title: Feasibility and effectiveness of a web-based positive psychology program for youth mental health: randomized controlled trial.
abstract: BACKGROUND
  Youth mental health is a significant public health concern due to the high prevalence of mental health problems in this population and the low rate of those affected seeking help. While it is increasingly recognized that prevention is better than cure, most youth prevention programs have utilized interventions based on clinical treatments (eg, cognitive behavioral therapy) with inconsistent results.
  
  
  OBJECTIVE
  This study explores the feasibility of the online delivery of a youth positive psychology program, Bite Back, to improve the well-being and mental health outcomes of Australian youth. Further aims were to examine rates of adherence and attrition, and to investigate the program's acceptability.
  
  
  METHODS
  Participants (N=235) aged 12-18 years were randomly assigned to either of two conditions: Bite Back (n=120) or control websites (n=115). The Bite Back website comprised interactive exercises and information across a variety of positive psychology domains; the control condition was assigned to neutral entertainment-based websites that contained no psychology information. Participants in both groups were instructed to use their allocated website for 6 consecutive weeks. Participants were assessed pre- and postintervention on the Depression Anxiety Stress Scale-Short form (DASS-21) and the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS).
  
  
  RESULTS
  Of the 235 randomized participants, 154 (65.5%) completed baseline and post measures after 6 weeks. Completers and dropouts were equivalent in demographics, the SWEMWBS, and the depression and anxiety subscales of the DASS-21, but dropouts reported significantly higher levels of stress than completers. There were no differences between the Bite Back and control conditions at baseline on demographic variables, DASS-21, or SWEMWBS scores. Qualitative data indicated that 49 of 61 Bite Back users (79%) reported positive experiences using the website and 55 (89%) agreed they would continue to use it after study completion. Compared to the control condition, participants in the Bite Back condition with high levels of adherence (usage of the website for 30 minutes or more per week) reported significant decreases in depression and stress and improvements in well-being. Bite Back users who visited the site more frequently (≥3 times per week) reported significant decreases in depression and anxiety and improvements in well-being. No significant improvements were found among Bite Back users who demonstrated low levels of adherence or who used the website less frequently.
  
  
  CONCLUSIONS
  Results suggest that using an online positive psychology program can decrease symptoms of psychopathology and increase well-being in young people, especially for those who use the website for 30 minutes or longer per week or more frequently (≥3 times per week). Acceptability of the Bite Back website was high. These findings are encouraging and suggest that the online delivery of positive psychology programs may be an alternate way to address mental health issues and improve youth well-being nationally.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry: ACTRN1261200057831; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362489 (Archived by Webcite at http://www.webcitation.org/6NXmjwfAy).
authors.affiliation: Black Dog Institute, School of Psychiatry, UNSW Australia, Randwick, Australia. v.manicavasagar@unsw.edu.au.
authors.forename: Vijaya
authors.initials: V
authors.lastname: Manicavasagar
authors.forename: Deserae
authors.initials: D
authors.lastname: Horswood
authors.forename: Rowan
authors.initials: R
authors.lastname: Burckhardt
authors.forename: Alistair
authors.initials: A
authors.lastname: Lum
authors.forename: Dusan
authors.initials: D
authors.lastname: Hadzi-Pavlovic
authors.forename: Gordon
authors.initials: G
authors.lastname: Parker
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000628:therapy*; D001315:Australia; D002648:Child; D003863:Depression / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008603:Mental Health; D010342:Patient Acceptance of Health Care; D010352:Patient Dropouts; D000297:Psychology, Adolescent; D017216:Telemedicine
keywords: Internet; adolescent; early medical intervention; mental health; psychological; resilience