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. 2025 May 16:41:100834.
doi: 10.1016/j.invent.2025.100834. eCollection 2025 Sep.

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

Lynn Boschloo  1 , Jasmijn Wijnands  1 , Nadia Garnefski  2 , Vivian Kraaij  2 , Petra Hurks  3 , Danielle Remmerswaal  4 , Reinout W Wiers  5 , Sascha Struijs  6 , Elske Salemink  1
Affiliations

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

Lynn Boschloo et al. Internet Interv. .

Abstract

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.

Keywords: Depression symptoms; Internet-based CBT; Network estimation techniques; Perceived stress; Quality of life; University students.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flow chart of the study.
Fig. 2
Fig. 2
Mean and standard deviations (SDs) of individual depression symptoms (range 0–3) and individual stress symptoms (range 0–4).
Fig. 3
Fig. 3
Network structure of individual depression and stress symptoms as well as overall quality of life in our sample of students eligible to participate in the Moodpep intervention (N = 1446).
Fig. 4
Fig. 4
Improvements in individual depression symptoms and stress symptoms (Cohen's d, with 95 % confidence intervals).
Fig. 5
Fig. 5
Network structure of changes of individual depression and stress symptoms as well as overall quality of life in our sample of students who registered for the Moodpep intervention had valid data at the post-treatment assessment (N = 351).
See this image and copyright information in PMC

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