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Review
. 2023 Jan 9:10:e38955.
doi: 10.2196/38955.

Efficacy of Virtual Care for Depressive Disorders: Systematic Review and Meta-analysis

Crystal Edler Schiller  1 , Julianna Prim  1 , Anna E Bauer  1 , Linda Lux  1 , Laura Claire Lundegard  1 , Michelle Kang  1 , Samantha Hellberg  1 , Katherine Thompson  1 , Theresa Webber  1 , Adonay Teklezghi  1 , Noah Pettee  1 , Katherine Gaffney  1 , Gabrielle Hodgins  1 , Fariha Rahman  1 , J Nikki Steinsiek  1 , Anita Modi  1 , Bradley N Gaynes  1
Affiliations
Review

Efficacy of Virtual Care for Depressive Disorders: Systematic Review and Meta-analysis

Crystal Edler Schiller et al. JMIR Ment Health. .

Abstract

Background: The COVID-19 pandemic has created an epidemic of distress-related mental disorders such as depression, while simultaneously necessitating a shift to virtual domains of mental health care; yet, the evidence to support the use of virtual interventions is unclear.

Objective: The purpose of this study was to evaluate the efficacy of virtual interventions for depressive disorders by addressing three key questions: (1) Does virtual intervention provide better outcomes than no treatment or other control conditions (ie, waitlist, treatment as usual [TAU], or attention control)? (2) Does in-person intervention provide better outcomes than virtual intervention? (3) Does one type of virtual intervention provide better outcomes than another?

Methods: We searched the PubMed, EMBASE, and PsycINFO databases for trials published from January 1, 2010, to October 30, 2021. We included randomized controlled trials of adults with depressive disorders that tested a virtual intervention and used a validated depression measure. Primary outcomes were defined as remission (ie, no longer meeting the clinical cutoff for depression), response (ie, a clinically significant reduction in depressive symptoms), and depression severity at posttreatment. Two researchers independently selected studies and extracted data using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Risk of bias was evaluated based on Agency for Healthcare and Research Quality guidelines. We calculated odds ratios (ORs) for binary outcomes and standardized mean differences (SMDs) for continuous outcomes.

Results: We identified 3797 references, 24 of which were eligible. Compared with waitlist, virtual intervention had higher odds of remission (OR 10.30, 95% CI 5.70-18.60; N=619 patients) and lower posttreatment symptom severity (SMD 0.81, 95% CI 0.52-1.10; N=1071). Compared with TAU and virtual attention control conditions, virtual intervention had higher odds of remission (OR 2.27, 95% CI 1.10-3.35; N=512) and lower posttreatment symptom severity (SMD 0.25, 95% CI 0.09-0.42; N=573). In-person intervention outcomes were not significantly different from virtual intervention outcomes (eg, remission OR 0.84, CI 0.51-1.37; N=789). No eligible studies directly compared one active virtual intervention to another.

Conclusions: Virtual interventions were efficacious compared with control conditions, including waitlist control, TAU, and attention control. Although the number of studies was relatively small, the strength of evidence was moderate that in-person interventions did not yield significantly better outcomes than virtual interventions for depressive disorders.

Keywords: depression; depressive disorder; digital health; digital intervention; digital mental health; eHealth; efficacy; health intervention; health outcome; mental health; meta-analysis; review; therapy; treatment; virtual; virtual care; virtual intervention.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Study selection. *See Table A2 in Multimedia Appendix 1.
Figure 2
Figure 2
Forest plots of virtual intervention compared with waitlist control clinical outcomes. ΔBDI: Change in Beck Depression Inventory Score; ΔPHQ: Change in Patient Health Questionnaire-9 Score; BDI: Beck Depression Inventory; CES-D: Center for Epidemiologic Studies Depression Scale; MADRS-SR: Montgomery–Åsberg Depression Rating Scale – Self-Report Questionnaire; MDD: Major Depressive Disorder; PHQ-9: Patient Health Questionnaire-9.
Figure 3
Figure 3
Forest plots of virtual intervention compared with treatment as usual (TAU) clinical outcomes. ΔMADRS: Change in Montgomery–Åsberg Depression Rating Scale Score; ΔMADRS-SR: Change in Montgomery–Åsberg Depression Rating Scale – Self-Report Questionnaire Score; BDI: Beck Depression Inventory; EPDS: Edinburgh Postnatal Depression Scale; MDD: Major Depressive Disorder; MADRS: Montgomery–Åsberg Depression Rating Scale Interview; MADRS-SR: Montgomery–Åsberg Depression Rating Scale – Self-Report Questionnaire; PHQ-9: Patient Health Questionnaire-9.
Figure 4
Figure 4
Forest plots for virtual intervention (internet-based cognitive behavioral therapy [iCBT]) compared with virtual sham intervention clinical outcomes. ΔBDI: Change in Beck Depression Inventory Score; BDI: Beck Depression Inventory; HAMD: Hamilton Depression Rating Scale; IDS-SR: Inventory for Depressive Symptomatology – Self-Report; MDD: Major Depressive Disorder; SCID: Semi-Structured Clinical Interview for DSM Disorders.
Figure 5
Figure 5
Forest plots for in-person intervention compared with virtual intervention clinical outcomes (key question 2). ΔBDI: Change in Beck Depression Inventory Score; ΔHAMD: Change in Hamilton Depression Rating Scale Score; ΔMADRS: Change in Montgomery–Åsberg Depression Rating Scale Score; BDI: Beck Depression Inventory; HAMD: Hamilton Depression Rating Scale; MDD: Major Depressive Disorder; SCID: Semi-Structured Clinical Interview for DSM Disorders.
See this image and copyright information in PMC

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