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

Eirini Karyotaki¹, David Daniel Ebert², Liesje Donkin³, Heleen Riper⁴, Jos Twisk⁵, Simone Burger⁴, Alexander Rozental⁶, Alfred Lange⁷, Alishia D Williams⁸, Anna Carlotta Zarski², Anna Geraedts⁹, Annemieke van Straten⁴, Annet Kleiboer⁴, Björn Meyer¹⁰, Burçin B Ünlü Ince¹¹, Claudia Buntrock², Dirk Lehr¹², Frank J Snoek¹³, Gavin Andrews¹⁴, Gerhard Andersson¹⁵, Isabella Choi¹⁶, Jeroen Ruwaard⁴, Jan Philipp Klein¹⁷, Jill M Newby¹⁸, Johanna Schröder¹⁹, Johannes A C Laferton², Kim Van Bastelaar²⁰, Kotaro Imamura²¹, Kristofer Vernmark²², Leif Boß¹², Lisa B Sheeber²³, Marie Kivi²⁴, Matthias Berking², Nickolai Titov²⁵, Per Carlbring²⁶, Robert Johansson²⁷, Robin Kenter²⁸, Sarah Perini²⁹, Steffen Moritz⁴, Stephanie Nobis³⁰, Thomas Berger³¹, Viktor Kaldo³², Yvonne Forsell³³, Nils Lindefors³³, Martin Kraepelien³³, Cecilia Björkelund³⁴, Norito Kawakami²¹, Pim Cuijpers⁴

Affiliations

¹ Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands. Electronic address: e.karyotaki@vu.nl.
² Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
³ The Brain and Mind Research Institute, University of Sydney, NSW 2050, Australia.
⁴ Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands.
⁵ Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands.
⁶ Institute of Child Health, University College London, United Kingdom; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
⁷ Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands.
⁸ Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.
⁹ HumanTotalCare, Utrecht, the Netherlands.
¹⁰ Research Department, Gaia AG, Hamburg, Germany; Department of Psychology, City, University of London, London, United Kingdom.
¹¹ Informatics Institute, Middle East Technical University, Ankara, Turkey.
¹² Institute of Psychology, Leuphana University Lüneburg, Germany.
¹³ Department of Medical Psychology, VU Medical Center, Academic Medical Center, Public Health Research institute, Amsterdam, the Netherlands.
¹⁴ Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia.
¹⁵ Department of Behavioral Sciences and Learning, Linköping University, Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institute for Disability Research, Stockholm, Sweden.
¹⁶ Brain and Mind Centre, University of Sydney, Sydney, Australia.
¹⁷ Department of Psychiatry and Psychotherapy, Luebeck University, Luebeck, Germany.
¹⁸ Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia; The MRC Cognition and Brain Sciences Unit, Cambridge, United Kingdom; School of Psychology, the University of New South Wales, Sydney, Australia.
¹⁹ Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute for Sex Research and Forensic Psychiatry, Hamburg, Germany.
²⁰ Department of Medical Psychology, VU Medical Center, Amsterdam, the Netherlands.
²¹ Department of Mental Health, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyō-ku, Tokyo, Japan.
²² Department of Behavioural Sciences and Learning, Linkoping University, Linkoping, Sweden.
²³ Oregon Research Institute, Eugene, OR, USA.
²⁴ Department of Psychology, University of Gothenburg, Göteborg, Sweden.
²⁵ MindSpot Clinic and eCentreClinic, Department of Psychology, Macquarie University, Australia.
²⁶ Department of Psychology, Stockholm University, Stockholm, Sweden; Department of Psychology, University of Southern Denmark, Denmark.
²⁷ Department of Behavioral Sciences and Learning, Linköping University, and Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
²⁸ Department of Clinical Psychology, University of Bergen, Bergen, Norway.
²⁹ Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, New South Wales, Australia.
³⁰ Division of Online Health Training, Innovation Incubator, Leuphana University Lüneburg, Germany.
³¹ Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
³² Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
³³ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
³⁴ Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

PMID: 29940401
DOI: 10.1016/j.cpr.2018.06.007

Review

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

Eirini Karyotaki et al. Clin Psychol Rev. 2018 Jul.

. 2018 Jul:63:80-92.

doi: 10.1016/j.cpr.2018.06.007. Epub 2018 Jun 19.

Authors

Affiliations

¹ Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands. Electronic address: e.karyotaki@vu.nl.
² Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
³ The Brain and Mind Research Institute, University of Sydney, NSW 2050, Australia.
⁴ Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands.
⁵ Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands.
⁶ Institute of Child Health, University College London, United Kingdom; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
⁷ Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands.
⁸ Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.
⁹ HumanTotalCare, Utrecht, the Netherlands.
¹⁰ Research Department, Gaia AG, Hamburg, Germany; Department of Psychology, City, University of London, London, United Kingdom.
¹¹ Informatics Institute, Middle East Technical University, Ankara, Turkey.
¹² Institute of Psychology, Leuphana University Lüneburg, Germany.
¹³ Department of Medical Psychology, VU Medical Center, Academic Medical Center, Public Health Research institute, Amsterdam, the Netherlands.
¹⁴ Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia.
¹⁵ Department of Behavioral Sciences and Learning, Linköping University, Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institute for Disability Research, Stockholm, Sweden.
¹⁶ Brain and Mind Centre, University of Sydney, Sydney, Australia.
¹⁷ Department of Psychiatry and Psychotherapy, Luebeck University, Luebeck, Germany.
¹⁸ Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia; The MRC Cognition and Brain Sciences Unit, Cambridge, United Kingdom; School of Psychology, the University of New South Wales, Sydney, Australia.
¹⁹ Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute for Sex Research and Forensic Psychiatry, Hamburg, Germany.
²⁰ Department of Medical Psychology, VU Medical Center, Amsterdam, the Netherlands.
²¹ Department of Mental Health, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyō-ku, Tokyo, Japan.
²² Department of Behavioural Sciences and Learning, Linkoping University, Linkoping, Sweden.
²³ Oregon Research Institute, Eugene, OR, USA.
²⁴ Department of Psychology, University of Gothenburg, Göteborg, Sweden.
²⁵ MindSpot Clinic and eCentreClinic, Department of Psychology, Macquarie University, Australia.
²⁶ Department of Psychology, Stockholm University, Stockholm, Sweden; Department of Psychology, University of Southern Denmark, Denmark.
²⁷ Department of Behavioral Sciences and Learning, Linköping University, and Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
²⁸ Department of Clinical Psychology, University of Bergen, Bergen, Norway.
²⁹ Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, New South Wales, Australia.
³⁰ Division of Online Health Training, Innovation Incubator, Leuphana University Lüneburg, Germany.
³¹ Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
³² Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
³³ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
³⁴ Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

PMID: 29940401
DOI: 10.1016/j.cpr.2018.06.007

Abstract

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.

Keywords: Depression; Internet-based guided self-help; Meta-analysis; Psychotherapy.

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

Affiliations

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

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Abstract

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LinkOut - more resources

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