***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective The purpose of this study was to develop a new Internet-based computerized cognitive behavior therapy ( iCBT ) program in Manga format , the Japanese cartoon , for workers and to examine the effects of the iCBT program on improving  subthreshold depression  using a r and omized controlled trial ( RCT ) design among workers employed in private companies in Japan . Method All workers in a company ( n = 290 ) and all workers in three departments ( n = 1,500 ) at the headquarters of another large company were recruited by an invitation e-mail . Participants who fulfilled the inclusion criteria were r and omly allocated to intervention or control groups ( N = 381 for each group ) . A six-week , six-lesson iCBT program using Manga ( Japanese comic ) story was developed . The program included several CBT skills : self-monitoring , cognitive restructuring , assertiveness , problem solving , and relaxation . The intervention group studied the iCBT program at a frequency of one lesson per week . Depression ( Beck Depression Inventory II ; BDI-II ) was assessed as a primary outcome at baseline , and three- and six-month follow-ups for both intervention and control groups were performed . Results The iCBT program showed a significant intervention effect on BDI-II ( t = −1.99 , p<0.05 ) with small effect sizes ( Cohen 's d : −0.16 , 95 % Confidence Interval : −0.32 to 0.00 , at six-month follow-up ) . Conclusions The present study first demonstrated that a computerized cognitive behavior therapy delivered via the Internet was effective in improving depression in the general working population . It seems critical to improve program involvement of participants in order to enhance the effect size of an iCBT program . Trial Registration UMIN Clinical Trials Registry Background Most work sites engage in some form of health promotion programming design ed to improve worker health and reduce health care costs . Although these programs have typically been delivered through combinations of seminars and print material s , workplace health promotion programs are increasingly being delivered through the Internet . Objective The purpose of this research was to evaluate the effectiveness of a Web-based multimedia health promotion program for the workplace , design ed to improve dietary practice s , reduce stress , and increase physical activity . Methods Using a r and omized controlled trial design with pretest-posttest comparisons within each group , 419 employees of a human re sources company were r and omly assigned to the Web-based condition or to a condition that provided print material s on the same topics . All subjects were assessed at pretest and posttest through an online question naire containing multiple measures of health behavior and attitudes . The test period was 3 months . Question naire data were analyzed mainly by analysis of covariance and t tests . Results Retention rates were good for both groups—85 % for the Web-based group and 87 % for the print group . Subjects using the Web-based program performed significantly better than the print group on Attitudes Toward a Healthful Diet ( F1,415 = 7.104 , P = .008 ) and Dietary Stage of Change ( F1,408 = 6.487 , P = .01 ) , but there were no significant group differences on the five other dietary measures . Both groups also showed improvement from pretest to posttest on most dietary measures , as indicated by significant t tests . Within the Web-based group , dosage analyses showed significant effects of the number of times the subject accessed the program on measures of Dietary Self-Efficacy ( F2,203 = 5.270 , P = .003 ) , Attitudes Toward a Healthful Diet ( F2,204 = 2.585 , P = .045 ) , and Dietary Stage of Change ( F2,200 = 4.627 , P = .005 ) . No significant differences were found between the two groups on measures of stress or physical activity , although t tests of pretest-posttest changes indicated that both groups improved on several of these measures . The Web-based group gave significantly higher ratings to the program material s than the print group on all health topics and in their overall evaluation ( F1,410 = 9.808 , P = .002 ) . Conclusions The Web-based program was more effective than print material s in producing improvements in the areas of diet and nutrition but was not more effective in reducing stress or increasing physical activity . The higher ratings given to the Web-based program suggest that workers preferred it to the print material s. Both groups showed numerous pretest-posttest improvements in all health topics , although such improvements might be attributable in part to a Hawthorne effect . Results suggest that a multimedia Web-based program can be a promising means of delivering health promotion material to the workforce , particularly in the area of diet and nutrition Background Depression and anxiety are major causes of absence from work and underperformance in the workplace . Cognitive behavioural therapy ( CBT ) can be effective in treating such problems and online versions offer many practical advantages . The aim of the study was to investigate the effectiveness of a computerized CBT