{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T14:49:43Z","timestamp":1785854983817,"version":"3.56.0"},"reference-count":60,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"\n Background<\/jats:title>\n A significant number of individuals with depression in Hong Kong remain undiagnosed and untreated through traditional face-to-face psychotherapy. Internet-based cognitive behavioral therapy (iCBT) has emerged as a tool to improve access to mental health services. However, iCBT remains underdeveloped in Chinese communities, particularly in Hong Kong.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aims to (1) develop and evaluate the effectiveness of a culturally and linguistically appropriate guided iCBT program for Hong Kong Chinese with depressive symptoms, and (2) explore their treatment adherence.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n An 11-week guided iCBT program, \u201cConfront and Navigate Depression Online\u201d (CANDO), consisting of 8 online modules, was developed and implemented for Hong Kong residents. The program was accessible via either an online platform (web-based iCBT) or a smartphone app (app-based iCBT). A 3-arm randomized controlled trial was conducted, with participants recruited through open recruitment and referrals from 2 local non-governmental organizations. A total of 402 eligible participants with mild to moderate depressive symptoms were randomly allocated into 3 groups: (1) web-based iCBT (n=139); (2) app-based iCBT (n=131); and (3) waitlist control (WLC) group (n=132), who transitioned to the web-based iCBT group after waiting for 11 weeks. Therapist support was provided by a clinical psychologist through 3 counseling sessions and weekly assignment feedback. The primary outcomes were the Beck Depression Inventory-II (BDI-II) and the 9-item Patient Health Questionnaire (PHQ-9), while the secondary outcome measures included the 12-item General Health Questionnaire (GHQ-12), the Chinese Automatic Thoughts Questionnaire (CATQ), and the Chinese Affect Scale (CAS). These scales were administered at preintervention, postintervention, and at 3-month and 6-month follow-up assessments. Data analysis was conducted using linear mixed effects modeling, adhering to the intent-to-treat principle.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Participants in both the web- and app-based iCBT groups reported significant improvements compared with the WLC group on all primary (P<.001) and secondary measures (P<.001 and P=.009) at posttreatment. Large between-group effect sizes were observed in the reduction of depressive symptoms, with Cohen's d value of 1.07 (95% CI 0.81-1.34) for the web-based group and 1.15 (95% CI 0.88-1.43) for the app-based group on the BDI-II. Additionally, the web- and app-based groups showed effect sizes of 0.78 (95% CI 0.52-1.04) and 0.95 (95% CI 0.63-1.27) on PHQ-9, respectively. Medium to large effect sizes were observed for secondary outcomes at posttreatment. These positive effects were maintained at both the 3- and 6-month follow-ups, with medium to large within-group effect sizes. The adherence rate in the 2 iCBT groups was 154 out of 270 (57.0%) for completing all 8 online modules and 152 out of 270 (56.3%) for attending all 4 counseling sessions (including an intake interview). The recovery rate, as measured by the BDI-II at posttreatment, was 35 out of 90 (39%) for the web-based group and 36 out of 91 (40%) for the app-based group, compared with 3 out of 112 (3%) in the WLC group.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Culturally and linguistically adapted iCBT is an effective and feasible treatment for Hong Kong Chinese with mild to moderate depressive symptoms, demonstrating a satisfactory recovery rate and treatment adherence. ICBT offers an accessible and viable alternative to face-to-face interventions in Hong Kong. The Hong Kong government should allocate more resources and support the use of iCBT as a tool to treat people with depressive symptoms.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n ClinicalTrials.gov (NCT04388800); https:\/\/clinicaltrials.gov\/study\/NCT04388800<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/64303","type":"journal-article","created":{"date-parts":[[2025,2,25]],"date-time":"2025-02-25T10:00:32Z","timestamp":1740477632000},"page":"e64303","source":"Crossref","is-referenced-by-count":8,"title":["Culturally Adapted Guided Internet-Based Cognitive Behavioral Therapy for Hong Kong People With Depressive Symptoms: Randomized Controlled Trial"],"prefix":"10.2196","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3622-540X","authenticated-orcid":false,"given":"Jia-Yan","family":"Pan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6292-4389","authenticated-orcid":false,"given":"Jonas","family":"Rafi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2025,2,25]]},"reference":[{"key":"ref1","year":"2021","journal-title":"Comprehensive Mental Health Action Plan 2013-2030"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(19)33160-5"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-015-1014-5"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.116.188078"},{"key":"ref5","author":"Bains, N","year":"2023","journal-title":"Major Depressive Disorder"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1097\/hrp.0000000000000198"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-021-10637-8"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20083"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1007\/s40258-019-00551-x"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2020.4364"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.2196\/18100"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1037\/ccp0000301"},{"key":"ref13","unstructured":"Survey on IT usage and penetrationOffice of the Government Chief Information Officer20242024-06-12https:\/\/www.ogcio.gov.hk\/en\/about_us\/facts\/it_usage_penetration_survey.html"},{"key":"ref14","unstructured":"StatistaPenetration rate of smartphone among people over ten years old in Hong Kong from June to September 2022Statista20222024-06-12https:\/\/www.statista.com\/statistics\/1093416\/hong-kong-penetration-rate-of-smartphone\/"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.2196\/40187"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.2196\/42786"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajp.2021.102656"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1017\/s0033291722000599"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.6737"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1177\/10497315221087904"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1111\/aphw.12512"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2018-026820"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2018.06.007"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2016.11.002"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1186\/1471-244x-13-268"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0100674"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1002\/cpp.2571"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.2196\/14648"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1037\/ccp0000759"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1177\/0004867417741555"},{"key":"ref31","author":"Wong, D","year":"2005","journal-title":"Coming out of the valley of depression: Cognitive therapy self-help manual (in Chinese)"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1016\/j.invent.2022.100600"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1515\/ijamh-2015-0099"},{"key":"ref34","doi-asserted-by":"publisher","DOI":"10.3724\/sp.j.1041.2016.00818"},{"key":"ref35","unstructured":"CANDO2024-12-23https:\/\/cando.hkbu.edu.hk\/"},{"key":"ref36","author":"Beck, JS","year":"2011","journal-title":"Cognitive Behavior Therapy: Basics and Beyond (2nd Edition)"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.1177\/1049731520962181"},{"key":"ref38","doi-asserted-by":"publisher","DOI":"10.1007\/bf01447045"},{"key":"ref39","author":"Beck, A","year":"1996","journal-title":"Manual for BDI-II. 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