Maintenance Notice

Due to necessary scheduled maintenance, the JMIR Publications website will be unavailable from Wednesday, July 01, 2020 at 8:00 PM to 10:00 PM EST. We apologize in advance for any inconvenience this may cause you.

Who will be affected?


Currently submitted to: JMIR Mental Health

Date Submitted: May 10, 2020
Open Peer Review Period: May 10, 2020 - Jul 5, 2020
(closed for review but you can still tweet)

NOTE: This is an unreviewed Preprint

Warning: This is a unreviewed preprint (What is a preprint?). Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn (a note "no longer under consideration" will appear above).

Peer-review me: Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period (in this case, a "Peer-Review Me" button to sign up as reviewer is displayed above). All preprints currently open for review are listed here. Outside of the formal open peer-review period we encourage you to tweet about the preprint.

Citation: Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author).

Final version: If our system detects a final peer-reviewed "version of record" (VoR) published in any journal, a link to that VoR will appear below. Readers are then encourage to cite the VoR instead of this preprint.

Settings: If you are the author, you can login and change the preprint display settings, but the preprint URL/DOI is supposed to be stable and citable, so it should not be removed once posted.

Submit: To post your own preprint, simply submit to any JMIR journal, and choose the appropriate settings to expose your submitted version as preprint.

Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.

The Feasibility of a Transdiagnostic Internet Intervention for Indonesian University Students with Depression and Anxiety

  • Metta Rahmadiana; 
  • Eirini Karyotaki; 
  • Mieke Schulte; 
  • David Daniel Ebert; 
  • Jan Passchier; 
  • Pim Cuijpers; 
  • Thomas Berger; 
  • Wouter van Ballegooijen; 
  • Supra Wimbarti; 
  • Heleen Riper



University students with depression and anxiety do not easily receive or seek treatment, therefore Internet-based interventions have been suggested to be a promising way to improve treatment accessibility and availability. However, it has not been examined whether a guided, culturally adapted, transdiagnostic, Internet-based intervention is effective for treating symptoms of depression and/or anxiety among university students in Indonesia.


This study aims to investigate the feasibility (acceptability and satisfaction, usability, and uptake) of a guided, culturally adapted, transdiagnostic, Internet-based intervention among university students with symptoms of depression and/or anxiety in Indonesia.


Students from Universitas Gadjah Mada, Yogyakarta, Indonesia were screened for symptoms of depression and/or anxiety, filled online informed consent, demographic questionnaires, and a quality of life measure at pre-treatment assessment (T0). Subsequently, the participants started the intervention. Seven weeks after T0, the primary outcomes of this feasibility study were analyzed at post-treatment assessment (T1) using the Client Satisfaction Questionnaire-8 (CSQ-8), and the System Usability Scale (SUS). Mean and standard deviations for the CSQ-8 and SUS were calculated to examine feasibility. Within-group secondary outcomes (depression, anxiety, and quality of life) were inspected for outliers and normal distribution. Paired-sample t-tests were used to investigate differences between time points of secondary outcomes. A mixed-method approach of quantitative and qualitative analyses was adopted. Both the primary and secondary outcomes were additionally explored with an individual semi-structured interview and synthesized descriptively.


A total of 50 participants completed the intervention. We found a moderate to high level of satisfaction and acceptability, a slightly below-average level of desirable usability (≥ 70), and an adherence rate of 52% which was higher than expected given the novelty of the intervention. Results for the secondary outcomes showed that the intervention had large effects in reducing depression, g = 1.15 (95% CI, 2.75 – 5.1) and anxiety, g = 1.02 (95% CI, 2.06 – 4.61). Further, a moderate effect in improving quality of life was found, g = .50. Overall, participants were positive about the online intervention and ECoaches (online guidance), and they found the intervention to be culturally appropriate.


A culturally adapted, transdiagnostic, Internet-based intervention appears to be acceptable and feasible for reducing symptoms of depression and/or anxiety, and increasing quality of life in university students in Indonesia. Future studies should include a randomized controlled trial to assess the effectiveness of such interventions as they may supplement existing counseling services in universities, reduce the treatment costs and maximize treatment accessibility in low resourced settings.


Please cite as:

Rahmadiana M, Karyotaki E, Schulte M, Ebert DD, Passchier J, Cuijpers P, Berger T, van Ballegooijen W, Wimbarti S, Riper H

The Feasibility of a Transdiagnostic Internet Intervention for Indonesian University Students with Depression and Anxiety

JMIR Preprints. 10/05/2020:20036

DOI: 10.2196/preprints.20036


Download PDF

Request queued. Please wait while the file is being generated. It may take some time.

© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.