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

Arjadi, Retha

NARCIS 

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

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

ARTS repository - University of Groningen

   University of GroningenA step toward bridging the mental health gap using the internetArjadi, RethaIMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2018Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Arjadi, R. (2018). A step toward bridging the mental health gap using the internet: Internet interventions forcommon mental health disorders in low and middle income countries, and treating depression in Indonesia.[Thesis fully internal (DIV), University of Groningen]. Rijksuniversiteit Groningen.CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 13-02-2023Table of ContentsCHAPTER 11Chapter 1101General Introduction11DepressionMental Health Gap and recommendations by the World Health Organization (WHO)1Chapter 1121General Introduction13Depression and the mental health gap in Indonesia1Chapter 114Internet-based interventions in Indonesia1General Introduction151Chapter 116Depression measures in Indonesia1General Introduction17Treating depression: behavioral activation1Chapter 118Non-specialist support in minimal interventions1General Introduction19Thesis scope and outline1Chapter 1202Systematic review of internet-based intervention in LMICs21CHAPTER 22Chapter 2222Systematic review of internet-based intervention in LMICs23Abstract2Chapter 224Introduction2Systematic review of internet-based intervention in LMICs252Chapter 226Methods2Systematic review of internet-based intervention in LMICs27Results2Chapter 228•••••2Systematic review of internet-based intervention in LMICs292Chapter 230Discussions2Systematic review of internet-based intervention in LMICs31Strengths and limitations of the reviewImplication2Chapter 2323Acceptability of internet-based intervention for depression in Indonesia33CHAPTER 33Chapter 3343Acceptability of internet-based intervention for depression in Indonesia35Abstract3Chapter 336Introduction3Acceptability of internet-based intervention for depression in Indonesia373Chapter 3383Acceptability of internet-based intervention for depression in Indonesia39Methods3Chapter 3403Acceptability of internet-based intervention for depression in Indonesia413Chapter 342Results3Acceptability of internet-based intervention for depression in Indonesia433Chapter 3443Acceptability of internet-based intervention for depression in Indonesia453Chapter 3463Acceptability of internet-based intervention for depression in Indonesia473Chapter 3483Acceptability of internet-based intervention for depression in Indonesia49Discussion3Chapter 3503Acceptability of internet-based intervention for depression in Indonesia513Chapter 352Conclusion3Acceptability of internet-based intervention for depression in Indonesia53CHAPTER 44Indonesian version of IDS-SR57Abstract4Chapter 458Introduction4Indonesian version of IDS-SR59Materials and methods4Chapter 460Procedure4Indonesian version of IDS-SR61Data analyses4Chapter 462Results4Indonesian version of IDS-SR634Chapter 4644Indonesian version of IDS-SR65Discussion4Chapter 4664Indonesian version of IDS-SR674Chapter 468ConclusionsCHAPTER 55Trial protocol of internet-based behavioral activation for depression in Indonesia71Abstract5Chapter 5725Trial protocol of internet-based behavioral activation for depression in Indonesia73Introduction5Chapter 5745Trial protocol of internet-based behavioral activation for depression in Indonesia755Chapter 576Methods5Trial protocol of internet-based behavioral activation for depression in Indonesia77Participants5Chapter 5785Trial protocol of internet-based behavioral activation for depression in Indonesia795Chapter 5805Trial protocol of internet-based behavioral activation for depression in Indonesia81Support5Chapter 5825Trial protocol of internet-based behavioral activation for depression in Indonesia835Chapter 584••5Trial protocol of internet-based behavioral activation for depression in Indonesia855Chapter 586Analysis5Trial protocol of internet-based behavioral activation for depression in Indonesia875Chapter 588Discussions5Trial protocol of internet-based behavioral activation for depression in Indonesia89CHAPTER 66Effectiveness of internet-based behavioral activation for depression in Indonesia93Abstract6Chapter 6946Effectiveness of internet-based behavioral activation for depression in Indonesia95Introduction6Chapter 6966Effectiveness of internet-based behavioral activation for depression in Indonesia97Methods6Chapter 6986Effectiveness of internet-based behavioral activation for depression in Indonesia996Chapter 61006Effectiveness of internet-based behavioral activation for depression in Indonesia1016Chapter 61026Effectiveness of internet-based behavioral activation for depression in Indonesia1036Chapter 61046Effectiveness of internet-based behavioral activation for depression in Indonesia1056Chapter 61066Effectiveness of internet-based behavioral activation for depression in Indonesia1076Chapter 6108Discussion6Effectiveness of internet-based behavioral activation for depression in Indonesia1096Chapter 61106Effectiveness of internet-based behavioral activation for depression in Indonesia1116Chapter 61126Effectiveness of internet-based behavioral activation for depression in Indonesia113Research in context6Chapter 6114CHAPTER 77General discussion1177Chapter 71187General discussion1197Chapter 7120Acceptability of internet-based interventions 7General discussion1217Chapter 71227General discussion1237Chapter 7124Assessments7General discussion1257Chapter 7126Conducting trials assessing the effectiveness of internet-based interventions in LMICs7General discussion1277Chapter 71287General discussion129Task sharing: collaborating with mental healthspecialists and (lay) counselors7Chapter 7130Final conclusionsREFERENCESRReferences133ReferencesRReferences134RReferences135RReferences136RReferences137RReferences138RReferences139RReferences140RReferences141RReferences142RReferences143RReferences144RReferences145RReferences146RReferences147RReferences148RReferences149RReferences150RReferences151RReferences152RReferences153RReferences154RReferences155ENGLISHSUMMARYEsEnglish summary159English summaryEsEnglish summary160EsEnglish summary161EsEnglish summary162NEDERLANDSE SAMENVATTINGNs165Nederlandse samenvattingNs166Ns167Ns168Ns169ACKNOWLEDGMENTSA173AcknowledgementsA174A175CURRICULUMVITAECVCurriculum Vitae179Curriculum Vitae

