussion group only. A randomised controlled trial was conducted to compare the effects of internet-based cognitive-behavioural therapy with minimal therapist contact (plus participation in a discussion group) with the effects of participation in a discussion group only. Internet-based therapy with minimal therapist contact, combined with activity in a discussion group, resulted in greater reductions of depressive symptoms compared with activity in a discussion group only (waiting-list control group). At 6 months' follow-up, improvement was maintained to a large extent. Internet-delivered cognitive cognitive-behavioural therapy should be pursued further as a complement or treatment alternative for mild-to-moderate depression.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                JMIR
                Journal of Medical Internet Research
                Gunther Eysenbach (Centre for Global eHealth Innovation, Toronto, Canada )
                1438-8871
                Jul-Sep 2009
                30 September 2009
                : 11
                : 3
                : e40
                Affiliations
                [1] 1simpleCentre for Mental Health Research simpleThe Australian National University CanberraAustralia
                Article
                v11i3e40
                10.2196/jmir.1270
                2802256
                19793719
                15419ac2-a7a5-4ea6-a058-0c3a7edf5c7e
                © Kathleen M Griffiths, Alison L Calear, Michelle Banfield. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 30.09.2009.  

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 28 May 2009
                : 22 June 2009
                : 15 July 2009
                : 31 July 2009
                Categories
                Original Paper

                Medicine
                depression,consumer participation,internet,self-help groups
                Medicine
                depression, consumer participation, internet, self-help groups

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