{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T09:24:53Z","timestamp":1780737893629,"version":"3.54.1"},"reference-count":56,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2018,3,22]],"date-time":"2018-03-22T00:00:00Z","timestamp":1521676800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Indian Council of Medical Research,ICMR,New Delhi, India"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behavioral Sciences"],"abstract":"<jats:p>There is a dearth of published research on uptake and utility of mental health apps in India, despite a rising global trend in the application of technology in the field of mental health. We describe the development and pilot testing of a self-help intervention for depression, PUSH-D (Practice and Use Self-Help for Depression) for urban Indians. This guided self-help app, with essential and optional zone sections, was developed to provide a comprehensive coverage of therapeutic strategies drawn from cognitive behavior therapy, interpersonal therapy, supportive psychotherapy, and positive psychology. Pilot testing was carried out using a single group pre-, post- and follow-up design in 78 eligible participants. Participants were typically young adults with major depression or dysthymia and significant impairment in functioning. Almost two-thirds of the participants had never sought professional mental health help. Significant reductions in depression and improvement in the functioning and well-being were notedon standardized measures in participants completing all 10 essential zone sections. These gains were maintained at follow-up. The results were similar for partial completers, who completed fiveout of the 10 essential sections. PUSH-D is one of the first indigenously developed self-help apps for depression and it shows promise in reducing the treatment gap for depression in India.<\/jats:p>","DOI":"10.3390\/bs8040036","type":"journal-article","created":{"date-parts":[[2018,3,22]],"date-time":"2018-03-22T05:14:55Z","timestamp":1521695695000},"page":"36","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Development and Pilot Testing of an Internet-Based Self-Help Intervention for Depression for Indian Users"],"prefix":"10.3390","volume":"8","author":[{"given":"Seema","family":"Mehrotra","sequence":"first","affiliation":[{"name":"Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulomi","family":"Sudhir","sequence":"additional","affiliation":[{"name":"Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka 560029, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girish","family":"Rao","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Center for Public health, NIMHANS, Bangalore 560029, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jagadisha","family":"Thirthalli","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, NIMHANS, Bangalore 560029, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"TK","family":"Srikanth","sequence":"additional","affiliation":[{"name":"E-health Research Center, IIIT, Bangalore 560100, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,3,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"203","DOI":"10.31887\/DCNS.2016.18.2\/jschroeder","article-title":"Internet interventions for depression: New developments","volume":"18","author":"Berger","year":"2016","journal-title":"Dialogues Clin. Neurosci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1002\/cpp.1855","article-title":"mHealth: A mechanism to deliver more accessible, more effective mental health care","volume":"21","author":"Price","year":"2014","journal-title":"Clin. Psychol. Psychother."},{"key":"ref_3","first-page":"e1626","article-title":"The effectiveness of Internet-based cognitive behavioral therapy in treatment of psychiatric disorders","volume":"9","author":"Kumar","year":"2017","journal-title":"Cureus"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e16","DOI":"10.2196\/mhealth.3713","article-title":"Finding a depression app: A review and content analysis of the depression app marketplace","volume":"3","author":"Shen","year":"2015","journal-title":"JMIR mHealthuHealth"},{"key":"ref_5","unstructured":"World Health Organization (WHO) (2007). The Optimal Mix of Services, WHO. Available online: http:\/\/www.who.int\/mental_health\/policy\/services\/2_Optimal%20Mix%20of%20Services_Infosheet."},{"key":"ref_6","unstructured":"National Institute for Health and CareExcellence (NICE) (2018, March 18). Depression in adults: Recognition and Management. Available online: https:\/\/www.nice.org.uk\/guidance\/cg90\/chapter\/1-Guidance#stepped-care."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.cpr.2010.09.008","article-title":"A review of technology-assisted self-help and minimal contact therapies for anxiety and depression: Is human contact necessary for therapeutic efficacy?","volume":"31","author":"Newman","year":"2011","journal-title":"Clin. Psychol. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Johansson, R., Ekbladh, S., Hebert, A., Lindstr\u00f6m, M., M\u00f6ller, S., Petitt, E., Poysti, S., Larsson, M.H., Rousseau, A., and Carlbring, P. (2012). Psychodynamic guided self help for adult depression through the internet: A randomised controlled trial. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0038021"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e82","DOI":"10.2196\/jmir.2307","article-title":"Internet-delivered interpersonal psychotherapy versus internet-delivered cognitive behavioral therapy for adults with depressive symptoms: Randomized controlled noninferiority trial","volume":"15","author":"Donker","year":"2013","journal-title":"J. Med. Internet Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1186\/s13063-017-1960-1","article-title":"Reducing depressive symptomatology with a smartphone app: Study protocol for a randomized, placebo-controlled trial","volume":"18","author":"Giosan","year":"2017","journal-title":"Trials"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1080\/16506070902916400","article-title":"What makes internet therapy work?","volume":"38","author":"Andersson","year":"2009","journal-title":"Cogn. Behav. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"707","DOI":"10.4103\/IJPSYM.IJPSYM_151_17","article-title":"Unguided mental health self-help apps: Reflections on challenges through a clinician\u2019s lens","volume":"39","author":"Mehrotra","year":"2017","journal-title":"Indian J. Psychol. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2196\/jmir.8598","article-title":"Assessing the efficacy of mobile health apps using the basic principles of cognitive behavioral therapy: Systematic review","volume":"19","author":"Rathbone","year":"2017","journal-title":"J. Med. Internet Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e383","DOI":"10.2196\/jmir.7351","article-title":"Self-guided web-based interventions: Scoping review on user needs and the potential of embodied conversational agents to address them","volume":"19","author":"Scholten","year":"2017","journal-title":"J. Med. Internet Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1080\/16506070903318960","article-title":"Internet-based and other computerized psychological treatments for adult depression: A meta-analysis","volume":"38","author":"Andersson","year":"2009","journal-title":"Cogn. Behav. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1002\/wps.20472","article-title":"The efficacy of smartphone-based mental health interventions for depressive symptoms: A meta-analysis of randomized controlled trials","volume":"16","author":"Firth","year":"2017","journal-title":"World Psychiatry"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1001\/jamapsychiatry.2017.0044","article-title":"Efficacy of self-guided internet-based cognitive behavioral therapy in the treatment of depressive symptoms: A meta-analysis of individual participant data","volume":"74","author":"Karyotaki","year":"2017","journal-title":"JAMA Psychiatry"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.jad.2017.07.021","article-title":"Internet- and mobile-based depression interventions for people with diagnosed depression: A systematic review and meta-analysis","volume":"223","author":"Josephine","year":"2017","journal-title":"J. Affect. Disord."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.2196\/mental.7722","article-title":"Preferences for internet-based mental health interventions in an adult online sample: Findings from an online community survey","volume":"4","author":"Batterham","year":"2017","journal-title":"JMIR Mental Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/wps.20083","article-title":"Advantages and limitations of internet-based interventions for common mental disorders","volume":"13","author":"Andersson","year":"2014","journal-title":"World Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"19","DOI":"10.4236\/etsn.2014.33003","article-title":"Mental health apps: Innovations, risks and ethical considerations","volume":"3","author":"Giota","year":"2014","journal-title":"E-HealthTelecommun Syst. Netw."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.2196\/mental.4984","article-title":"Mental health smartphone apps: Review and evidence-based recommendations for future developments","volume":"3","author":"Bakker","year":"2016","journal-title":"JMIR Ment. Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1177\/0091217417720899","article-title":"Moodivate: A self-help behavioral activation mobile app for utilization in primary care\u2014Development and clinical considerations","volume":"52","author":"Dahne","year":"2017","journal-title":"Int. J. Psychiatry Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e247","DOI":"10.2196\/jmir.2791","article-title":"Smartphones for smarter delivery of mental health programs: A systematic review","volume":"15","author":"Donker","year":"2013","journal-title":"J Med. Internet Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.ajp.2017.03.031","article-title":"Free mobile apps on depression for Indian users: A brief overview and critique","volume":"28","author":"Kumar","year":"2017","journal-title":"Asian J. Psychiatry"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e330","DOI":"10.2196\/jmir.6482","article-title":"The use and eefectiveness of mobile apps for depression: Results from a fully remote clinical trial","volume":"18","author":"Arean","year":"2016","journal-title":"J. Med. Internet Res."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Patel, U., Sobowale, K., Fan, J., Liu, N., Kuwabara, S., Lei, Z., Sherer, R., and van Voorhees, V. (2016). Cultural considerations for the adaptation of an internet-based intervention for depression prevention in Mainland China. Int. J. Adolesc. Med. Health, 29.","DOI":"10.1515\/ijamh-2015-0099"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1037\/pro0000122","article-title":"Evidence-based apps? A review of mental health mobile applications in a psychotherapy context","volume":"48","author":"Lui","year":"2017","journal-title":"Prof. Psychol. Res. Pract."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.ajp.2011.12.009","article-title":"Applying mobile technologies to mental health service delivery in South Asia","volume":"5","author":"Aggarwal","year":"2012","journal-title":"Asian J. Psychiatry"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"359","DOI":"10.4103\/0971-5916.169185","article-title":"Mobile mental health care\u2014An opportunity for India","volume":"142","author":"Yellowlees","year":"2015","journal-title":"Indian J. Med. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e136","DOI":"10.2196\/resprot.4783","article-title":"The feasibility, acceptability, and efficacy of delivering internet-based self-help and guided self-help interventions for generalized anxiety disorder to Indian University students: Design of a randomized controlled trial","volume":"4","author":"Kanuri","year":"2015","journal-title":"JMIR Res. Protoc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.18203\/2394-6040.ijcmph20172059","article-title":"Why urban Indians are interested in an internet-based self-care app for depression? A brief pilot survey","volume":"4","author":"Mehrotra","year":"2017","journal-title":"Int. J. Community Med. Public Health"},{"key":"ref_33","unstructured":"Gururaj, G., Varghese, M., Benegal, V., Rao, G.N., Pathak, K., Singh, L.K., Mehta, R.Y., Ram, D., Shibukumar, T.M., and Kokane, A. (2016). National Mental Health Survey of India, 2015\u201316, National Institute of Mental Health and Neuro Sciences."