Depression in Internet and Face-to-Face Cancer Support Groups: A Pilot Study

Paula Klemm

Thomas L. Hardie

ONF 2007, 29(4), E45-E51. DOI: 10.1188/02.ONF.E45-E51

Purpose/Objectives: To examine depression in Internet cancer support groups as compared to traditional (face-to-face) cancer support groups and to explore the relationship between Internet use and levels of depression.

Design: Exploratory, descriptive.

Setting: Traditional (face-to-face) and Internet cancer support groups.

Sample: Convenience sample of 40 patients with cancer, 14 from traditional face-to-face groups and 26 from an Internet support group, with different cancer diagnoses.

Methods: Traditional paper or Internet surveys consisting of an investigator-developed questionnaire including demographic information, brief medical history, support group history, and the Center for Epidemiologic Studies Depression Scale (CES-D).

Main Research Variable: Depression scores on the CES-D.

Findings: Participants in the face-to-face groups were 100% male. The online group was 56% male and 44% female. Groups did not differ significantly by income, health insurance status, or days since initial diagnosis. Groups differed significantly on level of depression. The traditional (face-to-face) group had a CES-D mean score of 1.86 (SD = 2.69), and the online group had a mean score of 29.27 (SD = 11.89, p < 0.000). A comparison of CES-D scores of men in the face-to-face and Internet groups revealed that they differed significantly on level of depression. Men in the traditional group had a mean score of 1.86 (SD = 2.69), and men in the online group had a mean score of 27.42 (SD= 112.69, p < 0.000).

Conclusions: These data suggest that more depressed patients with cancer use Internet support groups instead of face-to-face support. Before online interventions can be implemented effectively, their efficacy needs to be evaluated.

Implications for Nursing: Patients with cancer are at increased risk for developing depression. This should be a consideration during nursing assessments. Traditional cancer support groups can help people cope with their cancer, but the efficacy of Internet cancer support groups in providing psychoeducation and psychotherapeutic intervention remains to be proven.

