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Testing the Differential Impact of an Internet-Based Mental Health Intervention on Outcomes of Well-being and Psychological Distress During COVID-19: Uncontrolled Intervention Study

Sep 15, 2021

February 20, 2021 . Testing the Differential Impact of an Internet-Based Mental Health Intervention on Outcomes of Well-being and Psychological Distress During COVID-19: Uncontrolled Intervention Study Testing the Differential Impact of an Internet-Based Mental Health Intervention on Outcomes of Well-being and Psychological Distress During COVID-19: Uncontrolled Intervention Study Authors of this article: 2Órama Institute for Mental Health and Wellbeing, Flinders University, Adelaide, Australia 3College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia 4College of Nursing and Health Sciences, Flinders University, Adelaide, Australia 5Health Counselling & Disability Services, Flinders University, Adelaide, Australia 6Adelaide Nursing School, Adelaide University, Adelaide, Australia Corresponding Author: North Terrace Abstract Background: During COVID-19, the psychological distress and well-being of the general population has been precarious, increasing the need to determine the impact of complementary internet-based psychological interventions on both positive mental health as well as distress states. Psychological distress and mental well-being represent distinct dimensions of our mental health, and congruent changes in outcomes of distress and well-being do not necessarily co-occur within individuals. When testing intervention impact, it is therefore important to assess change in both outcomes at the individual level, rather than solely testing group differences in average scores at the group level. Objective: This study set out to investigate the differential impact of an internet-based group mental health intervention on outcomes of positive mental health (ie, well-being, life satisfaction, resilience) and indicators of psychological distress (ie, depression, anxiety, stress). Methods: A 5-week mental health intervention was delivered to 89 participants using the Zoom platform during 2020. Impact on outcomes of distress, well-being, and resilience was assessed at the start and end of the program with multiple analysis of variance (MANOVA) and reliable change indices (RCIs) being used to determine program impact at the group and individual levels, respectively. Results: The intervention significantly improved all mental health outcomes measured, (F6,83=5.60, P<.001; Wilks Λ=.71; partial η2=.29) showing small to moderate effect sizes on individual outcomes. The largest effect sizes were observed for life satisfaction and overall well-being (η2=.22 and η2=.2, respectively). Larger effect sizes were noted for those with problematic mental health scores at baseline. A total of 92% (82/89) of participants demonstrated reliable change in at least one mental health outcome. Differential response patterns using RCI revealed that more than one-half of the participants showed improvement in both mental well-being and psychological distress, over one-quarter in outcomes of well-being only, and almost one-fifth in distress only. Conclusions: The results provide evidence for the significant impact of an internet-based mental health intervention during COVID-19 and indicate the importance of assessing dimensions of both well-being and distress when determining mental health intervention effectiveness. JMIR Ment Health 2021;8(9):e28044 0.68 aProblematic scores refer to scores where participants did not meet the cut-off for high well-being, normal resilience, or no presence of distress. Discussion This study demonstrated that an internet-based mental health program could elicit differential change in outcomes of mental well-being and psychological distress in a nonclinical population during COVID-19. Results demonstrated that mental health outcomes in the sample improved from the beginning to the end of the intervention and that participants with poorer baseline scores had a significantly better response compared to those with greater average baseline scores. Furthermore, the results highlighted that reliable change in outcomes of mental well-being and psychological distress could occur independently, with type of distress (depression, anxiety, stress) resulting in differential response patterns. The results here bolster the evidence that internet-based interventions can play a significant role in dealing with the mental health consequences