Commentary

A paucity of research exists on the effect of internet based mental health clinical interventions, particularly those focusing on depression, one of the most common mental health diagnoses in primary care settings in both developed and developing countries.¹ The study by Christensen et al advances our knowledge about the effect of online clinical interventions, specifically CBT and psychoeducation for depression. Their promising results are supported by other studies.^2,3 However, 2 trials, 1 using psychoeducation⁴ and one using stand-alone online CBT for depression⁵ reported less successful outcomes. In the study by Christensen et al, the authors postulated that their minimal dropout rate was related to the interactive nature of the websites, as well as the weekly personal contacts made by lay interviewers. Other successful internet based interventions have also included personal contact by interviewers or clinicians through email or phone.

The sample was representative of people who had internet access, high levels of education, and had previously sought help from a clinician for depression. Although these results appear promising, it is premature to suggest that online CBT or psychoeducation should be widely adopted for use by the general population with internet access. The effect of personal contacts, programme content, degree of interactivity, and tailoring of responses requires more investigation before effective models of service delivery can be determined.

This study is relevant to nurses working in mental health and community health settings, as well as nurse practitioners in primary care settings.