Online and Social Networking Interventions for the Treatment of Depression in Young People: A Systematic Review

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.     

Approaches for drawing causal inferences from epidemiological birth cohorts: A review

Large-scale population-based birth cohorts, which recruit women during pregnancy or at birth and follow up their offspring through infancy and into childhood and adolescence, provide the opportunity to monitor and model early life exposures in relation to developmental characteristics and later life outcomes. However, due to confounding and other limitations, identification of causal risk factors has proved challenging and published findings are often not reproducible. A suite of methods has been developed in recent years to minimise problems afflicting observational epidemiology, to strengthen causal inference and to provide greater insights into modifiable intra-uterine and early life risk factors. The aim of this review is to describe these causal inference methods and to suggest how they may be applied in the context of birth cohorts and extended along with the development of birth cohort consortia and expansion of “omic” technologies.     

The value of nurse mentoring relationships: Lessons learnt from a work‐based resilience enhancement programme for nurses working in the forensic setting

This study aimed to evaluate a mentoring programme embedded in a work‐based personal resilience enhancement intervention for forensic nurses. This qualitative study formed part of a wider mixed‐methods study that aimed to implement and evaluate the intervention. Twenty‐four semistructured interviews were carried out with forensic nurse mentees and senior nurse mentors; these explored their experiences of the mentoring programme and any benefits and challenges involved in constructing and maintaining a mentor–mentee relationship. Qualitative data were analysed thematically using the Framework Method. Four key themes relating to the initiation and maintenance of mentor–mentee relationships were identified: finding time and space to arrange mentoring sessions; building rapport and developing the relationship; setting expectations of the mentoring relationship and the commitment required; and the impact of the mentoring relationship for both mentees and mentors. Study findings highlight the benefits of senior nurses mentoring junior staff and provide evidence to support the integration of mentoring programmes within wider work‐based resilience enhancement interventions. Effective mentoring can lead to the expansion of professional networks, career development opportunities, increased confidence and competence at problem‐solving, and higher levels of resilience, well‐being, and self‐confidence.     

Analysis of naturally processed peptides eluted from HLA DRB1 *0402 and *0404

Understanding the structural features of naturally processed peptides found within the major histocompatibility complex (MHC) class II peptide binding groove from disease-associated MHC molecules may provide insights into the nature of potential disease-related antigens. Class II MHC/peptide complexes were purified by immunoaffinity from transformed B cell lines homozygous for DRB1*0404 (an allele associated with rheumatoid arthritis) and *0402 (a closely related allele not associated with this disease). Peptides were eluted at acidic pH, fractionated by reversed phase HPLC, and analyzed by capillary electrophoresis. Those fractions containing a single dominant peptide were sequenced by automated Edman degradation and tandem mass spectrometry. The predominant peptide species identified came from non-polymorphic regions of the HLA class I molecules expressed by each cell line. Peptides from DRB1*0404 were found to be nested clusters derived from positions 26–43 of the HLA-B and -C α-chain. DRB1*0402 contained as the predominant peptide species a nested cluster from positions 129–145 of the HLA-B α-chain. The primary structure of the class I derived peptides was consistent with that seen by peptides exhibiting promiscuous DR binding behavior. Processing of MHC-derived peptides by MHC class II molecules is a common occurrence in the transformed B cell lines analyzed. © 1996 Wiley-Liss, Inc.     

Stability and structural properties of vacancy-ordered and -disordered ZrCx

Vacancy-ordered superstructural phases of zirconium carbide have been intermittently observed at low temperatures for over 50 years. However, little is known about these ordered phases as they have proven to be challenging to fabricate experimentally, although theoretical predictions suggest that they should be significantly more stable than the more-observed vacancy-disordered solid solution ZrC_x (x ≤ 1) phase at low temperatures. The stability and structural properties of the vacancy-ordered and vacancy-disordered phases are investigated using first-principles calculations. The stability of the ordered superstructural phases is related to the driving force from the relative instability of certain vacancy configurations, which are preferred or avoided in ordered structures. The trend of the vacancy ordering and the underlying mechanisms of the relative instability are explained in terms of the geometry of the crystal structures and the electronic charge distribution and atomic bonding features.

The origin of vacancy ordering in ZrC_x is explained considering structure geometry, electronic charge distribution, and atomic bonding features, and linked to stability and volume trends in the vacancy-ordered and -disordered zirconium carbides.