of the pandemic [ 60 , 61 , 85 , 86 ]. This intervention was delivered over internet-based teleconferencing software using trained professionals outside of a clinical setting. The training, which focuses on promoting mental health, not the specific treatment of mental illness, was designed to be able to be delivered without the reliance on clinical staff. This approach of upskilling nonclinical staff to deliver mental health training has successfully been utilized by our team before and facilitates scalability and reach of the solution [ 87 , 88 ]. Mental health systems are typically under-resourced, which has further deteriorated during COVID-19, fueling calls for innovative solutions as the one presented in this article, particularly those that safeguard ethical principles [ 85 , 89 ]. Finding positive results for interventions that aim to promote mental health in both outcomes of well-being and distress in a general population under duress makes for promising standalone first-line interventions or as solutions to deal with existing system issues (eg, waitlists) [ 18 ]. While the significant impact of the intervention in a general nonclinical population was promising, the use of the term “nonclinical” warrants attention. This term mainly reflects the inclusion criteria rather than an actual lack of clinical symptoms among participants. As may be expected, the majority of participants did in fact show mild symptoms of distress (53/89, 60%). This proportion, at first glance, may appear higher than typically reported in the general population, such as the frequently cited “one in five who are struggling with symptoms of a common mental disorder” [ 90 ]. This increased rate may partly be attributed to the result of the pandemic but may also be explained by the fact that our sample stemmed from 2 different population pools: the general adult population and tertiary university students. Previous studies have demonstrated that mental health outcomes in students are worse across many domains than in the general population [ 51 , 91 , 92 ], which was supported in our study. These findings first elicit the need to thoroughly investigate and improve the mental health of, demands on, and lifestyle of our tertiary students [ 93 ], but second, highlights an area that requires the attention of researchers who may use student cohorts for their mental health research and wish to compare their findings to a sample of the general population. The findings support previous research indicating that improvements in distress do not automatically result in improvements in well-being and vice versa. Similar to the findings by Trompetter et al [ 68 ], this study showed that, while participation in the intervention led to overall improved mental well-being and reduced psychological distress, not every individual improved in both domains. These results provide an additional piece of evidence that supports the independence of outcomes for mental well-being and mental disorder [ 27 ]. As research by dual-factor model scholars such as Keyes [ 24 ] and Greenspoon and Saklofske [ 53 ] proposes, the ultimate end goal of our mental health care system ought to strive for “complete” states of mental health, that is states of high well-being and no distress or symptoms of mental disorder in as many people as possible. This indeed would be the expectation if we were to deliver mental health care that lived up to and met the contemporary definitions of mental health such as the one posited by the World Health Organization [ 1 ]. Results here show though, that in order to meet this aspirational international standard, it is critical to systematically measure both outcomes of well-being as well as psychological distress when assessing the impact of psychological interventions in research and practice [ 27 ]. The difference in intra-individual responses between psychological distress types furthermore points to the complex relationship between states of well-being and distress and their outcome measures [ 25 ]. Most participants who showed changes in depression had simultaneous improvements in well-being outcomes, which was not the case for anxiety or stress. A possible explanation for these patterns of change points to the inherent similarity between the construct of depression and happiness [ 29 ]. For instance, evidence for dual-factor models is less convincing for people with severe depression [ 94 ], and these models do not work as well when outcome measures specifically take advantage of the emotion of “happiness” or other affective states of hedonic well-being. In the data presented here, even the moderate correlation (r=.5) between the measure of life satisfaction (SWLS) and general well-being (MHC-SF), which captures the factors of hedonic, eudemonic, and social well-being, shows that these 2 well-being measures vary substantially. Therefore, it is essential to carefully consider the most appropriate measure when assessing the impact of interventions or treatment modalities, as this decision has consequences for the perceived impact of the intervention in both types of outcomes [ 95 ]. Our finding that effect sizes were higher for people meeting the threshold of psychological distress or low well-being is encouraging. In addition to providing insight into the impact of interventions for individuals with different states of mental health, promoting the importance of baseline mental health on interventions has practical implications for treatment models. There is an ever-increasing burden of mental health problems, with mental health systems around the globe feeling the strain [ 96 , 97 ]. Advocates of change have long been calling for new solutions to help support the provision of complementary services and group-based mental health interventions that can be delivered online and in person. The Be Well Plan program offers a solution that can be implemented to ameliorate current system pressures, complementing other accessible solutions such as low-intensity cognitive behavioral therapy [ 98 , 99 ]. Consequently, it is important to determine an effective model of universal programs that have the greatest impact on mental health outcomes, while reducing the burden of disease. While more research is needed to understand the particular effectiveness of each program component on different mental health outcomes [ 73 ], our findings support the need to improve and innovate lower tiers in evidence-based, stepped-care models or stimulate a stronger focus on well-being within integrated care models [ 100 , 101 ]. This research has limitations requiring comment. First, the results stem from an uncontrolled study, which means that the evidence is not conclusive in supporting the efficacy of the intervention. The intervention was delivered in response to the immediate mental health demands in the community during the pandemic; therefore, the team made a conscious call to deliver the intervention to anyone who signed on immediately, rather than randomize them into waitlists. This design limitation, however, does not impact the validity of the findings, as a core aim of the study was to explore a within-subject change design. That said, it is important to compare and verify reliable change between an active intervention and a comparable control condition in future studies. Uncontrolled studies, for example, do not account for various confounding factors (eg, the impact of extraneous events and lifestyle factors). In this case, the study was conducted while the COVID-19 pandemic was ongoing, which could have had a significant impact on mental health outcomes during this extraordinary period [ 45 ] and therefore would have impacted the results one way or the other. Second, the results presented only refer to short-term outcomes, clearly warranting the need to examine long-term changes. For instance, improvement in well-being has been shown to be associated with long-term recovery of mental disorder in observational studies [ 31 ]. It is hypothesized that well-being may therefore be a therapeutic focus for long-term (symptom) recovery [ 18 ], but a rigorous body of research intervention studies is yet to be established [ 27 ]. Third, the current results apply to a general population cohort; extrapolation to clinical populations should be used with caution. Although the sample did include participants that showed higher distress levels, the presence of psychological symptoms does not equal the presence of disorder, which requires assessment using different outcome measures [ 5 ]. The results presented by Trompetter and colleagues [ 68 ], however, did apply to clinical populations and therefore pose a reference point for those working in the clinical area. A fourth and similar limitation lies in the specificity of our outcome measures. This study used a general measure of distress implying that the results should not be generalized to determining the impact on explicit symptoms of mental disorder [ 102 ]. The current results only refer to the differential changes in well-being and distress, demonstrating