title: Online and social networking interventions for the treatment of depression in young people: a systematic review.
abstract: BACKGROUND
  Major depression accounts for the greatest burden of all diseases globally. The peak onset of depression occurs between adolescence and young adulthood, and for many individuals, depression displays a relapse-remitting and increasingly severe course. Given this, the development of cost-effective, acceptable, and population-focused interventions for depression is critical. A number of online interventions (both prevention and acute phase) have been tested in young people with promising results. As these interventions differ in content, clinician input, and modality, it is important to identify key features (or unhelpful functions) associated with treatment outcomes.
  
  
  OBJECTIVE
  A systematic review of the research literature was undertaken. The review was designed to focus on two aspects of online intervention: (1) standard approaches evaluating online intervention content in randomized controlled designs (Section 1), and (2) second-generation online interventions and services using social networking (eg, social networking sites and online support groups) in any type of research design (Section 2).
  
  
  METHODS
  Two specific literature searches were undertaken. There was no date range specified. The Section 1 search, which focused on randomized controlled trials, included only young people (12-25 years) and yielded 101 study abstracts, of which 15 met the review inclusion criteria. The Section 2 search, which included all study design types and was not restricted in terms of age, yielded 358 abstracts, of which 22 studies met the inclusion criteria. Information about the studies and their findings were extracted and tabulated for review.
  
  
  RESULTS
  The 15 studies identified in Section 1 described 10 trials testing eight different online interventions, all of which were based on a cognitive behavioral framework. All but one of the eight identified studies reported positive results; however, only five of the 15 studies used blinded interviewer administered outcomes with most trials using self-report data. Studies varied significantly in presentation of intervention content, treatment dose, and dropout. Only two studies included moderator or clinician input. Results for Section 2 were less consistent. None of the Section 2 studies reported controlled or randomized designs. With the exception of four studies, all included participants were younger than 25 years of age. Eight of the 16 social networking studies reported positive results for depression-related outcomes. The remaining studies were either mixed or negative. Findings for online support groups tended to be more positive; however, noteworthy risks were identified.
  
  
  CONCLUSIONS
  Online interventions with a broad cognitive behavioral focus appear to be promising in reducing depression symptomology in young people. Further research is required into the effectiveness of online interventions delivering cognitive behavioral subcomponents, such as problem-solving therapy. Evidence for the use of social networking is less compelling, although limited by a lack of well-designed studies and social networking interventions. A range of future social networking therapeutic opportunities are highlighted.
authors.affiliation: Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia. simon.rice@unimelb.edu.au.
authors.forename: Simon M
authors.identifier: http://orcid.org/0000-0003-4045-8553
authors.initials: SM
authors.lastname: Rice
authors.forename: Joanne
authors.identifier: http://orcid.org/0000-0002-6036-9681
authors.initials: J
authors.lastname: Goodall
authors.forename: Sarah E
authors.identifier: http://orcid.org/0000-0003-2532-0142
authors.initials: SE
authors.lastname: Hetrick
authors.forename: Alexandra G
authors.identifier: http://orcid.org/0000-0002-2398-6306
authors.initials: AG
authors.lastname: Parker
authors.forename: Tamsyn
authors.identifier: http://orcid.org/0000-0001-6649-8866
authors.initials: T
authors.lastname: Gilbertson
authors.forename: G Paul
authors.identifier: http://orcid.org/0000-0001-8969-4595
authors.initials: GP
authors.lastname: Amminger
authors.forename: Christopher G
authors.identifier: http://orcid.org/0000-0003-1431-3852
authors.initials: CG
authors.lastname: Davey
authors.forename: Patrick D
authors.identifier: http://orcid.org/0000-0002-3789-6168
authors.initials: PD
authors.lastname: McGorry
authors.forename: John
authors.identifier: http://orcid.org/0000-0001-7969-492X
authors.initials: J
authors.lastname: Gleeson
authors.forename: Mario
authors.identifier: http://orcid.org/0000-0002-3535-9086
authors.initials: M
authors.lastname: Alvarez-Jimenez
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D003865:Major Depressive Disorder / Q000191:economics / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D060756:Social Networking; D016896:Treatment Outcome; D055815:Young Adult
keywords: Internet; adolescent; depression; review; social networking; support groups; young adult