Individual Differences in Online Self-Help Intervention for Depression: The Influence of Self-Stigma of Depression and Incremental Theory of Emotion on Intervention Outcomes and Adherence (Preprint)

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Ningning Mao, Sinan Fu, Rongqi Ding, Zhuo Rachel Han

Published: 20 Oct 2025, Last Modified: 16 Mar 2026CrossrefEveryoneRevisionsCC BY-SA 4.0
Abstract: Although numerous randomized controlled trials (RCTs) support the efficacy of online self-help interventions for depression, individual differences in intervention outcomes and low adherence remain significant barriers to the widespread adoption of these interventions. Self-stigma of depression (SSD) and the incremental theory of emotion (ITE) have been identified as important variables influencing intervention outcomes and adherence in traditional face-to-face interventions. However, little is known about their role in online self-help-related psychological interventions. This study employed an RCT to assess the efficacy of an online self-help intervention for depressive symptoms while examining the effects of ITE and SSD on intervention outcomes and adherence. A total of 1320 participants with depressive symptoms were recruited through online posts. Eligible participants were randomly assigned to either the online self-help intervention group (n = 86) or the online reading waitlist group (n = 97). Depressive symptoms (measured by the PHQ-9), SSD, and ITE were collected via online questionnaires at three time points: before the intervention (T1), 6 weeks after the intervention began (T2), and 14 weeks after the intervention began (T3). For participants in the self-help intervention group, adherence was measured by the dropout rate and the overall completion rate of the intervention (number of completed days/total intervention days). The results indicated that both interventions can alleviate depressive symptoms, with a significant joint moderating effect of ITE and SSD on intervention outcomes. Individuals with low ITE and low SSD benefited more from the online intervention in the early stages, whereas individuals with high ITE and high SSD in the reading waitlist group showed no significant improvement in symptoms. Furthermore, ITE was found to enhance adherence (lower dropout rate), whereas SSD had no significant effect. Future interventions may focus on adjusting beliefs, such as strengthening belief in mental health plasticity and reducing self-stigma through mental health education and peer support, to increase the effectiveness of online self-help interventions.