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    Aasa, N., Fossa, S.D., Dahl, A.A., & Moe, T.J. (1997). Prevalence of anxiety and depression in cancer patients seen at the Norwegian Radium Hospital. European Journal of Cancer, 33, 1597-1604.
    Bastecky, J., Tondlova, H, Vesela, J., Brizekova, S., & Boleloucky, Z. (1996). Prevalence of psychopathology in patients suffering from breast and gastrointestinal cancer. Patient Education and Counseling, 28(2), 175-178.
    Beeber, L.S., Shea, J., & McCorkle, R. (1998). The Center for Epidemiologic Studies Depression Scale as a measure of depressive symptoms in newly diagnosed patients. Journal of Psychosocial Oncology, 16(1), 1-20.
    Bottomley, A. (1997). Psychosocial problems in cancer care: A brief review of common problems. Journal of Psychiatric and Mental Health Nursing, 4, 323-331.
    Breitbart, W. (1995). Identifying patients at risk for and treatment of major psychiatric complications of cancer. Supportive Care in Cancer, 3(1), 45-60.
    Carroll, B.T., Kathol, R.G., Noyes, R., Walk, T.G., & Clamon, G.H. (1993). Screening for depression and anxiety in cancer patients using the hospital anxiety and depression scale. General Hospital Psychology, 15(2), 69-74.
    Cella, D.F., & Yellen, S.B. (1993). Cancer support groups: The state of the art. Cancer Practice, 1, 56-61.
    Chernecky, C. (1999). Temporal differences in coping, mood, and stress with chemotherapy. Cancer Nursing, 22, 266-276.
    Colleoni, M., Mandala, M., Peruzzotti, G., Robertson, C., Bredart, A., & Goldhirsch, A. (2000). Depression and degree of acceptance of adjuvant cytotoxic drugs. Lancet, 356, 1326-1327.
    Coreil, J., & Behal, R. (1999). Man to man prostate cancer support groups. Cancer Practice, 7, 122-129.
    Coward, D.D. (1998). Facilitation of self-transcendence in a breast cancer support group. Oncology Nursing Forum, 25, 75-84.
    Curn, M.M. (1993). A prostate cancer support group: Does it work? Uro-logic Nursing, 13, 95-96.
    Derogatis, L.R., Morrow, G.R., Fetting, J., Penman, D., Piasetsky, S., Schmale, A.M., et al. (1983). The prevalence of psychiatric disorders among cancer patients. JAMA, 249, 751-757.
    De Walden-Galuszko, K. (1996). Prevalence of psychological morbidity in terminally-ill cancer patients. Psycho-Oncology, 5, 414-419.
    Fawcett, J., & Buhle, E.L. (1995). Using the Internet for data collection: An innovative electronic strategy. Computers in Nursing, 13, 273-279.
    Fernsler, J.I., Klemm, P., & Miller, M.A. (1999). Spiritual well-being and demands of illness in people with colorectal cancer. Cancer Nursing, 22, 134-140.
    Fernsler, J.I., & Manchester, L.J. (1997). Evaluation of a computer-based cancer support network. Cancer Practice, 5, 46-51.
    Ferrell, B.R., Grant, M., Funk, B., Otis-Green, S., & Garcia, N. (1998). Quality of life in breast cancer survivors: Implications for developing support services. Oncology Nursing Forum, 25, 887-895.
    Fife, B.L., Kennedy, V.N., & Robinson, L. (1994). Gender and adjustment to cancer: Clinical implications. Journal of Psychosocial Oncology, 12(1/2), 1-21.
    Finfgeld, D.L. (2000). Therapeutic groups online: The good, the bad, and the unknown. Issues in Mental Health Nursing, 21, 241-255.
    Fobair, P. (1997). Cancer support groups and group therapies: Part I. Historical and theoretical background and research on effectiveness. Journal of Psychosocial Oncology, 15(1), 63-81.
    Galloway, S.C., & Graydon, J.E. (1996). Uncertainty, symptom distress, and information needs after surgery for cancer of the colon. Cancer Nursing, 19, 112-117.
    Gaston-Johansson, F., Ohly, K.V., Fall-Dickson, J.M., Nanda, J.P., & Kennedy, M.J. (1999). Pain, psychological distress, health status, and coping in patients with breast cancer scheduled for autotransplantation. Oncology Nursing Forum, 26, 1337-1345.
    Grassman, D. (1993). Development of inpatient oncology educational and support programs. Oncology Nursing Forum, 20, 669-676.
    Gray, R.E., Fitch, M., Davis, C., & Phillips, C. (1997). Interviews with men with prostate cancer about their self-help group experience. Journal of Palliative Care, 13(1), 15-21.
    Gustafson, D., Wise, M., McTavish, F., Taylor, J.O., Wolberg, W., Stewart, J., et al. (1993). Development and pilot evaluation of a computer-based support system for women with breast cancer. Journal of Psychosocial Oncology, 11(4), 69-93.
    Hann, D., Winter, K., & Jacobsen, P. (1999). Measurement of depressive symptoms in cancer patients: Evaluation of the Center for Epidemiological Studies' Depression Scale (CES-D). Journal of Psychosomatic Research, 5, 437-443.
    Hurt, G.J., McQuellen, R.P., & Barrett, R.J. (1994). After treatment ends. Cancer Practice, 2, 417-420.
    Jemal, A., Thomas, A., Murray, T., & Thun, M. (2002). Cancer statistics, 2002. CA: A Cancer Journal for Clinicians, 52, 23-47.
    Klemm, P., Hurst, M., Dearholt, S., & Trone, S. (1999). Cyber solace: Gender differences on Internet cancer support groups. Computers in Nursing, 17, 65-72.
