Online Support Groups

Online Support Groups

PEP Topic 

Online support groups are Internet-only forums for peer communication. In regard to patients with cancer, researchers have studied the impact of online support groups on a variety of psychosocial symptoms, including anxiety and depression.

Effectiveness Not Established

Systematic Review/Meta-Analysis

Griffiths, K.M., Calear, A.L., & Banfield, M. (2009). Systematic review on Internet Support Groups (ISGs) and depression (1): Do ISGs reduce depressive symptoms? Journal of Medical Internet Research, 11(3), e40-e40.



To evaluate the evidence concerning the efficacy of Internet support groups (ISGs) in reducing symptoms of depression

Search Strategy:

  • Databases searched were PubMed, PsycINFO, and Cochrane Database.
  • Searched keywords were computer, Internet communication, and support.
  • Studies were included if they employed an online peer-to-peer support group, incorporated either a depression outcome or involved an Internet support group relating to unipolar depression, or reported either quantitative or qualitative data.
  • Authors did not specify exclusion criteria.

Literature Evaluated:

  • Investigators retrieved a total of 158 studies.
  • Investigators recorded study characteristics regarding design and other aspects of study quality. Investigators used no other method of quality evaluation.
  • Of the studies retrieved, 16 involved a single component of peer-to-peer support. Of these 16, 4 reported that ISG had had a positive effect on symptoms of depression. Five of the 16 studies involved women with breast cancer.
  • Twelve studies involved intervention components in addition to ISG. Only two of these reported positive results.
  • Studies employed a bulletin board, chat room, or mailing list—alone or in combination. The duration of ISG intervention was 12 minutes to 12 months. Approximately 50% of interventions were moderated interventions, and the moderator was a healthcare professional.
  • Only one study focused on rural participants.
  • Of the final set of 28 studies, 9 involved patients with cancer. Most of these patients were women with breast cancer.

Sample Characteristics:

  • The final number of studies included in the sample was 28.
  • The mean range of participants was 10–2,373.
  • Across studies, the median age range of patients was 26–65 years. Few samples focused on men, and most studies had a preponderance of women. 


  • Multicomponent studies were less likely to yield significant positive outcomes than were stand-alone interventions (p = 0.01).
  • Breast cancer ISGs were more successful than others (p = 0.02); however, all the studies involving ISGs originated from a single research group
  • Authors noted no differences in outcomes between interventions involving chat rooms versus interventions involving static content.
  • Authors noted no relationship between ISG participation and duration of intervention or ISG participation and outcomes or length of follow-up.
  • Most studies were of low quality. Authors noted a correlation between low study quality and highly positive findings.


There is a need for high-quality research regarding the effect of ISGs on symptoms of depression.


This systematic review included data from studies available as of July 2007. Internet use and and social networking have increased since 2007—a fact that could alter the findings about the use and effect of ISGs. More research in this area is needed.

Nursing Implications:

This review points to the need for high-quality research in this area. Theoretically, ISGs could be important for users who are isolated or unable to access face-to-face services readily; therefore, further research should be done.

Research Evidence Summaries

Klemm, P. (2012). Effects of online support group format (moderated vs peer-led) on depressive symptoms and extent of participation in women with breast cancer. Computers, Informatics, Nursing: CIN, 30(1), 9–18.


Study Purpose:

To evaluate the effects, in women with breast cancer, of moderated and peer-led online support group format on symptoms of depression and degree of participation

Intervention Characteristics/Basic Study Process:

Investigator distributed recruitment material via postal mail, online, or through nonprofit organizations or the media. Interested women contacted the investigator after receiving or seeing recruitment material. Participants were placed into a moderated or peer-led group, in groups of 15 according to time of recruitment. All online support was accessed via a university-owned web page devoted to the work. Participants could not access groups to which they were not assigned. Moderators were master's-prepared social workers with experience with online and telephone help for people with cancer and their caregivers. Investigators obtained study measures at baseline and at 6, 12, and 16 weeks. The group was maintained for 12 weeks.

Sample Characteristics:

  • The sample was composed of 50 participants.
  • Mean patient age was 52.22 years, and the age range was 28–77 years.
  • All participants were female.
  • All participants had breast cancer and were to have completed treatment within the 32 days prior to inclusion.
  • Most participants were married and white, and they reported an income above $50,000 annually. Most had stage I or II cancer and had received multimodal therapy. Of all participants, 96% were not taking any antidepressant.


  • Single site
  • Home 
  • Newark, Delaware, United States

Phase of Care and Clinical Applications:

  • Phases of care: multiple
  • Clinical applications: late effects and survivorship


Study Design:

Longitudinal two-group design

Measurement Instruments/Methods:

Center for Epidemiological Studies Depression Scale (CESD)


At the end of the study, findings revealed no significant effects, on symptoms of depression, in regard to group, time, or time by group format. CESD scores in peer-led groups declined slightly at all study time points but were not significantly different from the scores of moderator-led groups. In both groups, symptoms of depression were mild. More messages were posted and read in moderated groups than in peer-led groups.


The study showed no effect of peer- or moderator-led online support groups on symptoms of depression in women with breast cancer.


  • The study had a small sample size, with fewer than 100 participants.
  • The study had risks of bias due to no blinding and the characteristics of the sample.
  • The CESD was not sensitive enough to pick up significant changes, and the study was probably underpowered.
  • The sample was self-selected, and participants tended to be affluent. Results would not necessarily be applicable to other groups. 
  • Women with higher depression scores were in the peer-led group. Overall, all participants had low depression scores.

Nursing Implications:

This study does not provide strong support for the effectiveness of either peer-led or moderated online support groups on symptoms of depression; however, at baseline the depression scores of most participants were fairly low, and study groups were not balanced on baseline depression symptoms. It is not clear if such support efforts are beneficial to individuals who do not have a high level of depression symptoms. This finding could have influenced study results. Research in this area should stratify samples on the basis of the level of symptoms at baseline.