title: Effects of mental health self-efficacy on outcomes of a mobile phone and web intervention for mild-to-moderate depression, anxiety and stress: secondary analysis of a randomised controlled trial.
abstract: BACKGROUND
  Online psychotherapy is clinically effective yet why, how, and for whom the effects are greatest remain largely unknown. In the present study, we examined whether mental health self-efficacy (MHSE), a construct derived from Bandura's Social Learning Theory (SLT), influenced symptom and functional outcomes of a new mobile phone and web-based psychotherapy intervention for people with mild-to-moderate depression, anxiety and stress.
  
  
  METHODS
  STUDY I: Data from 49 people with symptoms of depression, anxiety and/or stress in the mild-to-moderate range were used to examine the reliability and construct validity of a new measure of MHSE, the Mental Health Self-efficacy Scale (MHSES).
  We conducted a secondary analysis of data from a recently completed randomised controlled trial (N = 720) to evaluate whether MHSE effected post-intervention outcomes, as measured by the Depression, Anxiety and Stress Scales (DASS) and Work and Social Adjustment Scale (WSAS), for people with symptoms in the mild-to-moderate range.
  
  
  RESULTS
  STUDY I: The data established that the MHSES comprised a unitary factor, with acceptable internal reliability (Cronbach's alpha = .89) and construct validity.
  The intervention group showed significantly greater improvement in MHSE at post-intervention relative to the control conditions (p's < = .000). MHSE mediated the effects of the intervention on anxiety and stress symptoms. Furthermore, people with low pre-treatment MHSE reported the greatest post-intervention gains in depression, anxiety and overall distress. No effects were found for MHSE on work and social functioning.
  
  
  CONCLUSIONS
  Mental health self-efficacy influences symptom outcomes of a self-guided mobile phone and web-based psychotherapeutic intervention and may itself be a worthwhile target to increase the effectiveness and efficiency of online treatment programs.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry ACTRN12610000625077.
authors.forename: Janine
authors.initials: J
authors.lastname: Clarke
authors.forename: Judith
authors.initials: J
authors.lastname: Proudfoot
authors.forename: Mary-Rose
authors.initials: MR
authors.lastname: Birch
authors.forename: Alexis E
authors.initials: AE
authors.lastname: Whitton
authors.forename: Gordon
authors.initials: G
authors.lastname: Parker
authors.forename: Vijaya
authors.initials: V
authors.lastname: Manicavasagar
authors.forename: Virginia
authors.initials: V
authors.lastname: Harrison
authors.forename: Helen
authors.initials: H
authors.lastname: Christensen
authors.forename: Dusan
authors.initials: D
authors.lastname: Hadzi-Pavlovic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy*; D040421:Cell Phone; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results; D020377:Self Efficacy; D012917:Social Adjustment; D013315:Stress, Psychological / Q000523:psychology / Q000628:therapy*; D017216:Telemedicine / Q000379:methods; D055815:Young Adult