},{"key":"ref_34","unstructured":"Assocham India (2017, July 02). India\u2019s Internet Population Likely to Touch 600 Million by 2020: Study. Available online: http:\/\/www.assocham.org\/newsdetail.php?id=6070."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1093\/inthealth\/ihs011","article-title":"Stigma and discrimination as a barrier to mental health service utilization in India","volume":"5","author":"Shidhaye","year":"2013","journal-title":"Int. Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1108\/JPMH-06-2013-0043","article-title":"Enhancing mental health literacy in India to reduce stigma: The fountainhead to improve help-seeking behaviour","volume":"13","author":"Gaiha","year":"2014","journal-title":"J. Pub. Mental Health."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1017\/S0033291713001943","article-title":"Barriers to mental health treatment: Results from the WHO World Mental Health Surveys","volume":"44","author":"Andrade","year":"2014","journal-title":"Psychol. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1037\/0022-3514.87.3.354","article-title":"Culture and social support: Who seeks it and why?","volume":"87","author":"Taylor","year":"2004","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Beck, A.T., Steer, R.A., and Brown, G.K. (1996). Beck Depression Inventory: Manual, The Psychological Corporation. [2nd ed.].","DOI":"10.1037\/t00742-000"},{"key":"ref_40","first-page":"22","article-title":"The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10","volume":"59","author":"Sheehan","year":"1998","journal-title":"J. Clin. Psychiatry"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"3202","DOI":"10.18203\/2394-6040.ijcmph20173618","article-title":"Profile of seekers of an internet-based self-help program for depression in India: Observations and implications","volume":"4","author":"Mehrotra","year":"2017","journal-title":"Int. J. Community Med. Public Health"},{"key":"ref_42","unstructured":"First, M.B., Williams, J.B.W., Benjamin, L.S., and Spitzer, R.L. (2016). User\u2019s Guide for the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD), APA Publishing."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: Validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J. Gen. Intern. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1192\/bjp.180.5.461","article-title":"The work and social adjustment scale: A simple measure of impairment in functioning","volume":"180","author":"Mundt","year":"2002","journal-title":"Br. J. Psychiatry"},{"key":"ref_45","unstructured":"American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, APA. [4th ed.]. Text Revision."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Rosenberg, M. (1965). Society and the Adolescent Self-Image, Princeton University Press.","DOI":"10.1515\/9781400876136"},{"key":"ref_47","unstructured":"Dawson, A., and Tylee, A. (2001). Male depression: Stress and aggression as pathways to major depression. Depression: Social and Economic Time-Bomb, BMJ Books."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/BF02289823","article-title":"On methods in the analysis of profile data","volume":"24","author":"Greenhouse","year":"1959","journal-title":"Psychometrika"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Field, A. (2005). Discovering Statistics Using SPSS, Sage. [2nd ed.].","DOI":"10.53841\/bpspag.2005.1.56.31"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"81","DOI":"10.2196\/jmir.1772","article-title":"A systematic review of the impact of adherence on the effectiveness of e-therapies","volume":"13","author":"Donkin","year":"2011","journal-title":"J. Med. Internet Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e13","DOI":"10.2196\/jmir.1194","article-title":"Adherence in internet interventions for anxiety and depression: Systematic review","volume":"11","author":"Christensen","year":"2009","journal-title":"J. Med. Internet Res."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1177\/0017896913514738","article-title":"Adherence to self-care interventions for depression or anxiety: A systematic review","volume":"73","author":"Simco","year":"2014","journal-title":"Health Educ. J."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"3269","DOI":"10.1017\/S0033291715001270","article-title":"Minimal clinically important difference on the Beck Depression Inventory\u2013II according to the patient\u2019s perspective","volume":"45","author":"Button","year":"2015","journal-title":"Psychol. Med."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"So, M., Yamaguchi, S., Hashimoto, S., Sado, M., Furukawa, T.A., and McCrone, P. (2013). Is computerised CBT really helpful for adult depression?-A meta-analytic re-evaluation of CCBT for adult depression in terms of clinical implementation and methodological validity. BMC Psychiatry, 13.","DOI":"10.1186\/1471-244X-13-113"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.jad.2017.12.028","article-title":"The association between adherence and outcome in an Internet intervention for depression","volume":"229","author":"Fuhr","year":"2018","journal-title":"J. Affect. Disord."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1001\/jamapsychiatry.2017.1406","article-title":"Internet-based self-help interventions for depression in routine care\u2014Reply","volume":"74","author":"Karyotaki","year":"2017","journal-title":"JAMA Psychiatry"}],"container-title":["Behavioral Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-328X\/8\/4\/36\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T14:58:02Z","timestamp":1760194682000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-328X\/8\/4\/36"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3,22]]},"references-count":56,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2018,4]]}},"alternative-id":["bs8040036"],"URL":"https:\/\/doi.org\/10.3390\/bs8040036","relation":{},"ISSN":["2076-328X"],"issn-type":[{"value":"2076-328X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3,22]]}}}