    Klemm, P., Reppert, K., & Visich, L. (1998). A nontraditional support group: The Internet. Computers in Nursing, 16, 31-36.
    Kogan, M.M., Biswas, A., Pearl, D., Carlson, R., & Spiegel, D. (1997). Effects of medical and psychotherapeutic treatment on the survival of women with metastatic breast cancer. Cancer, 80, 225-230.
    Kraut, R., Patterson, M., Lundmark, V., Kiesler, S., Mukophadhyay, T., & Scherlis, W. (1998). Internet paradox: A social technology that reduces social involvement and psychological well-being? American Psychologist, 53, 1017-1031.
    Leavitt, M.B., Lamb, S.A., & Voss, B.S. (1996). Brain tumor support group: Content themes and mechanisms of support. Oncology Nursing Forum, 23, 1247-1256.
    Leopold, K.A., Ahles, T.A., Walch, S., Amdur, R.J., Mott, L.A., Weigand-Packard, L., et al. (1998). Prevalence of mood disorders and utility of the PRIME-MD in patients undergoing radiation therapy. International Journal of Radiation Oncology, Biology, and Physics, 42, 1105-1112.
    Lovejoy, N.C., Tabor, D., & Deloney, P. (2000). Cancer-related depression: Part II-Neurologic alterations and evolving approaches to psychopharmacology. Oncology Nursing Forum, 27, 795-808.
    Madara, E., & White, B.J. (1997). On-line mutual support: The experience of a self-help clearinghouse. Information and Referral: The Journal of the Alliance of Information and Referral Systems, 19, 91-107.
    Massie, M.J., & Holland, J.C. (1990). Depression and the hospitalized cancer patient. Journal of Clinical Psychiatry, 51(Suppl. 7), 12-17.
    McLeod, E. (1999). Self-help support groups in secondary breast cancer-A new UK initiative. European Journal of Palliative Care, 6(3), 103-105.
    McTavish, F.M., Gustafson, D.H., Owens, B.H., Hawkins, R.P., Pingree, S., Wise, M., et al. (1995). CHESS: An interactive computer system for women with breast cancer piloted with an underserved population. Journal of Ambulatory Care Management, 18(3), 35-41.
    Mermelstein, H.T., & Lesko, L. (1992). Depression in patients with cancer. Psycho-Oncology, 1, 199-215.
    Newport, D.J., & Nemeroff, C.B. (1999). Treatment of depression in the cancer patient. Clinical Geriatrics, 7(4), 40-55.
    Nie, N.H., & Lutz, E. (2000, February 17). Internet and society: A preliminary report. Stanford Institute for the Quantitative Study of Society, 1-11. Retrieved August 23, 2001, from
    Oravec, J.A. (2000). Online medical information and service delivery: Implications for health education. Journal of Health Education, 31(2), 105-110.
    Pasacreta, J.V. (1997). Depressive phenomena, physical symptom distress, and functional status among women with breast cancer. Nursing Research, 46, 214-221.
    Pillon, L.R., & Joannides, G. (1991). An 11-year evaluation of a living-with-cancer program. Oncology Nursing Forum, 18, 707-711.
    Radloff, L.S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401.
    Samarel, N., Fawcett, J., Krippendorf, K., Piacentino, J.C., Eliasof, B., Hughes, P., et al. (1998). Women's perceptions of group support and adaptation to breast cancer. Journal of Advanced Nursing, 28, 1259-1268.
    Sellick, S.M., & Crooks, D.L. (1999). Depression and cancer: An appraisal of the literature for prevalence, detection, and practice guideline development for psychological interventions. Psycho-Oncology, 8, 315-333.
    Shapiro, D.E., Boggs, S.R., Rodngue, J.R., Urry, H.L., Algma, J.J., Hellman, R., et al. (1997). Stage II breast cancer: Differences between four coping patterns in side effects during adjuvant chemotherapy. Journal of Psychosomatic Research, 43, 143-157.
    Sharf, B.F. (1997). Communicating breast cancer on-line: Support and empowerment on the Internet. Women and Health, 26(1), 65-83.
    Spiegel, D., Bloom, J.R., Kraemer, H.C., & Gottheil, E. (1989). Effects of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet, 2, 888-891.
    Spiegel, D., & Classen, C. (2000). Group therapy for cancer patients: A research-based handbook of psychosocial care. New York: Basic Books.
    Stanton, A.L., Danoff-Burg, S., Cameron, C.L., Bishop, M., Collins, C.A., Kirk, S.B., et al. (2000). Emotionally expressive coping predicts psychological and physical adjustment to breast cancer. Journal of Consulting and Clinical Psychology, 68, 875-882.
    Thomas, B., Leeseberg-Stamler, L., Lafreniere, K., & Dumala, R. (2000). The Internet: An effective tool for nursing research with women. Computers in Nursing, 18, 13-18.
    Watson, M., Haviland, J.S., Greer, S., Davidson, J., & Bliss, J.M. (1999). Influence of psychological response on survival in breast cancer: A populationbased cohort study. Lancet, 354, 1331-1336.
    Weinberg, N., Schmale, J., Uken, J., & Wessel, K. (1996). Online help: Cancer patients participate in a computer-mediated support group. Health and Social Work, 21(1), 24-29.
    Wellisch, D.K. (1993). Beyond the year 2000. The future of groups for patients with cancer. Cancer Practice, 1, 198-201.
    Zabalegui, A. (1999). Coping strategies and psychological distress in patients with advanced cancer. Oncology Nursing Forum, 26, 1511-1518.