that changes in outcomes of mental well-being and psychological distress do not automatically go hand in hand after participation in a mental health intervention. Both outcomes should be considered and assessed when investigating the impact of psychological interventions and changes in mental health outcomes. Finally, the study did not collect in-depth data on intervention usage, which means the study is limited in being able to talk to the fidelity of the training or its short- or long-term use by the participants. This will be an important focus area for future studies on the Be Well Plan. To conclude, this study provides evidence for the impact of an internet-based mental health intervention during a period of significant community need. The intervention resulted in improvements in both participant mental well-being and psychological distress. After analyzing within-individual effects of the program, a differential response pattern was observed, indicating that improvement in mental well-being and reduction in psychological distress were not necessarily congruent. This indicates the importance of assessing dimensions of both well-being and distress when determining intervention effectiveness, which in the case of the Be Well Plan, added evidence to the impact that internet-based mental health promotion interventions can have generally and during times of societal distress such as pandemics. Acknowledgments The author team would like to acknowledge the contributions of South Australian Health and Medical Research Institute staff members including Monique Newberry, Marissa Carey, Kim Seow, Stuart Freebairn, and Laura Lo. Conflicts of Interest The South Australian Health and Medical Research Institute, which employs JvA and MI, receives financial compensation from providing the Be Well Plan to organizations and the community. References Mental health: strengthening our response. World Health Organization. 2018 Mar 30. URL: [accessed 2020-11-10] Wood AM, Tarrier N. Positive Clinical Psychology: a new vision and strategy for integrated research and practice. Clin Psychol Rev 2010 Nov;30(7):819-829. [ CrossRef ] [ Medline ] Manderscheid R, Ryff C, Freeman E, McKnight-Eily L, Dhingra S, Strine T. Evolving definitions of mental illness and wellness. Prev Chronic Dis 2010 Jan;7(1):A19 [ FREE Full text ] [ Medline ] Telles-Correia D, Saraiva S, Gonçalves J. Mental Disorder-The Need for an Accurate Definition. Front Psychiatry 2018 Mar 12;9:64 [ FREE Full text ] [ CrossRef ] [ Medline ] Payton AR. Mental health, mental illness, and psychological distress: same continuum or distinct phenomena? J Health Soc Behav 2009 Jun 01;50(2):213-227. [ CrossRef ] [ Medline ] Drapeau A, Marchand A, Beaulieu-Prévost D. Epidemiology of psychological distress. In: Mental illnesses-understanding, prediction and control. London, England: InTechOpen Limited; 2012:105-134. Waters L, Algoe SB, Dutton J, Emmons R, Fredrickson BL, Heaphy E, et al. Positive psychology in a pandemic: buffering, bolstering, and building mental health. The Journal of Positive Psychology 2021 Feb 09:1-21. [ CrossRef ] Campion J, Javed A, Sartorius N, Marmot M. Addressing the public mental health challenge of COVID-19. The Lancet Psychiatry 2020 Aug;7(8):657-659. [ CrossRef ] Fava GA, Ruini C. Development and characteristics of a well-being enhancing psychotherapeutic strategy: well-being therapy. Journal of Behavior Therapy and Experimental Psychiatry 2003 Mar;34(1):45-63. [ CrossRef ] Leamy M, Bird V, Le Boutillier C, Williams J, Slade M. Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. Br J Psychiatry 2011 Dec 02;199(6):445-452. [ CrossRef ] [ Medline ] Huppert FA. The state of wellbeing science: Concepts, measures, interventions, and policies. In: Huppert FA, Cooper CL, editors. Wellbeing: A complete reference guide. Hoboken, NJ: John Wiley & Sons, Ltd; 2014. Disabato D, Goodman F, Kashdan TB. A hierarchical framework for the measurement of well-being. PsyArXiv. 