Do guided internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis

Abstract

Little is known about clinically relevant changes in guided Internet-based interventions for depression. Moreover, methodological and power limitations preclude the identification of patients' groups that may benefit more from these interventions. This study aimed to investigate response rates, remission rates, and their moderators in randomized controlled trials (RCTs) comparing the effect of guided Internet-based interventions for adult depression to control groups using an individual patient data meta-analysis approach. Literature searches in PubMed, Embase, PsycINFO and Cochrane Library resulted in 13,384 abstracts from database inception to January 1, 2016. Twenty-four RCTs (4889 participants) comparing a guided Internet-based intervention with a control group contributed data to the analysis. Missing data were multiply imputed. To examine treatment outcome on response and remission, mixed-effects models with participants nested within studies were used. Response and remission rates were calculated using the Reliable Change Index. The intervention group obtained significantly higher response rates (OR = 2.49, 95% CI 2.17-2.85) and remission rates compared to controls (OR = 2.41, 95% CI 2.07-2.79). The moderator analysis indicated that older participants (OR = 1.01) and native-born participants (1.66) were more likely to respond to treatment compared to younger participants and ethnic minorities respectively. Age (OR = 1.01) and ethnicity (1.73) also moderated the effects of treatment on remission.Moreover, adults with more severe depressive symptoms at baseline were more likely to remit after receiving internet-based treatment (OR = 1.19). Guided Internet-based interventions lead to substantial positive treatment effects on treatment response and remission at post-treatment. Thus, such interventions may complement existing services for depression and potentially reduce the gap between the need and provision of evidence-based treatments.

Effects of an epilepsy‐specific Internet intervention (Emyna) on depression: Results of the ENCODE randomized controlled trial

“…Potential advantages include efficacy, low‐threshold availability, flexibility, low cost, and low clinician burden. Meta‐analyses have shown that eCBT Internet interventions for depression are effective in the general population, on average, and certain clinician‐supported forms of eCBT have been shown to be as effective as face‐to‐face psychotherapy, which suggests that these interventions might be effective for PwE as well …”

“…Meta-analyses have shown that eCBT Internet interventions for depression are effective in the general population, on average, and certain clinician-supported forms of eCBT have been shown to be as effective as face-to-face psychotherapy, which suggests that these interventions might be effective for PwE as well. 9,10 Despite these advantages and encouraging findings, several limitations of eCBT must also be considered, including concerns about data security, incapacity to respond to crises, low adherence, and potential lack of safety and efficacy. For example, the effects of some fully automated eCBT interventions are only modest, although providing clinician support may improve adherence and outcomes.…”

The effects of component‐specific treatment compliance in individually tailored internet‐based treatment

“…There is a growing interest in offering internet-based interventions as a way of improving access to psychological treatments in the primary care population, for example, in the United Kingdom (Richards et al, 2018). Therapist-guided internet-based treatments result in large and clinically relevant improvements on depression in clinical trials (Karyotaki et al, 2018) and other conditions (Andersson, Cuijpers, Carlbring, Riper, & Hedman, 2014) and have shown effectiveness for several conditions when implemented in routine care (Andersson & Hedman, 2013;Hedman et al, 2014;Nordgreen, Gjestad, Andersson, Carlbring, & Havik, 2018;Titov et al, 2017).…”

An examination of dysfunctional attitudes and extreme response styles as predictors of relapse in guided internet‐based cognitive behavioral therapy for depression

“…Evidence is accumulating for the efficacy of internet‐based cognitive behavioral treatments (iCBT; Andersson et al, 2013; Andrews, Cuijpers, Craske, McEvoy, & Titov, 2010; Cuijpers, Donker, Van Straten, Li, & Andersson, 2010; Spek et al, 2007; Wagner, Horn, & Maercker, 2014; Wright et al, 2005). Especially when provided with the help of a coach, guided iCBT consistently outperforms waitlist conditions and appears to achieve levels of efficacy similar to face‐to‐face CBT (Andersson & Cuijpers, 2009; Andrews et al, 2018; Cuijpers, Donker, van Straten, Li, & Andersson, 2010; Gellatly et al, 2007; Karyotaki et al, 2018; Richards & Richardson, 2012; Spek et al, 2007). Much less is known about the long‐term effects of guided iCBT programs.…”