A step toward bridging the mental health gap using the internet: Internet interventions for common mental health disorders in low and middle income countries, and treating depression in Indonesia

Retha Arjadi

Research output: ThesisThesis fully internal (DIV)

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Depression is a leading contributor to the global burden of disease, including in low and middle income countries (LMICs), where the prevalence is reported to be around 4.2%. However, treatment availability is far from ideal in LMICs, known as the mental health gap (World Health Organization). Indonesia is one of these LMICs. The need to improve treatment availability for mental health problems in Indonesia is widely recognized.

Because Indonesia is an archipelago, mental health facilities are unequally distributed. Therefore, innovative strategies to address the mental health gap and improve access to treatment in Indonesia and other LMICs need to be developed, including use of technology in combination with delivery by non-specialists to facilitate access. Guided Act and Feel Indonesia (GAF-ID) is an internet-based intervention for depression that is guided by trained lay counselors and based on a treatment protocol for behavioral activation that has been adapted to the Indonesian context.

In a randomized clinical trial, we investigated the effectiveness of internet-based behavioural activation with lay counselor support compared to online minimal psychoeducation without support for depression in 313 participants in Indonesia. Depressive symptoms were significantly lower over 10 weeks and chance of remission was 50% higher in the GAF-ID group than in the online psychoeducation group. The effect was sustained over time – with an effect size 0·27 at 6 months. This may open up new ways to bridge the mental health gap in LMICs.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • University of Groningen
  • Bockting, Claudi, Supervisor
  • Nauta, Maaike, Supervisor
Award date13-Dec-2018
Place of Publication[Groningen]
Print ISBNs978-94-034-1189-7
Electronic ISBNs978-94-034-1188-0
Publication statusPublished - 2018

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