{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T14:02:21Z","timestamp":1787320941402,"version":"build-2736575974"},"reference-count":35,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Ment Health"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Internet-based interventions for depression are increasingly integrated into health care due to their effectiveness, availability, and cost-effectiveness. However, negative effects have largely been ignored.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aimed to evaluate both positive and negative effects of an unguided intervention.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In total, 303 participants were analyzed using mixed models for repeated measures to assess changes in depressive symptoms via Beck Depression Inventory-II (primary outcome) after 12 weeks compared to waitlist controls with care as usual. Secondary endpoints included depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]), self-esteem, and quality of life. Negative effects were evaluated using the positive and negative effects of psychotherapy scale for internet-based interventions (PANEPS-I). Moderation analyses were conducted to explore influential effects on treatment outcomes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The intervention group showed greater reduction in depressive symptoms compared to controls, with small to medium effect sizes (\n g<\/jats:italic>\n =0.30\u20100.42) with averaged 14 logins. Although improvements in self-esteem and quality of life were not observed in intention-to-treat analyses, the completer sample indicated higher self-esteem in the intervention group. Negative effects were reported by 22% (22\/100) to 68% (66\/97), with the highest rates for program-related effects (eg, not addressing personal problems). No moderation effects were identified.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The intervention effectively reduces depressive symptoms. Although negative effects were present, they did not impact treatment outcome, tentatively suggesting that overall benefits may outweigh the negative effects for users.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/71274","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T21:51:46Z","timestamp":1753825906000},"page":"e71274-e71274","source":"Crossref","is-referenced-by-count":1,"title":["Treatment Without Cost? 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