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

Eirini Karyotaki, David Daniel Ebert, Liesje Donkin, Heleen Riper, Jos Twisk, Simone Burger, Alexander Rozental, Alfred Lange, Alishia D. Williams, Anna Carlotta Zarski, Anna Geraedts, Annemieke van Straten (+36 others)
2018 Clinical Psychology Review  
Little is known about clinically relevant changes in guided Internet-based interventions. • Guided Internet-based interventions result in significantly higher remission and response compared to controls • Severity of depression, age and ethnicity significantly moderate treatment outcome. 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
more » ... nefit 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. E. Karyotaki et al.
doi:10.1016/j.cpr.2018.06.007 pmid:29940401 fatcat:gvs7glgkznbmnb6motbeov45xe