English

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

University of Groningen Research Database

   University of GroningenA step toward bridging the mental health gap using the internetArjadi, RethaIMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2018Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Arjadi, R. (2018). A step toward bridging the mental health gap using the internet: Internet interventions forcommon mental health disorders in low and middle income countries, and treating depression in Indonesia.[Thesis fully internal (DIV), University of Groningen]. Rijksuniversiteit Groningen.CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 31-10-2023Table of ContentsCHAPTER 11Chapter 1101General Introduction11DepressionMental Health Gap and recommendations by the World Health Organization (WHO)1Chapter 1121General Introduction13Depression and the mental health gap in Indonesia1Chapter 114Internet-based interventions in Indonesia1General Introduction151Chapter 116Depression measures in Indonesia1General Introduction17Treating depression: behavioral activation1Chapter 118Non-specialist support in minimal interventions1General Introduction19Thesis scope and outline1Chapter 1202Systematic review of internet-based intervention in LMICs21CHAPTER 22Chapter 2222Systematic review of internet-based intervention in LMICs23Abstract2Chapter 224Introduction2Systematic review of internet-based intervention in LMICs252Chapter 226Methods2Systematic review of internet-based intervention in LMICs27Results2Chapter 228•••••2Systematic review of internet-based intervention in LMICs292Chapter 230Discussions2Systematic review of internet-based intervention in LMICs31Strengths and limitations of the reviewImplication2Chapter 2323Acceptability of internet-based intervention for depression in Indonesia33CHAPTER 33Chapter 3343Acceptability of internet-based intervention for depression in Indonesia35Abstract3Chapter 336Introduction3Acceptability of internet-based intervention for depression in Indonesia373Chapter 3383Acceptability of internet-based intervention for depression in Indonesia39Methods3Chapter 3403Acceptability of internet-based intervention for depression in Indonesia413Chapter 342Results3Acceptability of internet-based intervention for depression in Indonesia433Chapter 3443Acceptability of internet-based intervention for depression in Indonesia453Chapter 3463Acceptability of internet-based intervention for depression in Indonesia473Chapter 3483Acceptability of internet-based intervention for depression in Indonesia49Discussion3Chapter 3503Acceptability of internet-based intervention for depression in Indonesia513Chapter 352Conclusion3Acceptability of internet-based intervention for depression in Indonesia53CHAPTER 44Indonesian version of IDS-SR57Abstract4Chapter 458Introduction4Indonesian version of IDS-SR59Materials and methods4Chapter 460Procedure4Indonesian version of IDS-SR61Data analyses4Chapter 462Results4Indonesian version of IDS-SR634Chapter 4644Indonesian version of IDS-SR65Discussion4Chapter 4664Indonesian version of IDS-SR674Chapter 468ConclusionsCHAPTER 55Trial protocol of internet-based behavioral activation for depression in Indonesia71Abstract5Chapter 5725Trial protocol of internet-based behavioral activation for depression in Indonesia73Introduction5Chapter 5745Trial protocol of internet-based behavioral activation for depression in Indonesia755Chapter 576Methods5Trial protocol of internet-based behavioral activation for depression in Indonesia77Participants5Chapter 5785Trial protocol of internet-based behavioral activation for depression in Indonesia795Chapter 5805Trial protocol of internet-based behavioral activation for depression in Indonesia81Support5Chapter 5825Trial protocol of internet-based behavioral activation for depression in Indonesia835Chapter 584••5Trial protocol of internet-based behavioral activation for depression in Indonesia855Chapter 586Analysis5Trial protocol of internet-based behavioral activation for depression in Indonesia875Chapter 588Discussions5Trial protocol of internet-based behavioral activation for depression in Indonesia89CHAPTER 66Effectiveness of internet-based behavioral