2019 Dec 31. URL: [accessed 2021-08-24] Diener E. The Science of Well-Being: The Collected Works of Ed Diener. Switzerland: Springer Nature; 2009. Ryff CD. Psychological well-being revisited: advances in the science and practice of eudaimonia. Psychother Psychosom 2014;83(1):10-28 [ FREE Full text ] [ CrossRef ] [ Medline ] Keyes CLM. Social Well-Being. Social Psychology Quarterly 1998 Jun;61(2):121. [ CrossRef ] Gable SL, Haidt J. What (and Why) is Positive Psychology? Review of General Psychology 2005 Jun 01;9(2):103-110. [ CrossRef ] Cross MP, Hofschneider L, Grimm M, Pressman SD. Subjective well-being and physical health. In: Diener E, Oishi S, Tay L, editors. Handbook of Well-Being. Salt Lake City, UT: DEF Publishers; 2018. Slade M. Mental illness and well-being: the central importance of positive psychology and recovery approaches. BMC Health Serv Res 2010 Jan 26;10(1):26 [ FREE Full text ] [ CrossRef ] [ Medline ] Steptoe A, Deaton A, Stone AA. Subjective wellbeing, health, and ageing. The Lancet 2015 Feb;385(9968):640-648. [ CrossRef ] DuBois CM, Lopez OV, Beale EE, Healy BC, Boehm JK, Huffman JC. Relationships between positive psychological constructs and health outcomes in patients with cardiovascular disease: A systematic review. Int J Cardiol 2015 Sep 15;195:265-280 [ FREE Full text ] [ CrossRef ] [ Medline ] Diener E, Pressman SD, Hunter J, Delgadillo-Chase D. If, Why, and When Subjective Well-Being Influences Health, and Future Needed Research. Appl Psychol Health Well Being 2017 Jul 14;9(2):133-167. [ CrossRef ] [ Medline ] Pressman SD, Jenkins BN, Moskowitz JT. Positive Affect and Health: What Do We Know and Where Next Should We Go? Annu Rev Psychol 2019 Jan 04;70(1):627-650. [ CrossRef ] [ Medline ] Dubois CM, Beach SR, Kashdan TB, Nyer MB, Park ER, Celano CM, et al. Positive psychological attributes and cardiac outcomes: associations, mechanisms, and interventions. Psychosomatics 2012 Jul;53(4):303-318. [ CrossRef ] [ Medline ] Keyes CLM. Mental Illness and/or Mental Health? Investigating Axioms of the Complete State Model of Health. Journal of Consulting and Clinical Psychology 2005 Jun;73(3):539-548. [ CrossRef ] van Agteren J, Iasiello M. Advancing our understanding of mental wellbeing and mental health: The call to embrace complexity over simplification. Australian Psychologist 2021 Mar 11;55(4):307-316. [ CrossRef ] Keyes CLM. Promoting and protecting mental health as flourishing: A complementary strategy for improving national mental health. American Psychologist 2007;62(2):95-108. [ CrossRef ] Iasiello M, van Agteren J, Muir-Cochrane E. Mental Health and/or Mental Illness: A Scoping Review of the Evidence and Implications of the Dual-Continua Model of Mental Health. Evidence Base 2020;2020(1):1-45. [ CrossRef ] Keyes CLM, Dhingra SS, Simoes EJ. Change in Level of Positive Mental Health as a Predictor of Future Risk of Mental Illness. Am J Public Health 2010 Dec;100(12):2366-2371. [ CrossRef ] Wood AM, Joseph S. The absence of positive psychological (eudemonic) well-being as a risk factor for depression: a ten year cohort study. J Affect Disord 2010 May;122(3):213-217. [ CrossRef ] [ Medline ] Keyes CLM, Yao J, Hybels CF, Milstein G, Proeschold-Bell RJ. Are changes in positive mental health associated with increased likelihood of depression over a two year period? A test of the mental health promotion and protection hypotheses. J Affect Disord 2020 Jun 01;270:136-142. [ CrossRef ] [ Medline ] Iasiello M, van Agteren J, Keyes CL, Cochrane EM. Positive mental health as a predictor of recovery from mental illness. J Affect Disord 2019 May 15;251:227-230 [ FREE Full text ] [ CrossRef ] [ Medline ] Schotanus-Dijkstra M, Keyes CL, de Graaf R, Ten Have M. Recovery from mood and anxiety disorders: The influence of positive mental health. J Affect Disord 2019 Jun 01;252:107-113. [ CrossRef ] [ Medline ] Xiong J, Lipsitz O, Nasri F, Lui LM, Gill H, Phan L, et al. Impact of COVID-19 pandemic on mental health in the general population: A systematic review. J Affect Disord 2020 Dec 01;277:55-64 [ FREE Full text ] [ CrossRef ] [ Medline ] Nearchou F, Flinn C, Niland R, Subramaniam SS, Hennessy E. Exploring the Impact of COVID-19 on Mental Health Outcomes in Children and Adolescents: A Systematic Review. Int J Environ Res Public Health 2020 Nov 16;17(22):8479 [ FREE Full text ] [ CrossRef ] [ Medline ] Robinson E, Sutin AR, Daly M, Jones A. A systematic review and meta-analysis of longitudinal cohort studies comparing mental health before versus during the COVID-19 pandemic. medRxiv. 