Shorter communicationBehavior change through automated e-mails: Mediation analysis of self-help strategy use for depressive symptoms
Highlights
► Adults with depressive symptoms received emails with coping advice or information. ► The coping advice emails increased use of effective self-help techniques. ► Increased use of self-help techniques led to a reduction in depression symptoms. ► Messages about effective self-help can change behavior and improve mild depression.
Section snippets
Participants
Participants were 568 adults with sub-threshold depression who completed the trial and for whom baseline and post-intervention data were available. Sub-threshold depression was defined as 2 to 4 symptoms of depression experienced more than half the days or nearly every day for two or more weeks, which had affected work, home, or social functioning. Participants were recruited online to the study website (www.moodmemos.com) from a variety of internet-based sources including Google advertising,
Results
Table 1 presents the means and standard deviations of depressive symptoms, frequency of use of all self-help strategies combined and frequency of use of each strategy individually at baseline and post-intervention. Mean scores on the PHQ-9 at baseline were in the mild to moderate severity range (Kroenke et al., 2010). All self-help strategies had potential for improvement in mean usage.
The total strategy use score was examined first as a potential mediator, to test the overall effect of the use
Discussion
The central precept of the Mood Memos study was that the active e-mails would lead to an increase in usage of the promoted strategies, relative to the control group, and that this increase would improve depressive symptoms. This hypothesis was supported for use of the strategies overall. The total use of the promoted self-help strategies completely mediated the effect of the intervention on depression symptoms. This finding provides strong support for the premise that the intervention worked as
Acknowledgments
This research was supported by a National Health and Medical Research Council Postgraduate Scholarship (567056), a Sidney Myer Health Scholarship, and an NHMRC Australia Fellowship. Orygen Youth Health Research Centre receives funding from the Colonial Foundation. The funding sources had no role in the study design, collection, analysis or interpretation of data, in the writing of the report, and in the decision to submit the paper for publication. Thanks to the working group of Sarah
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