Predictors of treatment dropout in self-guided web-based interventions for depression: an ‘individual patient data’ meta-analysis

Karyotaki, Eirini; Kleiboer, Annet; Smit, Filip; Turner, David T.; Pastor, Antoni; Andersson, Gerhard; Berger, Thomas; Botella, Cristina; Bretón-López, Juana; Carlbring, Per; Christensen, Helen; Graaf, Esther De; Griffiths, Kathleen M; Donker, Tara; Farrer, Louise; Huibers, Marcus J.H.; Lenndin, Jan; Mackinnon, Andrew; Meyer, Björn; Moritz, Steffen; Riper, Heleen; Spek, Viola; Vernmark, Kristofer; Cuijpers, Pim

doi:10.1017/s0033291715000665

Cited by 303 publications

(263 citation statements)

References 36 publications

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“…The potential predictors of dropout were chosen in keeping with meta-analytic analyses of dropout [32]. Dropout status at the post-assessment was entered as a dependent variable and the above-mentioned potential predictors of dropout were entered as independent variables.…”

Section: Resultsmentioning

confidence: 99%

Effects of a Psychological Internet Intervention in the Treatment of Mild to Moderate Depressive Symptoms: Results of the EVIDENT Study, a Randomized Controlled Trial

Klein¹,

Berger²,

Schröder³

et al. 2016

Psychother Psychosom

126

100

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Background: Mild to moderate depressive symptoms are common but often remain unrecognized and treated inadequately. We hypothesized that an Internet intervention in addition to usual care is superior to care as usual alone (CAU) in the treatment of mild to moderate depressive symptoms in adults. Methods: This trial was controlled, randomized and assessor-blinded. Participants with mild to moderate depressive symptoms (Patient Health Questionnaire, PHQ-9, score 5-14) were recruited from clinical and non-clinical settings and randomized to either CAU or a 12-week Internet intervention (Deprexis) adjunctive to usual care. Outcomes were assessed at baseline, 3 months (post-assessment) and 6 months (follow-up). The primary outcome measure was self-rated depression severity (PHQ-9). The main analysis was based on the intention-to-treat principle and used linear mixed models. Results: A total of 1,013 participants were randomized. Changes in PHQ-9 from baseline differed signiﬁcantly between groups (t₈₂₅ = 6.12, p < 0.001 for the main effect of group). The post-assessment between-group effect size in favour of the intervention was d = 0.39 (95% CI: 0.13-0.64). It was stable at follow-up, with d = 0.32 (95% CI: 0.06-0.69). The rate of participants experiencing at least minimally clinically important PHQ-9 change at the post-assessment was higher in the intervention group (35.6 vs. 20.2%) with a number needed to treat of 7 (95% CI: 5-10). Conclusions: The Internet intervention examined in this trial was superior to CAU alone in reducing mild to moderate depressive symptoms. The magnitude of the effect is clinically important and has public health implications.

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Section: Resultsmentioning

confidence: 99%

Effects of a Psychological Internet Intervention in the Treatment of Mild to Moderate Depressive Symptoms: Results of the EVIDENT Study, a Randomized Controlled Trial

Klein¹,

Berger²,

Schröder³

et al. 2016

Psychother Psychosom

126

100

View full text Add to dashboard Cite

show abstract

“…In addition, a per‐protocol analysis including only participants that completed at least 75% of the online modules of the Internet‐based treatment was performed (SA6). This operationalization of treatment completion has been used in a previous IPD‐MA evaluating the adherence to Internet‐based treatments, and was chosen based on the assumption that these participants were exposed to most of the core elements of the intervention (Karyotaki et al., 2015). We hypothesized that higher adherence to the intervention is associated with larger clinical effects.…”

Section: Methodsmentioning

confidence: 99%

Cost effectiveness of guided Internet-based interventions for depression in comparison with control conditions: An individual-participant data meta-analysis

