The present study found that use of BluePages was associated with different reports of help seeking behaviours relative to the control condition and MoodGYM. For specific treatment types, compared to MoodGYM, Bluepages use was associated with fewer reports of having taken up CBT, exercise, massage or music. Participants also had lower use of professional treatments, and everyday and complementary categories of treatment. BluePages was associated with decreased use of music, decreased help seeking from friends and family and decreased use of everyday treatments compared to the control condition. Specific self reported actions of participants over the trial period were associated with reduced depression symptoms at endpoint for the use of relaxation, and doing more enjoyable things, but not for other evidenced based and non-evidenced based treatments. Taking antidepressants, reading self-help books for depression, using alcohol and seeking professional treatments were associated with higher baseline depression scores.
Frequency with which treatments were sought and types of treatments sought
In some respects, these findings are similar to those reported in the recent help seeking literature. First, there is a low level of seeking help from mental health professionals and a preference for everyday treatments, rather than evidence-based treatments. Although figures might be better gauged from representative samples of the population rather than from a sample with high symptoms, only approximately 24% of participants in this study with elevated depression reported seeking the help of a GP. This concords closely with findings by Oliver et al., in the UK that 28% of individuals with high GHQ scores sought help from a general practitioner, and findings in Australia, that 33% of adults with an affective disorder and 56% of those with anxiety disorder did not seek help for their disorder in the last 12 months. A recent study  reported that 49% of individuals with a mood disorder perceived the need for care, but only 13% sought help from a mental health professional. Our findings also accord with others that demonstrate that many individuals seek complementary and non-traditional treatments [15, 16] rather than treatment through formal mental health services. The most preferred 'treatments' were exercise, doing things you enjoy, listening to music, and being with pets.
The effect of the specific interventions on reports of help seeking
Jorm et al.,  demonstrated that the provision of an evidence-based guide led to greater attitudinal change than a short brochure, with those reading the guide more likely to affirm that the endorsed treatments are more likely to be helpful. Those receiving the self help guide were more likely to report that they had tried a self help treatment, and to give advice to someone about it. However, the present study has failed to find strong evidence that the information website BluePages led to the reported initiation of evidence-based treatments either during the intervention or at six months. Compared to the control condition, BluePages participants were no more likely to report having sought any evidence-based specific treatment. Nevertheless, depression improved in the BluePages intervention relative to the control condition at post test  and at 6 months. BluePages was associated with a reduction in the use of music, the use of family and friends for support and the use of everyday treatments. We postulated that BluePages might exert its effect through the initiation of self help for evidence based treatments. However, the findings of the study suggest that the help seeking influence of BluePages may be to decrease the use of non-evidence based interventions. For example, seeking support from friends and relatives may be unnecessary, unhelpful, even toxic under certain circumstances and the website may have served to reduce inappropriate help seeking actions. This accords with some adolescent literature that reports that help seeking from younger friends may not be helpful. Moreover, it is possible that BluePages served as a partial substitute for the support and reassurance that might normally be sought from family and friends. The mechanism by which the psychoeducation website exerts it influence on depression symptoms needs further investigation.
The increase in the reported use of CBT in the MoodGYM condition is to be expected since CBT formed the core of the intervention and participants knew CBT was offered in their intervention. The reasons for the increased reporting of massage and exercise are less clear. Neither exercise nor massage was directly encouraged by the MoodGYM site although one of 29 self help exercises mentioned the use of physical activities as a means of rewarding positive thinking. One explanation is that massage and exercise arose a consequence of a reduction in depression symptoms. More generally, this explanation predicts that help seeking is linked to depression improvement across both MoodGYM and BluePages sites. However, although both MoodGYM and BluePages were equally effective in reducing depression symptoms, only MoodGYM was associated with reported increases in these activities.
Relationships between help sought and a reduction in depression symptoms
The present study found that relaxation therapy, doing enjoyable things, and not using alcohol were associated with lower depression symptoms at post test. These relationships were found controlling for both baseline levels of depression and intervention type. Taking specific evidenced based treatments such as anti-depressant medication (reported by one quarter of the participants) did not predict improvement in depression outcomes. Interpretations of these associations must consider the correlational nature of these relationships as well as the complexity of tracking the uptake of a range of treatments. For example, there may be a number of reasons for failing to find a relationship for anti-depressant medication. First, improvement in mood might be associated itself with the discontinuation of depression medication or the choice not to investigate this option. Other possible explanations are that participants might be unlikely to take antidepressants if they have engaged in online treatment, or the antidepressant effect for those already on antidepressants at commencement of the trial may have stablized at the time of enrolment in the trial. Conversely, the anti-depressant effect may be too small to detect over a six week period if this intervention is taken up later in the course of the trial. Finally, the medication may have been discontinued or used inappropriately and the use of medication might be combined with a number of positive or negative other treatments. These findings however, do also accord with recent data from the UK [3, 17] which show that increases in the use of anti-depressant medication for community depression is not associated with improvement in mental health outcomes. A range of methodological problems may be responsible for the absence of these effects, which require tracking longitudinally over a number of data points.
The findings are also interesting in view of the recent NICE guidelines for the management of depression in primary and secondary care which promote the use of guided self help, computerized CBT, and exercise in mild depression, but the use of medication and combined treatments in those with treatment resistant or severe depression .
Depression severity and outcomes
A set of analyses controlling for treatment intervention examined the effect of depression severity on different types of reported help seeking. These findings accord to some degree with those of Jorm et al.,  who reported that some actions such as taking antidepressants and seeing a doctor became increasingly prevalent with greater severity of symptoms while other actions were less prevalent at higher levels of severity, such as undertaking every day activities, for example, engaging in physical activity.
Limitations of the findings
There are a number of limitations of the present analysis and design of the study. The major limitation is that the help seeking data are based on self-report. We do not have data on the actual activities undertaken. Secondly, the sample was restricted to that community subgroup of participants who was prepared to participate in a randomised controlled trial of Internet websites. These individuals may have specific preferences for types of treatment not shared by the general community. By virtue of the population from which they were selected, they are likely to be from higher socio-economic groups. Evidence from other work indicates that higher education is associated with the uptake of complementary and alternative treatments . The screening questionnaire was completed by 22.7% of those approached. This level of response is lower than that achieved by US based surveys using the telephone (40%)  or surveys with reminders or multiple reminders, or those incorporating participants from established cohort studies. Nevertheless, the rate was consistent with earlier postal surveys of mental health using the electoral roll in Canberra . This lower rate may be due to the lack of personal approach as our broader epidemiological studies of the region yield higher response rates (approximately 60% when telephoned or home visited) . The analyses investigating depression severity and treatments sought are correlational and may reflect differences in the uptake of treatments as a function of changes in depression rather than the influence of particular interventions on the improvement of depression symptoms. The drop out rate was greater in the MoodGYM condition. The increased use of professional, everyday and complementary treatments in the MoodGYM condition may be due to the additive effect of increased use of a number of the individual specific treatments.
Despite these shortcomings the present paper has a number of strengths over previous reports of help seeking in mental health. It is one of the first trials to examine the effect of interventions on both evidence-based and non-evidence based help seeking using adequate comparison groups. The significant findings are that exposure to one internet site results in significantly greater increased help seeking of evidence based treatments (CBT, massage and exercise), and an increase in a range of help seeking. Exposure to BluePages reduces what may be unhelpful responses to mental health problems – seeking support from family and friends. It also confirms severity of depression as a risk factor for help seeking, and reveals the complexity of the relationship between self reported help and treatment outcomes.