Symptom heterogeneity in students with mild to severe depression symptomatology and their differential symptom-specific changes during an internet-based, guided cognitive behavioural therapy intervention

Background: Students often report depression and stress symptomatology but may differ in their symptoms and their symptom-specific changes during interventions. This study adopted a symptom-specific approach and examined 1) individual symptoms in students experiencing mild to severe depression sympt...

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Main Authors: Lynn Boschloo, Jasmijn Wijnands, Nadia Garnefski, Vivian Kraaij, Petra Hurks, Danielle Remmerswaal, Reinout W. Wiers, Sascha Struijs, Elske Salemink
Format: Article
Language:English
Published: Elsevier 2025-09-01
Series:Internet Interventions
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Online Access:http://www.sciencedirect.com/science/article/pii/S2214782925000351
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author Lynn Boschloo
Jasmijn Wijnands
Nadia Garnefski
Vivian Kraaij
Petra Hurks
Danielle Remmerswaal
Reinout W. Wiers
Sascha Struijs
Elske Salemink
author_facet Lynn Boschloo
Jasmijn Wijnands
Nadia Garnefski
Vivian Kraaij
Petra Hurks
Danielle Remmerswaal
Reinout W. Wiers
Sascha Struijs
Elske Salemink
author_sort Lynn Boschloo
collection DOAJ
description Background: Students often report depression and stress symptomatology but may differ in their symptoms and their symptom-specific changes during interventions. This study adopted a symptom-specific approach and examined 1) individual symptoms in students experiencing mild to severe depression symptomatology and 2) changes in individual symptoms during a guided, internet-based intervention. We zoomed in on how these (changes in) symptoms were related to each other and to (changes in) overall quality of life. Methods: This study included 1816 students with mild to severe baseline depression symptomatology, of which 412 activated their account for an eight-week, guided, internet-based Cognitive Behavioural Therapy intervention (Moodpep) and completed the post-treatment assessment. Depression symptomatology was assessed with the Patient Health Questionnaire, stress symptomatology with the Perceived Stress Scale and overall quality of life with a single item from the Mental Health Quality of Life questionnaire. Network estimations were conducted to examine the interrelations of (changes in) symptoms. Results: Mean scores of baseline symptoms differed substantially, and network estimations showed multiple positive connections across symptoms and negative connections of symptoms with overall quality of life. During the intervention, all symptoms reduced significantly, although with differential magnitude, and network estimations showed that changes in symptoms were differentially related to other changes in symptoms and changes in overall quality of life. Conclusions: Our findings highlight the importance of considering individual symptoms and their interrelations as a more complete and nuanced measure for 1) the heterogeneity of baseline symptomatology and 2) the heterogeneity of changes in symptomatology during an intervention.
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spelling doaj-art-7182315ab02540d1bfb7d220efd57a312025-08-26T04:14:16ZengElsevierInternet Interventions2214-78292025-09-014110083410.1016/j.invent.2025.100834Symptom heterogeneity in students with mild to severe depression symptomatology and their differential symptom-specific changes during an internet-based, guided cognitive behavioural therapy interventionLynn Boschloo0Jasmijn Wijnands1Nadia Garnefski2Vivian Kraaij3Petra Hurks4Danielle Remmerswaal5Reinout W. Wiers6Sascha Struijs7Elske Salemink8Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands; Corresponding author.Department of Clinical Psychology, Utrecht University, Utrecht, the NetherlandsDivision of Clinical Psychology, Leiden University, Leiden, the NetherlandsDivision of Clinical Psychology, Leiden University, Leiden, the NetherlandsFaculty of Psychology and Neuroscience, Maastricht University, Maastricht, the NetherlandsDepartment of Psychology, Education, and Child Studies, Erasmus University, Rotterdam, the NetherlandsAddiction Development and Psychopathology (ADAPT) lab, Department of Psychology, Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the NetherlandsDepartment of Clinical Psychology, VU University, Amsterdam, the NetherlandsDepartment of Clinical Psychology, Utrecht University, Utrecht, the NetherlandsBackground: Students often report depression and stress symptomatology but may differ in their symptoms and their symptom-specific changes during interventions. This study adopted a symptom-specific approach and examined 1) individual symptoms in students experiencing mild to severe depression symptomatology and 2) changes in individual symptoms during a guided, internet-based intervention. We zoomed in on how these (changes in) symptoms were related to each other and to (changes in) overall quality of life. Methods: This study included 1816 students with mild to severe baseline depression symptomatology, of which 412 activated their account for an eight-week, guided, internet-based Cognitive Behavioural Therapy intervention (Moodpep) and completed the post-treatment assessment. Depression symptomatology was assessed with the Patient Health Questionnaire, stress symptomatology with the Perceived Stress Scale and overall quality of life with a single item from the Mental Health Quality of Life questionnaire. Network estimations were conducted to examine the interrelations of (changes in) symptoms. Results: Mean scores of baseline symptoms differed substantially, and network estimations showed multiple positive connections across symptoms and negative connections of symptoms with overall quality of life. During the intervention, all symptoms reduced significantly, although with differential magnitude, and network estimations showed that changes in symptoms were differentially related to other changes in symptoms and changes in overall quality of life. Conclusions: Our findings highlight the importance of considering individual symptoms and their interrelations as a more complete and nuanced measure for 1) the heterogeneity of baseline symptomatology and 2) the heterogeneity of changes in symptomatology during an intervention.http://www.sciencedirect.com/science/article/pii/S2214782925000351University studentsDepression symptomsPerceived stressQuality of lifeInternet-based CBTNetwork estimation techniques
spellingShingle Lynn Boschloo
Jasmijn Wijnands
Nadia Garnefski
Vivian Kraaij
Petra Hurks
Danielle Remmerswaal
Reinout W. Wiers
Sascha Struijs
Elske Salemink
Symptom heterogeneity in students with mild to severe depression symptomatology and their differential symptom-specific changes during an internet-based, guided cognitive behavioural therapy intervention
Internet Interventions
University students
Depression symptoms
Perceived stress
Quality of life
Internet-based CBT
Network estimation techniques
title Symptom heterogeneity in students with mild to severe depression symptomatology and their differential symptom-specific changes during an internet-based, guided cognitive behavioural therapy intervention
title_full Symptom heterogeneity in students with mild to severe depression symptomatology and their differential symptom-specific changes during an internet-based, guided cognitive behavioural therapy intervention
title_fullStr Symptom heterogeneity in students with mild to severe depression symptomatology and their differential symptom-specific changes during an internet-based, guided cognitive behavioural therapy intervention
title_full_unstemmed Symptom heterogeneity in students with mild to severe depression symptomatology and their differential symptom-specific changes during an internet-based, guided cognitive behavioural therapy intervention
title_short Symptom heterogeneity in students with mild to severe depression symptomatology and their differential symptom-specific changes during an internet-based, guided cognitive behavioural therapy intervention
title_sort symptom heterogeneity in students with mild to severe depression symptomatology and their differential symptom specific changes during an internet based guided cognitive behavioural therapy intervention
topic University students
Depression symptoms
Perceived stress
Quality of life
Internet-based CBT
Network estimation techniques
url http://www.sciencedirect.com/science/article/pii/S2214782925000351
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