Kolovos

Dongen²,

Riper

et al. 2018

Depress Anxiety

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BackgroundThere is limited evidence on the cost effectiveness of Internet‐based treatments for depression. The aim was to evaluate the cost effectiveness of guided Internet‐based interventions for depression compared to controls.MethodsIndividual–participant data from five randomized controlled trials (RCT), including 1,426 participants, were combined. Cost‐effectiveness analyses were conducted at 8 weeks, 6 months, and 12 months follow‐up.ResultsThe guided Internet‐based interventions were more costly than the controls, but not statistically significant (12 months mean difference = €406, 95% CI: − 611 to 1,444). The mean differences in clinical effects were not statistically significant (12 months mean difference = 1.75, 95% CI: − .09 to 3.60 in Center for Epidemiologic Studies Depression Scale [CES‐D] score, .06, 95% CI: − .02 to .13 in response rate, and .00, 95% CI: − .03 to .03 in quality‐adjusted life‐years [QALYs]). Cost‐effectiveness acceptability curves indicated that high investments are needed to reach an acceptable probability that the intervention is cost effective compared to control for CES‐D and response to treatment (e.g., at 12‐month follow‐up the probability of being cost effective was .95 at a ceiling ratio of 2,000 €/point of improvement in CES‐D score). For QALYs, the intervention's probability of being cost effective compared to control was low at the commonly accepted willingness‐to‐pay threshold (e.g., at 12‐month follow‐up the probability was .29 and. 31 at a ceiling ratio of 24,000 and 35,000 €/QALY, respectively).ConclusionsBased on the present findings, guided Internet‐based interventions for depression are not considered cost effective compared to controls. However, only a minority of RCTs investigating the clinical effectiveness of guided Internet‐based interventions also assessed cost effectiveness and were included in this individual–participant data meta‐analysis.

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“…However, some studies have shown the efficacy of self-guided treatments (without any contact or support from a therapist, consultant or researcher) [43–47, 71]. Furthermore, unguided interventions have been shown to be much easier to implement and less costly than guided web-based interventions [72], and so it is important to continue to study their effectiveness. Thus, more research is needed to examine this issue [36].…”

Section: Discussionmentioning

confidence: 99%

An Internet-based treatment for flying phobia (NO-FEAR Airlines): study protocol for a randomized controlled trial

et al. 2016

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BackgroundFlying phobia (FP) is a common and disabling mental disorder. Although in vivo exposure is the treatment of choice, it is linked to a number of limitations in its implementation. Particularly important, is the limited access to the feared stimulus (i.e., plane). Moreover, the economic cost of in vivo exposure should be specially considered as well as the difficulty of applying the exposure technique in an appropriate way; controlling important variables such as the duration of the exposure or the number of sessions. ICTs could help to reduce these limitations. Computer-assisted treatments have remarkable advantages in treating FP. Furthermore, they can be delivered through the Internet, increasing their advantages and reaching more people in need. The Internet has been established as an effective way to treat a wide range of mental disorders. However, as far as we know, no controlled studies exist on FP treatment via the Internet. This study aims to evaluate the efficacy of an Internet-based treatment for FP (NO-FEAR Airlines) versus a waiting list control group. Secondary objectives will be to explore two ways of delivering NO-FEAR Airlines, with or without therapist guidance, and study the patients’ acceptance of the program. This paper presents the study protocol.Methods/designThe study is a randomized controlled trial. A minimum of 57 participants will be randomly assigned to three conditions: a) NO-FEAR Airlines totally self-applied, b) NO-FEAR Airlines with therapist guidance, or c) a waiting list control group (6 weeks). Primary outcomes measures will be the Fear of Flying Questionnaire-II and the Fear of Flying Scale. Secondary outcomes will be included to assess other relevant clinical measures, such as the Fear and Avoidance Scales, Clinician Severity Scale, and Patient’s Improvement scale. Analyses of post-treatment flights will be conducted. Treatment acceptance and preference measures will also be included. Intention-to-treat and per protocol analyses will be conducted.DiscussionAn Internet-based treatment for FP could have considerable advantages in managing in vivo exposure limitations, specifically in terms of access to treatment, acceptance, adherence, and the cost-effectiveness of the intervention. This is the first randomized controlled trial to study this issue.Trial registrationClinicaltrials.gov: NCT02298478. Trial registration date 3 November 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0996-1) contains supplementary material, which is available to authorized users.

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Predictors of treatment dropout in self-guided web-based interventions for depression: an ‘individual patient data’ meta-analysis

Abstract: Background: It is well known that web-based interventions can be effective treatments for

Cited by 303 publications

References 36 publications

Effects of a Psychological Internet Intervention in the Treatment of Mild to Moderate Depressive Symptoms: Results of the EVIDENT Study, a Randomized Controlled Trial

Effects of a Psychological Internet Intervention in the Treatment of Mild to Moderate Depressive Symptoms: Results of the EVIDENT Study, a Randomized Controlled Trial

Cost effectiveness of guided Internet-based interventions for depression in comparison with control conditions: An individual-participant data meta-analysis

An Internet-based treatment for flying phobia (NO-FEAR Airlines): study protocol for a randomized controlled trial

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