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Delivering interventions for depression by using the internet: randomised controlled trial

BMJ 2004; 328 doi: (Published 29 January 2004) Cite this as: BMJ 2004;328:265
  1. Helen Christensen, professor (Helen.Christensen{at},
  2. Kathleen M Griffiths, senior fellow1,
  3. Anthony F Jorm, professor1
  1. 1Centre for Mental Health Research, Australian National University, Canberra, ACT 0200, Australia
  1. Correspondence to: H Christensen
  • Accepted 11 November 2003


Objective To evaluate the efficacy of two internet interventions for community-dwelling individuals with symptoms of depression—a psychoeducation website offering information about depression and an interactive website offering cognitive behaviour therapy.

Design Randomised controlled trial.

Setting Internet users in the community, in Canberra, Australia.

Participants 525 individuals with increased depressive symptoms recruited by survey and randomly allocated to a website offering information about depression (n = 166) or a cognitive behaviour therapy website (n = 182), or a control intervention using an attention placebo (n = 178).

Main outcome measures Change in depression, dysfunctional thoughts; knowledge of medical, psychological, and lifestyle treatments; and knowledge of cognitive behaviour therapy.

Results Intention to treat analyses indicated that information about depression and interventions that used cognitive behaviour therapy and were delivered via the internet were more effective than a credible control intervention in reducing symptoms of depression in a community sample. For the intervention that delivered cognitive behaviour therapy the reduction in score on the depression scale of the Center for Epidemiologic Studies was 3.2 (95% confidence interval 0.9 to 5.4). For the “depression literacy” site (BluePages), the reduction was 3.0 (95% confidence interval 0.6 to 5.2). Cognitive behaviour therapy (MoodGYM) reduced dysfunctional thinking and increased knowledge of cognitive behaviour therapy. Depression literacy (BluePages) significantly improved participants' understanding of effective evidence based treatments for depression (P < 0.05).

Conclusions Both cognitive behaviour therapy and psychoeducation delivered via the internet are effective in reducing symptoms of depression.


  • Contributors All authors contributed to the conception and design of the study. HC and KMG led the teams responsible for the development and evaluation of the websites. HC wrote the paper, and KMG and AFJ contributed to the writing. HC undertook the data analysis. Kimberley Evans prepared the participation flow figures. Keith Dear undertook the randomisation procedures and power analysis. HC and KMG will act as guarantors for the paper.

  • Funding National Health and Medical Research Council Australia programme grant to the Centre for Mental Health Research, Australian National University, Canberra, ACT (chief investigators: A F Jorm, H Christensen, B Rodgers, K Dear, and K Anstey).

  • Competing interests None declared.

  • Ethical approval Human Ethics Committee of the Australian National University.

  • Accepted 11 November 2003
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