TY - JOUR

T1 - Do guided internet-based interventions result in clinically relevant changes for patients with depression?

T2 - An individual participant data meta-analysis

AU - Karyotaki, Eirini

AU - Ebert, David Daniel

AU - Donkin, Liesje

AU - Riper, Heleen

AU - Twisk, Jos

AU - Burger, Simone

AU - Rozental, Alexander

AU - Lange, Alfred

AU - Williams, Alishia D.

AU - Zarski, Anna Carlotta

AU - Geraedts, Anna

AU - van Straten, Annemieke

AU - Kleiboer, Annet

AU - Meyer, Björn

AU - Ünlü Ince, Burçin B.

AU - Buntrock, Claudia

AU - Lehr, Dirk

AU - Snoek, Frank J.

AU - Andrews, Gavin

AU - Andersson, Gerhard

AU - Choi, Isabella

AU - Ruwaard, Jeroen

AU - Klein, Jan Philipp

AU - Newby, Jill M.

AU - Schröder, Johanna

AU - Laferton, Johannes A.C.

AU - Van Bastelaar, Kim

AU - Imamura, Kotaro

AU - Vernmark, Kristofer

AU - Boß, Leif

AU - Sheeber, Lisa B.

AU - Kivi, Marie

AU - Berking, Matthias

AU - Titov, Nickolai

AU - Carlbring, Per

AU - Johansson, Robert

AU - Kenter, Robin

AU - Perini, Sarah

AU - Moritz, Steffen

AU - Nobis, Stephanie

AU - Berger, Thomas

AU - Kaldo, Viktor

AU - Forsell, Yvonne

AU - Lindefors, Nils

AU - Kraepelien, Martin

AU - Björkelund, Cecilia

AU - Kawakami, Norito

AU - Cuijpers, Pim

PY - 2018/7/1

Y1 - 2018/7/1

N2 - 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.

AB - 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.

KW - Psychology

KW - Depression

KW - Internet-based guided self-help

KW - Meta-analysis

KW - Psychotherapy

UR - http://www.scopus.com/inward/record.url?scp=85048853348&partnerID=8YFLogxK

U2 - 10.1016/j.cpr.2018.06.007

DO - 10.1016/j.cpr.2018.06.007

M3 - Scientific review articles

C2 - 29940401

AN - SCOPUS:85048853348

VL - 63

SP - 80

EP - 92

JO - Clinical Psychology Review

JF - Clinical Psychology Review

SN - 0272-7358

ER -