intervention ( MoodGYM ) in a workplace context . Method The study was a phase III two-arm , parallel r and omized controlled trial whose main outcome was total score on the Work and Social Adjustment Scale ( WSAS ) . Depression , anxiety , psychological functioning , costs and acceptability of the online process were also measured . Most data were collected online for 637 participants at baseline , 359 at 6 weeks marking the end of the intervention and 251 participants at 12 weeks post-baseline . Results In both experimental and control groups depression scores improved over 6 weeks but attrition was high . There was no evidence for a difference in the average treatment effect of MoodGYM on the WSAS , nor for a difference in any of the secondary outcomes . Conclusions This study found no evidence that MoodGYM was superior to informational websites in terms of psychological outcomes or service use , although improvement to subthreshold levels of depression was seen in nearly half the patients in both groups Background Work-related stress is highly prevalent among employees and is associated with adverse mental health consequences . Web-based interventions offer the opportunity to deliver effective solutions on a large scale ; however , the evidence is limited and the results conflicting . Objective This r and omized controlled trial evaluated the efficacy of guided Web- and mobile-based stress management training for employees . Methods A total of 264 employees with elevated symptoms of stress ( Perceived Stress Scale-10 , PSS-10≥22 ) were recruited from the general working population and r and omly assigned to an Internet-based stress management intervention ( iSMI ) or waitlist control group . The intervention ( GET.ON Stress ) was based on Lazarus ’s transactional model of stress , consisted of seven sessions , and applied both well-established problem solving and more recently developed emotion regulation strategies . Participants also had the opportunity to request automatic text messages on their mobile phone along with the iSMI . Participants received written feedback on every completed session from an e-coach . The primary outcome was perceived stress ( PSS-10 ) . Web-based self-report assessment s for both groups were scheduled at baseline , 7 weeks , and 6 months . At 12 months , an extended follow-up was carried out for the iSMI group only . Results An intention-to-treat analysis of covariance revealed significantly large effect differences between iSMI and waitlist control groups for perceived stress at posttest ( F 1,261=58.08 , P<.001 ; Cohen ’s d=0.83 ) and at the 6-month follow-up ( F 1,261=80.17 , P<.001 ; Cohen ’s d=1.02 ) . The effects in the iSMI group were maintained at 12-month follow-up . Conclusions This Web- and mobile-based intervention has proven effective in reducing stress in employees in the long term . Internet-based stress management interventions should be further pursued as a valuable alternative to face-to-face interventions . Trial Registration German Clinical Trials Register ( DRKS ) : 00004749 ; http://drks-neu.uniklinik-freiburg.de/ drks_web/setLocale_EN.do ( Archived by WebCite at http://www.webcitation.org/6e8rl98nl PURPOSE Our goal was to evaluate the efficacy of a multimedia support program delivered over the Internet to employed family caregivers of persons with dementia . DESIGN AND METHODS The evaluation of this program involved 299 employed family caregivers participating in a pretest-posttest r and omized clinical trial with a 30-day follow-up and a waitlist control condition . Vali date d instruments include the Center for Epidemiologic Studies -Depression scale , the State-Trait Anxiety Inventory , the Caregiver Strain scale from Benjamin Rose , and Positive Aspects of Caregiving used in the nationwide REACH study . RESULTS Those who viewed Caregiver 's Friend : Dealing with Dementia 30 days postexposure demonstrated significant improvements in depression , anxiety , level and frequency of stress , caregiver strain , self-efficacy , and intention to seek help , as well as perceptions of positive aspects of caregiving . IMPLICATION S Interactive multimedia interventions delivered over the Internet appear to be uniquely suited to provide low-cost , effective , convenient , individually tailored programs that present educational information , cognitive and behavioral skills , and affective learning opportunities . This makes Web-based multimedia a promising avenue for work-life balance programs , employee-assistance providers , and organizations interested in improving family caregiver health and well-being BACKGROUND Depressive disorders are highly prevalent in the working population and are associated with excessive costs . The evidence for effective worker-directed interventions for employees with depressive symptoms is limited . Treating employees with depressive symptoms before sick leave via the Internet could be beneficial and cost saving . OBJECTIVE In this study , we developed and tested the effectiveness of a Web-based guided self-help course for employees with depressive symptoms . We report on the posttreatment effectiveness of the intervention . METHODS This study is a