2021 Mar 08. URL: [accessed 2021-08-24] Kola L, Kohrt BA, Hanlon C, Naslund JA, Sikander S, Balaji M, et al. COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health. The Lancet Psychiatry 2021 Jun;8(6):535-550. [ CrossRef ] Chiesa V, Antony G, Wismar M, Rechel B. COVID-19 pandemic: health impact of staying at home, social distancing and 'lockdown' measures-a systematic review of systematic reviews. J Public Health (Oxf) 2021 Apr 13:2021 [ FREE Full text ] [ CrossRef ] [ Medline ] Moreno C, Wykes T, Galderisi S, Nordentoft M, Crossley N, Jones N, et al. How mental health care should change as a consequence of the COVID-19 pandemic. The Lancet Psychiatry 2020 Sep;7(9):813-824. [ CrossRef ] Singh S, Roy D, Sinha K, Parveen S, Sharma G, Joshi G. Impact of COVID-19 and lockdown on mental health of children and adolescents: A narrative review with recommendations. Psychiatry Res 2020 Nov;293:113429 [ FREE Full text ] [ CrossRef ] [ Medline ] Ganesan B, Al-Jumaily A, Fong KNK, Prasad P, Meena SK, Tong RK. Impact of Coronavirus Disease 2019 (COVID-19) Outbreak Quarantine, Isolation, and Lockdown Policies on Mental Health and Suicide. Front Psychiatry 2021 Apr 16;12:565190 [ FREE Full text ] [ CrossRef ] [ Medline ] Henssler J, Stock F, van Bohemen J, Walter H, Heinz A, Brandt L. Mental health effects of infection containment strategies: quarantine and isolation-a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2021 Mar 06;271(2):223-234 [ FREE Full text ] [ CrossRef ] [ Medline ] Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet 2020 Mar;395(10227):912-920. [ CrossRef ] WHO Coronavirus (COVID-19) Dashboard. World Health Organization. URL: [accessed 2021-08-24] Fisher JR, Tran TD, Hammarberg K, Sastry J, Nguyen H, Rowe H, et al. Mental health of people in Australia in the first month of COVID-19 restrictions: a national survey. Med J Aust 2020 Nov 26;213(10):458-464 [ FREE Full text ] [ CrossRef ] [ Medline ] Newby JM, O'Moore K, Tang S, Christensen H, Faasse K. Acute mental health responses during the COVID-19 pandemic in Australia. PLoS One 2020 Jul 28;15(7):e0236562 [ FREE Full text ] [ CrossRef ] [ Medline ] Rossell SL, Neill E, Phillipou A, Tan EJ, Toh WL, Van Rheenen TE, et al. An overview of current mental health in the general population of Australia during the COVID-19 pandemic: Results from the COLLATE project. Psychiatry Res 2021 Feb;296:113660 [ FREE Full text ] [ CrossRef ] [ Medline ] van Agteren J, Bartholomaeus J, Fassnacht DB, Iasiello M, Ali K, Lo L, et al. Using Internet-Based Psychological Measurement to Capture the Deteriorating Community Mental Health Profile During COVID-19: Observational Study. JMIR Ment Health 2020 Jun 11;7(6):e20696 [ FREE Full text ] [ CrossRef ] [ Medline ] Batterham PJ, Calear AL, McCallum SM, Morse AR, Banfield M, Farrer LM, et al. Trajectories of depression and anxiety symptoms during the COVID-19 pandemic in a representative Australian adult cohort. Med J Aust 2021 Jun 26;214(10):462-468 [ FREE Full text ] [ CrossRef ] [ Medline ] Li SH, Beames JR, Newby JM, Maston K, Christensen H, Werner-Seidler A. The impact of COVID-19 on the lives and mental health of Australian adolescents. Eur Child Adolesc Psychiatry 2021 Apr 28:1 [ FREE Full text ] [ CrossRef ] [ Medline ] Van Agteren J, Woodyatt L, Iasiello M, Rayner J, Kyrios M. Make it Measurable: Assessing Psychological Distress, Wellbeing and Resilience at Scale in Higher Education. SUCCESS 2019 Dec 11;10(3):1-13. [ CrossRef ] Dodd RH, Dadaczynski K, Okan O, McCaffery KJ, Pickles K. Psychological Wellbeing and Academic Experience of University Students in Australia during COVID-19. Int J Environ Res Public Health 2021 Jan 20;18(3):866 [ FREE Full text ] [ CrossRef ] [ Medline ] Greenspoon PJ, Saklofske DH. Toward an integration of subjective well-being and psychopathology. Social Indicators Research 2001;54(1):81-108. [ CrossRef ] Ruini C, Fava GA. Role of well-being therapy in achieving a balanced and individualized path to optimal functioning. Clin Psychol Psychother 2012 May 09;19(4):291-304. [ CrossRef ] [ Medline ] Jeste DV, Palmer BW, Rettew DC, Boardman S. Positive Psychiatry. J. Clin. Psychiatry 2015 May 12;76(06):675-683. [ CrossRef ] Carr A, Cullen K, Keeney C, Canning C, Mooney O, Chinseallaigh E, et al. Effectiveness of positive psychology interventions: a systematic review and meta-analysis. The Journal of Positive Psychology 2020 Sep 10:1-21. [ CrossRef ] Weiss LA, Westerhof GJ, Bohlmeijer ET. Can We Increase Psychological Well-Being? The Effects of Interventions on Psychological Well-Being: A Meta-Analysis of Randomized Controlled Trials. PLoS One 2016 Jun 21;11(6):e0158092 [ FREE Full text ] [ CrossRef ] [ Medline ] van Agteren J, Iasiello M, Lo L, Bartholomaeus J, Kopsaftis Z, Carey M, et al. A systematic review and meta-analysis of psychological interventions to improve mental wellbeing. Nat Hum Behav 2021 May 19;5(5):631-652. [ CrossRef ] [ Medline ] Seligman M, Csikszentmihalyi M. Positive Psychology: An Introduction. In: Csikszentmihalyi M, editor. Flow and the Foundations of Positive