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.

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

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.

• 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
   

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

Longitudinal two-group design

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.
   

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.