Christensen Helen, Griffiths Kathy, Groves Chloe, Korten Ailsa
Centre for Mental Health Research, The Australian National University, Canberra, Australian Capital Territory, Australia.
Aust N Z J Psychiatry. 2006 Jan;40(1):59-62. doi: 10.1080/j.1440-1614.2006.01743.x.
Little is known about the predictors of symptom change or the methods that might increase user 'compliance' on websites designed to improve mental health outcomes. The present paper: (i) examines predictors of expected final depression and anxiety scores on the MoodGYM website as a function of user characteristics; and (ii) compares the compliance rates of the original site with the new public version of the site (MoodGYM Mark II). The latter site requires compulsory completion of 'core' online assessments and may increase completion of site questionnaires.
MoodGYM Mark I participants were 19,607 visitors (public registrants) between April 2001 and September 2003 plus 182 participants who had been randomly assigned to MoodGYM in an earlier trial (The BlueMood Trial). MoodGYM Mark II participants were 38,791 public registrants of the MoodGYM Mark II site collected between September 2003 and October 2004. Symptom assessments are repeated within the website intervention to allow the examination of change in symptoms. Outcome variables were gender, initial depression severity scores, number of assessments completed and final anxiety and depression scores.
Men are predicted to be 0.19 units (SE=0.095) higher than women on depression, controlling for the initial depression level and number of modules completed. For initial depression scores above 2, it is predicted that the final score will indicate improvement relative to the initial score, the magnitude of the improvement increasing as a function of the number of modules attempted. For initial anxiety scores above 2, it is predicted that the final score will indicate improvement relative to the initial score, the magnitude of the improvement increasing as a function of the number of modules attempted. Mark II registrants were more likely than to Mark I registrants to complete onsite assessments.
Visitors to the MoodGYM site are likely to have better psychological outcomes if they complete more of the site material. Compulsory completion of core sections increases assessment completion. There is a need to examine further the significance of attrition from online interventions, to develop methods of handling missing data, and to investigate strategies to improve visitor dropout.
对于旨在改善心理健康状况的网站,症状变化的预测因素以及可能提高用户“依从性”的方法知之甚少。本文:(i)研究作为用户特征函数的MoodGYM网站上预期最终抑郁和焦虑得分的预测因素;(ii)比较原始网站与新的公开版本网站(MoodGYM Mark II)的依从率。后一个网站要求强制完成“核心”在线评估,可能会提高网站问卷的完成率。
MoodGYM Mark I的参与者包括2001年4月至2003年9月期间的19607名访客(公众注册者)以及在早期试验(The BlueMood Trial)中被随机分配到MoodGYM的182名参与者。MoodGYM Mark II的参与者是2003年9月至2004年10月期间收集的MoodGYM Mark II网站的38791名公众注册者。在网站干预过程中重复进行症状评估,以考察症状变化。结果变量包括性别、初始抑郁严重程度得分、完成的评估数量以及最终焦虑和抑郁得分。
在控制初始抑郁水平和完成的模块数量后,预计男性的抑郁得分比女性高0.19个单位(标准误=0.095)。对于初始抑郁得分高于2分的情况,预计最终得分相对于初始得分会有所改善,改善程度随着尝试的模块数量增加而增加。对于初始焦虑得分高于2分的情况,预计最终得分相对于初始得分会有所改善,改善程度随着尝试的模块数量增加而增加。Mark II的注册者比Mark I的注册者更有可能完成现场评估。
如果MoodGYM网站的访客完成更多的网站内容,他们可能会有更好的心理结果。强制完成核心部分会提高评估完成率。有必要进一步研究在线干预中损耗的重要性,开发处理缺失数据的方法,并研究改善访客退出的策略。