Evidence on Technology-Based Psychological Interventions in Diagnosed Depression: Systematic Review

Abstract

Background Evidence on technology-based psychological interventions (TBIs) for the treatment of depression is rapidly growing and covers a broad scope of research. Despite extensive research in this field, guideline recommendations are still limited to the general effectiveness of TBIs. Objective This study aims to structure evidence on TBIs by considering different application areas (eg, TBIs for acute treatment and their implementation in health care, such as stand-alone interventions) and treatment characteristics (eg, therapeutic rationale of TBIs) to provide a comprehensive evidence base and to identify research gaps in TBIs for diagnosed depression. Moreover, the reporting of negative events in the included studies is investigated in this review to enable subsequent safety assessment of the TBIs. Methods Randomized controlled trials on adults diagnosed with unipolar depression receiving any kind of psychotherapeutic treatment, which was at least partly delivered by a technical medium, were eligible for inclusion in our preregistered systematic review. We searched for trials in CENTRAL (Cochrane Central Register of Controlled Trials; until August 2020), MEDLINE, PsycINFO, PSYNDEX, CINAHL; until the end of January 2018), clinical trial registers, and sources of gray literature (until the end of January 2019). Study selection and data extraction were conducted by 2 review authors independently. Results Database searches resulted in 15,546 records, of which 241 publications were included, representing 83 completed studies and 60 studies awaiting classification (ie, preregistered studies, study protocols). Almost all completed studies (78/83, 94%) addressed the acute treatment phase, being largely either implemented as stand-alone interventions (66/83, 80%) or blended treatment approaches (12/83, 14%). Studies on TBIs for aftercare (4/83, 5%) and for bridging waiting periods (1/83, 1%) were scarce. Most TBI study arms (n=107) were guided (59/107, 55.1%), delivered via the internet (80/107, 74.8%), and based on cognitive behavioral treatment approaches (88/107, 79.4%). Almost all studies (77/83, 93%) reported information on negative events, considering dropouts from treatment as a negative event. However, reports on negative events were heterogeneous and largely unsystematic. Conclusions Research has given little attention to studies evaluating TBIs for aftercare and for bridging waiting periods in people with depression, even though TBIs are seen as highly promising in these application areas; thus, high quality studies are urgently needed. In addition, the variety of therapeutic rationales on TBIs has barely been represented by identified studies hindering the consideration of patient preferences when planning treatment. Finally, future studies should use specific guidelines to systematically assess and report negative events. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42016050413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016050413. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2018-028042

Effectiveness and acceptance of technology-based psychological interventions for the acute treatment of unipolar depression: a systematic review and meta-analysis (Preprint)

“…Although some information on dropouts [ 11 ] or treatment adherence [ 111 ] is addressed by most RCTs in this field, a comprehensive assessment of TBI acceptance was only partially possible, since data on dropouts were either missing or not usable (eg, data were only provided for one arm) or meta-analytic calculations were not possible (when no dropouts occurred in both study arms).…”

“…Discrepancies were resolved by discussion with a third reviewer (SL). In total, 241 publications representing 143 trials (83 completed studies and 60 ongoing studies awaiting further classification) fulfilled all inclusion criteria for the TIDECA study [ 11 ]. Of those, 78 completed studies assessed the acute treatment phase.…”

“…First, TBIs in depression have already been widely researched resulting in high-quality evidence [ 11 ], and certain moderators influencing the success of treatment have been identified (eg, guided TBIs result in lower dropout rates than unguided TBIs) [ 8 ]. However, guideline recommendations are still limited to the general effectiveness of specific TBIs (eg, computerized cognitive behavioral therapy [cCBT] [ 1 , 4 ]).…”

“…However, guideline recommendations are still limited to the general effectiveness of specific TBIs (eg, computerized cognitive behavioral therapy [cCBT] [ 1 , 4 ]). Additionally, there is no systematic review examining the effectiveness and acceptance of TBIs in the acute treatment phase regarding different application formats, even though the evidence base is available [ 11 ]. TBIs can be delivered as stand-alone interventions (TBIs replacing face-to-face [f2f] treatment), as blended treatments (combining TBIs and f2f treatment), or as part of stepped (eg, TBIs are used as a low-threshold initial treatment option for people with mild-to-moderate depressive disorder) and/or collaborative care models (TBIs may be provided alongside different treatment components, such as a TBI offered in addition to a care manager and general practitioners’ care; see section Application Formats of TBIs for details).…”

“…To the best of our knowledge, there is only one systematic review evaluating internet- and mobile-based interventions in people with formally diagnosed depression; however, it is limited to waitlist control group comparisons [ 13 ]. In light of a comprehensive evidence base for TBIs in acute treatment [ 11 ] and the necessity of diagnoses to initiate treatment in mental health care, we focused only on studies requiring diagnosis of depression with the aim of determining the effectiveness and acceptance of TBIs. Additionally, high-quality evidence (RCTs) in clinical samples with diagnosed depression is the preferred source of evidence for the development and updating of clinical treatment guidelines such as the German [ 1 ] and United Kingdom [ 4 ] guidelines for depression.…”