Abstract:

Depression is an important global public health issue, for which the internet cognitive-behavioral therapy (ICBT) is drawing increasingly broad attention in recent years. This intervention model is still in its infancy in China, whose validity, though, has already been tested by various studies in western countries. Beijing Suicide Research and Prevention Center (BSRPC) first introduced MoodGYM, a ICBT program for depression in 2014, and later made it available in Chinese. The aim of the present study is twofold: (1) to test the online intervention validity of the computerized intervention program of MoodGYM among college students with depression with randomized controlled trials (RCT); (2) to simultaneously explore the mechanism of cognitive distortion, a finding from clinic practice, and interpretation bias, a discovery in cognitive research, in ICBT for depression with multiple mediation model. The sample consisted of 62 college student subjects, who were randomly divided into either a MoodGYM intervention group (n = 47) and a delayed intervention group (n = 15), with a 3:1 proportion as the weighted random selection demands. This study uses the complete-case analysis, and the result of intention-to-treat analysis (ITT) is also reported. The results suggest that the computerized self-help intervention of MoodGYM on Chinese college students with depression indicates a statistically significant difference in the MoodGYM group after intervention (Center for Epidemiological Studies Depression Scale, CES-D, d = 0.93; Patient Health Questionnaire, PHQ-9, d = 0.79), regardless of whether complete-case analysis or intention-to-treat analysis was used. Meanwhile, clinical significance was also found in the validity of ICBT for depression. When compared to the control group, ICBT not only promoted the reduction of negative automatic thoughts as measured through the explicit self-report scale (Automatic Thoughts Questionnaire, ATQ), but resulted in a decrease of negative interpretation biases obtained from the implicit cognitive measure (Scrambled Sentences Test, SST) as well, and thus led to depressive symptom relief. In addition, while ICBT for depression enhanced the improvement of participants’ dysfunctional attitudes, no significance was observed in tests of mediation effect. Despite the limitations of the using computerized intervention for depression there are often too little professional staff for student counseling centers to meet the need of large student populations, whereas the self-help ICBT shows encouraging therapeutic effects and advantages to assist in the care of large numbers of users. Consequently, ICBT may well serve as a supplement to traditional psychotherapies, or as a self-help intervention in the gradient treatment model.

Key words: depression, online intervention, college student, effect, mechanism