activation for depression in Indonesia93Abstract6Chapter 6946Effectiveness of internet-based behavioral activation for depression in Indonesia95Introduction6Chapter 6966Effectiveness of internet-based behavioral activation for depression in Indonesia97Methods6Chapter 6986Effectiveness of internet-based behavioral activation for depression in Indonesia996Chapter 61006Effectiveness of internet-based behavioral activation for depression in Indonesia1016Chapter 61026Effectiveness of internet-based behavioral activation for depression in Indonesia1036Chapter 61046Effectiveness of internet-based behavioral activation for depression in Indonesia1056Chapter 61066Effectiveness of internet-based behavioral activation for depression in Indonesia1076Chapter 6108Discussion6Effectiveness of internet-based behavioral activation for depression in Indonesia1096Chapter 61106Effectiveness of internet-based behavioral activation for depression in Indonesia1116Chapter 61126Effectiveness of internet-based behavioral activation for depression in Indonesia113Research in context6Chapter 6114CHAPTER 77General discussion1177Chapter 71187General discussion1197Chapter 7120Acceptability of internet-based interventions 7General discussion1217Chapter 71227General discussion1237Chapter 7124Assessments7General discussion1257Chapter 7126Conducting trials assessing the effectiveness of internet-based interventions in LMICs7General discussion1277Chapter 71287General discussion129Task sharing: collaborating with mental healthspecialists and (lay) counselors7Chapter 7130Final conclusionsREFERENCESRReferences133ReferencesRReferences134RReferences135RReferences136RReferences137RReferences138RReferences139RReferences140RReferences141RReferences142RReferences143RReferences144RReferences145RReferences146RReferences147RReferences148RReferences149RReferences150RReferences151RReferences152RReferences153RReferences154RReferences155ENGLISHSUMMARYEsEnglish summary159English summaryEsEnglish summary160EsEnglish summary161EsEnglish summary162NEDERLANDSE SAMENVATTINGNs165Nederlandse samenvattingNs166Ns167Ns168Ns169ACKNOWLEDGMENTSA173AcknowledgementsA174A175CURRICULUMVITAECVCurriculum Vitae179Curriculum Vitae

University of Groningen

   University of GroningenA step toward bridging the mental health gap using the internetArjadi, RethaIMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2018Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Arjadi, R. (2018). A step toward bridging the mental health gap using the internet: Internet interventions forcommon mental health disorders in low and middle income countries, and treating depression in Indonesia.[Groningen]: Rijksuniversiteit Groningen.CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 13-11-2019Propositions associated with the dissertationA step toward bridging the mental health gap using the internetRetha Arjadi1. Depression is not only a prevalent mental health condition in high income countries, but also in low and middle income countries. (Chapter 1)2. Internet-based interventions for mental health conditions are understudied in low and middle income countries despite the potential. (Chapter 2)3. Internet-based intervention for depression is acceptable within the Indonesian population. (Chapter 3)4. The Inventory of Depressive Symptomatology-Self Report (IDS-SR) can be used in Indonesia to measure depression for research and clinical practice. (Chapter 4)5. Cultural adaptation of psychological interventions is necessary and possible. (Chapter 6)6. Internet-based behavioral activation intervention with lay counselor support is superior to psychoeducation in reducing depression and achieving remission in Indonesia. (Chapter 6)7. Remote guidance of internet intervention in low and middle income countries is feasible. (Chapter 6)8. A step toward bridging the mental health gap using the internet can start in one country and opens the door to the others.9. Hope is what keeps you believing and optimism is what keeps you going.

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

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ARTS repository - University of Groningen

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