two-arm r and omized controlled trial comparing a Web-based guided self-help course to care as usual ( CAU ) . We recruited employees from 6 different companies via the companies ' intranet and posters . The main inclusion criterion was elevated depressive symptoms as measured by a score of ≥16 on the Center for Epidemiological Studies Depression scale ( CES-D ) . The intervention ( Happy@Work ) was based on problem-solving treatment and cognitive therapy and consisted of 6 weekly lessons . Participants were asked to su bmi t their weekly assignment via the website after completion . They subsequently received feedback from a coach via the website  . Self-report question naires on depressive symptoms ( CES-D ; primary outcome ) , anxiety measured by the Hospital Anxiety and Depression Scale ( HADS ) , burnout measured by the Maslach Burnout Inventory ( MBI ) , and work performance measured by the Health and Work Performance Question naire ( HPQ ; secondary outcomes ) were completed at baseline and at posttreatment . RESULTS A total of 231 employees were r and omized to either the intervention group ( n=116 ) or CAU (n=115).The posttreatment assessment was completed by 171 ( 74.0 % ) participants . Both the intervention and the CAU group showed significant improvements in the primary outcome of depressive symptoms , but no differences between the conditions was found ( d=0.16 , 95 % CI -0.10 to 0.41 , P=.29 ) . Significant but small effects in favor of the intervention group were found for anxiety symptoms ( d=0.16 , 95 % CI -0.09 to 0.42 , P=.04 ) and exhaustion ( d=0.17 , 95 % CI -0.09 to 0.43 , P=.02 ) . CONCLUSIONS This study showed that a Web-based guided self-help course for employees with depressive symptoms was not more effective in reducing depressive symptoms among employees than CAU . Large improvements in depressive symptoms in the CAU group were unforeseen and potential explanations are discussed This study evaluated the effectiveness of a computer-based stress management training ( SMT ) program in improving  employees ’ psychological well-being and work performance . A total of 12 work units ( N=263 ) were r and omly assigned to either an intervention group ( 8 work units , n=142 ) or to a wait-list control group ( 4 work units , n=121 ) . All participants were requested to answer online question naires assessing psychological well-being as a primary outcome , and coping style , social support , and knowledge about stress management as secondary outcomes at baseline ( T0 ) , immediately after the intervention ( T1 ) , and 2 months after the intervention ( T2 ) . The group × time interaction was tested using a mixed-model repeated measures ANOVA . Results showed a group × time interaction for “ knowledge about stress management ” in the entire sample . Among participants who had more than 3 d of training , a significant group × time interaction was observed for “ problem-solving ” and “ avoidance and suppression ” as well as “ knowledge about stress management . ” Our computer-based stress management program was effective for improving knowledge about stress management . It was also effective for improving coping skills in instances where participants had enough time ( at least 3 d ) to complete all sessions Objective : The objective of this study was to determine whether a mindfulness program , created for the workplace , was both practical and efficacious in decreasing employee stress while enhancing resiliency and well-being . Methods : Participants ( 89 ) recruited from The Dow Chemical Company were selected and r and omly assigned to an online mindfulness intervention ( n = 44 ) or wait-list control ( n = 45 ) . Participants completed the Perceived Stress Scale , the Five Facets of Mindfulness Question naire , the Connor-Davidson Resiliency Scale , and the Shirom Vigor Scale at pre- and postintervention and 6-month follow-up . Results : The results indicated that the mindfulness intervention group had significant decreases in perceived stress as well as increased mindfulness , resiliency , and vigor . Conclusions : This online mindfulness intervention seems to 
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No statistically significant differences were found on either outcome between studies using cognitive behavioral therapy ( CBT ) approaches ( as defined by the authors ) compared with other psychological approaches , offering guidance compared with self-guidance , or recruiting from a targeted workplace population compared with a universal workplace population .
In-depth analysis of the interventions identified by the positive deviance approach suggests that interventions that offer guidance are delivered over a shorter time frame ( 6 to 7 weeks ) , utilize secondary modalities for delivering the interventions and engaging users ( ie , emails and text messages [ short message service , SMS ] ) , and use elements of persuasive technology ( ie , self-monitoring and tailoring ) , which may achieve greater engagement and adherence .
Conclusions This review provides evidence that occupational digital mental health interventions can improve workers ’  psychological well-being and increase work effectiveness .