TY - JOUR

T1 - Efficacy and Moderators of Internet-Based Interventions in Adults with Subthreshold Depression

T2 - An Individual Participant Data Meta-Analysis of Randomized Controlled Trials

AU - Reins, Jo Annika

AU - Buntrock, Claudia

AU - Zimmermann, Johannes

AU - Grund, Simon

AU - Harrer, Mathias

AU - Lehr, Dirk

AU - Baumeister, Harald

AU - Weisel, Kiona

AU - Domhardt, Matthias

AU - Imamura, Kotaro

AU - Kawakami, Norito

AU - Spek, Viola

AU - Nobis, Stephanie

AU - Snoek, Frank

AU - Cuijpers, Pim

AU - Klein, Jan Philipp

AU - Moritz, Steffen

AU - Ebert, David Daniel

PY - 2021/2

Y1 - 2021/2

N2 - Introduction: Evidence on effects of Internet-based interventions to treat subthreshold depression (sD) and prevent the onset of major depression (MDD) is inconsistent. Objective: We conducted an individual participant data meta-analysis to determine differences between intervention and control groups (IG, CG) in depressive symptom severity (DSS), treatment response, close to symptom-free status, symptom deterioration and MDD onset as well as moderators of intervention outcomes. Methods: Randomized controlled trials were identified through systematic searches via PubMed, PsycINFO, Embase and Cochrane Library. Multilevel regression analyses were used to examine efficacy and moderators. Results: Seven trials (2,186 participants) were included. The IG was superior in DSS at all measurement points (posttreatment: 6-12 weeks; Hedges' g = 0.39 [95% CI: 0.25-0.53]; follow-up 1: 3-6 months; g = 0.30 [95% CI: 0.15-0.45]; follow-up 2: 12 months, g = 0.27 [95% CI: 0.07-0.47], compared with the CG. Significantly more participants in the IG than in the CG reached response and close to symptom-free status at all measurement points. A significant difference in symptom deterioration between the groups was found at the posttreatment assessment and follow-up 2. Incidence rates for MDD onset within 12 months were lower in the IG (19%) than in the CG (26%). Higher initial DSS and older age were identified as moderators of intervention effect on DSS. Conclusions: Our findings provide evidence for Internet-based interventions to be a suitable low-threshold intervention to treat individuals with sD and to reduce the incidence of MDD. This might be particularly true for older people with a substantial symptom burden.

AB - Introduction: Evidence on effects of Internet-based interventions to treat subthreshold depression (sD) and prevent the onset of major depression (MDD) is inconsistent. Objective: We conducted an individual participant data meta-analysis to determine differences between intervention and control groups (IG, CG) in depressive symptom severity (DSS), treatment response, close to symptom-free status, symptom deterioration and MDD onset as well as moderators of intervention outcomes. Methods: Randomized controlled trials were identified through systematic searches via PubMed, PsycINFO, Embase and Cochrane Library. Multilevel regression analyses were used to examine efficacy and moderators. Results: Seven trials (2,186 participants) were included. The IG was superior in DSS at all measurement points (posttreatment: 6-12 weeks; Hedges' g = 0.39 [95% CI: 0.25-0.53]; follow-up 1: 3-6 months; g = 0.30 [95% CI: 0.15-0.45]; follow-up 2: 12 months, g = 0.27 [95% CI: 0.07-0.47], compared with the CG. Significantly more participants in the IG than in the CG reached response and close to symptom-free status at all measurement points. A significant difference in symptom deterioration between the groups was found at the posttreatment assessment and follow-up 2. Incidence rates for MDD onset within 12 months were lower in the IG (19%) than in the CG (26%). Higher initial DSS and older age were identified as moderators of intervention effect on DSS. Conclusions: Our findings provide evidence for Internet-based interventions to be a suitable low-threshold intervention to treat individuals with sD and to reduce the incidence of MDD. This might be particularly true for older people with a substantial symptom burden.

KW - eHealth

KW - Individual participant data meta-analysis

KW - Minor depression

KW - Moderators

KW - Online therapy

KW - Subclinical depression

KW - Health sciences

KW - Psychology

UR - http://www.scopus.com/inward/record.url?scp=85087341492&partnerID=8YFLogxK

U2 - 10.1159/000507819

DO - 10.1159/000507819

M3 - Journal articles

C2 - 32544912

AN - SCOPUS:85087341492

VL - 90

SP - 94

EP - 106

JO - Psychotherapy and Psychosomatics

JF - Psychotherapy and Psychosomatics

SN - 0033-3190

IS - 2

ER -