Psychology: The Collected Works of Mihaly Csikszentmihalyi. Dordrecht, Netherlands: Springer Netherlands; 2014:279-298. Wind TR, Rijkeboer M, Andersson G, Riper H. The COVID-19 pandemic: The 'black swan' for mental health care and a turning point for e-health. Internet Interv 2020 Apr;20:100317 [ FREE Full text ] [ CrossRef ] [ Medline ] Torous J, Jän Myrick K, Rauseo-Ricupero N, Firth J. Digital Mental Health and COVID-19: Using Technology Today to Accelerate the Curve on Access and Quality Tomorrow. JMIR Ment Health 2020 Mar 26;7(3):e18848 [ FREE Full text ] [ CrossRef ] [ Medline ] Amsalem D, Dixon L, Neria Y. The Coronavirus Disease 2019 (COVID-19) Outbreak and Mental Health: Current Risks and Recommended Actions. JAMA Psychiatry 2021 Jan 01;78(1):9-10. [ CrossRef ] [ Medline ] Rauschenberg C, Schick A, Hirjak D, Seidler A, Paetzold I, Apfelbacher C, et al. Evidence Synthesis of Digital Interventions to Mitigate the Negative Impact of the COVID-19 Pandemic on Public Mental Health: Rapid Meta-review. J Med Internet Res 2021 Mar 10;23(3):e23365 [ FREE Full text ] [ CrossRef ] [ Medline ] Chakhssi F, Kraiss JT, Sommers-Spijkerman M, Bohlmeijer ET. The effect of positive psychology interventions on well-being and distress in clinical samples with psychiatric or somatic disorders: a systematic review and meta-analysis. BMC Psychiatry 2018 Jun 27;18(1):211 [ FREE Full text ] [ CrossRef ] [ Medline ] Demyttenaere K. What is treatment resistance in psychiatry? A "difficult to treat" concept. World Psychiatry 2019 Oct 09;18(3):354-355 [ FREE Full text ] [ CrossRef ] [ Medline ] Schnyder N, Panczak R, Groth N, Schultze-Lutter F. Association between mental health-related stigma and active help-seeking: systematic review and meta-analysis. Br J Psychiatry 2017 Apr 02;210(4):261-268. [ CrossRef ] [ Medline ] Gloster AT, Rinner MT, Ioannou M, Villanueva J, Block VJ, Ferrari G, et al. Treating treatment non-responders: A meta-analysis of randomized controlled psychotherapy trials. Clin Psychol Rev 2020 Feb;75:101810. [ CrossRef ] [ Medline ] Trompetter H, Lamers S, Westerhof G, Fledderus M, Bohlmeijer E. Both positive mental health and psychopathology should be monitored in psychotherapy: Confirmation for the dual-factor model in acceptance and commitment therapy. Behav Res Ther 2017 Apr;91:58-63. [ CrossRef ] [ Medline ] Fu R, Holmer HK. Change Score or Followup Score? : An Empirical Evaluation of the Impact of Choice of Mean Difference Estimates. In: AHRQ Methods for Effective Health Care: Report No. : 15-EHC016-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2015. Ellis PD. The essential guide to effect sizes: statistical power, meta-analysis, and the interpretation of research results. Cambridge, United Kingdom: Cambridge University Press; 2010:1139488155. Osman A, Wong JL, Bagge CL, Freedenthal S, Gutierrez PM, Lozano G. The Depression Anxiety Stress Scales-21 (DASS-21): further examination of dimensions, scale reliability, and correlates. J Clin Psychol 2012 Dec 28;68(12):1322-1338. [ CrossRef ] [ Medline ] Bauer S, Lambert MJ, Nielsen SL. Clinical significance methods: a comparison of statistical techniques. J Pers Assess 2004 Feb;82(1):60-70. [ CrossRef ] [ Medline ] Hofmann SG, Hayes SC. The Future of Intervention Science: Process-Based Therapy. Clin Psychol Sci 2019 Jan 29;7(1):37-50 [ FREE Full text ] [ CrossRef ] [ Medline ] Wise EA. Methods for analyzing psychotherapy outcomes: a review of clinical significance, reliable change, and recommendations for future directions. J Pers Assess 2004 Feb;82(1):50-59. [ CrossRef ] [ Medline ] Jacobson N, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 1991 Feb;59(1):12-19. [ CrossRef ] [ Medline ] Clifton L, Clifton DA. The correlation between baseline score and post-intervention score, and its implications for statistical analysis. Trials 2019 Jan 11;20(1):43 [ FREE Full text ] [ CrossRef ] [ Medline ] Zimmerman M, Martinez JH, Young D, Chelminski I, Dalrymple K. Severity classification on the Hamilton Depression Rating Scale. J Affect Disord 2013 Sep 05;150(2):384-388. [ CrossRef ] [ Medline ] Matza LS, Morlock R, Sexton C, Malley K, Feltner D. Identifying HAM-A cutoffs for mild, moderate, and severe generalized anxiety disorder. Int J Methods Psychiatr Res 2010 Dec 18;19(4):223-232 [ FREE Full text ] [ CrossRef ] [ Medline ] Zoom Video Communications, Inc.   