Table 4 Summary results of anxiety and depression outcomes of included trials
Ellis et al. (2011) | Conley et al. (2020) | Mulfinger et al. (2018) | Alvarez-Jimenez et al. (2021) | Becker et al. (2010) | Ciao et al. (2021) | Kipela et al. (2016) | Resende et al. (2021) | German et al. (2012) | |
|---|---|---|---|---|---|---|---|---|---|
Measures | Anxiety and Depression (DASS-21); | Anxiety (GAD-7) Depression (CESD) | Depression (CESD) | Depression (CDSS) | Negative affect (PANAS-X) | Negative Affect (PANAS) | Negative Affect (PANAS) | Negative Affect (PANAS-B) | Depression (CESD) |
Groups | Online peer support (n = 13) Online CBT (n = 13) Controls (n = 13) | HOP-C (n = 63) Control (n = 55) | HOP (n = 49) Control (TAU; n = 49) | Horyzons + TAU (n = 84) Control (TAU; n = 86) | Cognitive dissonance (n = 53) Control (Media advocacy; n = 49) | Trial 1: Everybody Project (w/ expert—and peer leaders; n = 48) Control (waitlist; n = 50) Trial 2: Everybody Project (w/ peer leaders only; n = 65) Control (Video intervention; n = 76) | Mixed-gender (n = 77, Female-only (n = 65) Control (waitlist; n = 38) | Body Project (n = 38) Control (n = 36) | Peer education (n = 209) Control (Network peer education; n = 286) Life Skills (n = 206) Control (Network life skills; n = 282) |
Anxiety and Depression Results | |||||||||
Anxiety | Y*; online CBT, d = 0.99, p = .03, and online peer support, d = 0.95, p = .01, compared to controls | ns | |||||||
Depression | ns | ns | ns/Y* FU6W; HOP, d = 0.72, p < .001) compared to controls | ns | Y* Intervention: post-intervention mean difference = − 4.5251, SE = 0.7279; p < 0.0001), compared to baseline Control: ns | ||||
Negative Affect | Y* Intervention: post-intervention, d = 0.51, p < .05; 8 weeks d = 0.25, p < .05; 8 months d = 0.35, p < . 05; 14 months d = 0.48, p < .05, compared to baseline Control: post-intervention, ns; 8 weeks, ns; 8 months d = 0.58, p < .05; 14 months d = 0.34, p < .05, compared to baseline | Y* Trial 1 EVERYbody (w/ expert and peerleaders): post-intervention d = 0.56, p < .05; 1-month d = 0.42, p < .05, compared to controls; group x time interaction (b = − 0.03, t = − 4.45, p < .0001) Trial 2 EVERYbody (w/ peer-leaders only): post-intervention d = 0.01, p < .05; 1-month d = 0.10, p < .05 compared to controls; group x time interaction, ns | Y*a Males Intervention: Males in mixed gender group: postintervention, d = 0.40, p = 0.0080; 2-month ns; 6-month ns, compared to controls Females in mixed gender group: ns Females intervention: Female only group: ns | ns/Y*b FU24W Intervention: d = 0.60 p < .05) compared to controls | |||||
Participant Feedback | Online peer support compared to online CBT: • More helpful, • More enjoyable • Equally recommended • One-third reported they would continue using online peer support • Two-thirds reported they would continue using online CBT – possibly because the online CBT group were still feeling more anxious than the online peer-support group | Not reported | • Peer leader was viewed as an inspiring role-model • Enjoyed learning about their real-life experiences • Relief to talk about disclosure in a safe space • facilitated openness, trust, and respect within the group interactions • Some materials were deemed too theoretical, demanding, and hard to concentrate on or too detailed | • Some participants had positive experiences of social connection on Horyzons • Others did not due to social anxiety, paranoia and confusion within the social network of Horyzons | • Participants preferred the cognitive dissonance intervention over the control intervention • Both interventions were deemed useful • Suggested the control intervention may be a good follow up or refresher intervention | • Experts were able to address diverse body images (various gender, sexual, and racial identities) better than peer leaders • Peer leaders lacked lived experience in all diverse body images, which may have hindered them in connecting with all the participants | • Adding males to the Body Project created a mixed gender group, which established a warmer collaborative (versus activating) vibe • Normally the Body Project creates an angry vibe against the thin ideal through the historical struggle women have had against the thin ideal • This warmer vibe was carried over to the female only group, which may explain a lack of effects among females | Not reported | The research site (known as “House of Friends”): • Allowed participants to gather and socialise informally with each other • Was a safe place, as there was no social stigma or fear of being arrested, which was common for participants in the general community |