URL: [accessed 2021-08-24] Eldridge LKB, Markham CM, Ruiter RAC, Fernandez ME, Kok G, Parcel GS. Planning Health Promotion Programs: An Intervention Mapping Approach, 4th Edition. San Francisco, CA: Jossey-Bass; 2016. Lamers SM, Westerhof GJ, Bohlmeijer ET, ten Klooster PM, Keyes CL. Evaluating the psychometric properties of the Mental Health Continuum-Short Form (MHC-SF). J Clin Psychol 2011 Jan 22;67(1):99-110. [ CrossRef ] [ Medline ] Pavot W, Diener E. Review of the satisfaction with life scale. In: Diener E, editor. Assessing well-being. Dordrecht, Netherlands: Springer; 2009:101-117. Smith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Bernard J. The brief resilience scale: assessing the ability to bounce back. Int J Behav Med 2008 Sep;15(3):194-200. [ CrossRef ] [ Medline ] Richardson JT. Eta squared and partial eta squared as measures of effect size in educational research. Educational Research Review 2011 Jan;6(2):135-147. [ CrossRef ] Holmes EA, O'Connor RC, Perry VH, Tracey I, Wessely S, Arseneault L, et al. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. The Lancet Psychiatry 2020 Jun;7(6):547-560. [ CrossRef ] Willems SH, Rao J, Bhambere S, Patel D, Biggins Y, Guite JW. Digital Solutions to Alleviate the Burden on Health Systems During a Public Health Care Crisis: COVID-19 as an Opportunity. JMIR Mhealth Uhealth 2021 Jun 11;9(6):e25021 [ FREE Full text ] [ CrossRef ] [ Medline ] van Agteren J, Iasiello M, Lo L. Improving the wellbeing and resilience of health services staff via psychological skills training. BMC Res Notes 2018 Dec 22;11(1):924 [ FREE Full text ] [ CrossRef ] [ Medline ] Bartholomaeus JD, Van Agteren JEM, Iasiello MP, Jarden A, Kelly D. Positive Aging: The Impact of a Community Wellbeing and Resilience Program. Clin Gerontol 2019 Jan 18;42(4):377-386. [ CrossRef ] [ Medline ] Martinez-Martin N, Dasgupta I, Carter A, Chandler JA, Kellmeyer P, Kreitmair K, et al. Ethics of Digital Mental Health During COVID-19: Crisis and Opportunities. JMIR Ment Health 2020 Dec 22;7(12):e23776 [ FREE Full text ] [ CrossRef ] [ Medline ] Steel Z, Marnane C, Iranpour C, Chey T, Jackson J, Patel V, et al. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980-2013. Int J Epidemiol 2014 Apr;43(2):476-493 [ FREE Full text ] [ CrossRef ] [ Medline ] Stallman HM. Psychological distress in university students: A comparison with general population data. Australian Psychologist 2010 Nov 06;45(4):249-257. [ CrossRef ] Farrer LM, Gulliver A, Bennett K, Fassnacht DB, Griffiths KM. Demographic and psychosocial predictors of major depression and generalised anxiety disorder in Australian university students. BMC Psychiatry 2016 Jul 15;16(1):241 [ FREE Full text ] [ CrossRef ] [ Medline ] Brown JSL. Student mental health: some answers and more questions. J Ment Health 2018 Jun;27(3):193-196. [ CrossRef ] [ Medline ] van Erp Taalman Kip RM, Hutschemaekers GJM. Health, well-being, and psychopathology in a clinical population: Structure and discriminant validity of Mental Health Continuum Short Form (MHC-SF). J Clin Psychol 2018 Oct 30;74(10):1719-1729. [ CrossRef ] [ Medline ] Linton M, Dieppe P, Medina-Lara A. Review of 99 self-report measures for assessing well-being in adults: exploring dimensions of well-being and developments over time. BMJ Open 2016 Jul 07;6(7):e010641 [ FREE Full text ] [ CrossRef ] [ Medline ] Richter D, Wall A, Bruen A, Whittington R. Is the global prevalence rate of adult mental illness increasing? Systematic review and meta-analysis. Acta Psychiatr Scand 2019 Nov 03;140(5):393-407. [ CrossRef ] [ Medline ] Kilbourne AM, Beck K, Spaeth-Rublee B, Ramanuj P, O'Brien RW, Tomoyasu N, et al. Measuring and improving the quality of mental health care: a global perspective. World Psychiatry 2018 Feb 19;17(1):30-38 [ FREE Full text ] [ CrossRef ] [ Medline ] Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, et al. The Lancet Commission on global mental health and sustainable development. The Lancet 2018 Oct;392(10157):1553-1598. [ CrossRef ] Shafran R, Myles-Hooton P, Bennett S, Öst LG. The concept and definition of low intensity cognitive behaviour therapy. Behav Res Ther 2021 Mar;138:103803. [ CrossRef ] [ Medline ] Perkins D. Stepped Care, System Architecture and Mental Health Services in Australia. Int J Integr Care 2016 Sep 14;16(3):16 [ FREE Full text ] [ CrossRef ] [ Medline ] Cross S, Hickie I. Transdiagnostic stepped care in mental health. Public Health Res Pract 2017 Apr 27;27(2):e2721712 [ FREE Full text ] [ CrossRef ] [ Medline ] Pilgrim D. 'Recovery' and current mental health policy. Chronic Illn 2008 Dec 01;4(4):295-304. [ CrossRef ] [ Medline ] ‎

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