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1. Internet-Based Cognitive Behavioral Therapy for Depression: A Systematic Review and Individual Patient Data Network Meta-analysis

Author

Karyotaki, Eirini, Efthimiou, Orestis, Miguel, Clara, Bermpohl, Frederic Maas Genannt, Furukawa, Toshi A., Cuijpers, Pim, Riper, Heleen, Patel, Vikram, Mira, Adriana, Gemmil, Alan W., Yeung, Albert S., Lange, Alfred, Williams, Alishia D., Mackinnon, Andrew, Geraedts, Anna, Van Straten, Annemieke, Meyer, Björn, Björkelund, Cecilia, Knaevelsrud, Christine, Beevers, Christopher G., Botella, Cristina, Strunk, Daniel R., Mohr, David C., Ebert, David D., Kessler, David, Richards, Derek, Littlewood, Elizabeth, Forsell, Erik, Feng, Fan, Wang, Fang, Andersson, Gerhard, Hadjistavropoulos, Heather, Christensen, Heleen, Ezawa, Iony D., Choi, Isabella, Rosso, Isabelle M., Klein, Jan Philipp, Shumake, Jason, Garcia-Campayo, Javier, Milgrom, Jeannette, Smith, Jessica, Montero-Marin, Jesus, Newby, Jill M., Bretón-López, Juana, Schneider, Justine, Vernmark, Kristofer, Bücker, Lara, Sheeber, Lisa B., Warmerdam, Lisanne, Farrer, Louise, Heinrich, Manuel, Huibers, Marcus J.H., Kivi, Marie, Kraepelien, Martin, Forand, Nicholas R., Pugh, Nicky, Lindefors, Nils, Lintvedt, Ove, Zagorscak, Pavle, Carlbring, Per, Phillips, Rachel, Johansson, Robert, Kessler, Ronald C., Brabyn, Sally, Perini, Sarah, Rauch, Scott L., Gilbody, Simon, Moritz, Steffen, Berger, Thomas, Pop, Victor, Kaldo, Viktor, Spek, Viola, Forsell, Yvonne, Karyotaki, Eirini, Efthimiou, Orestis, Miguel, Clara, Bermpohl, Frederic Maas Genannt, Furukawa, Toshi A., Cuijpers, Pim, Riper, Heleen, Patel, Vikram, Mira, Adriana, Gemmil, Alan W., Yeung, Albert S., Lange, Alfred, Williams, Alishia D., Mackinnon, Andrew, Geraedts, Anna, Van Straten, Annemieke, Meyer, Björn, Björkelund, Cecilia, Knaevelsrud, Christine, Beevers, Christopher G., Botella, Cristina, Strunk, Daniel R., Mohr, David C., Ebert, David D., Kessler, David, Richards, Derek, Littlewood, Elizabeth, Forsell, Erik, Feng, Fan, Wang, Fang, Andersson, Gerhard, Hadjistavropoulos, Heather, Christensen, Heleen, Ezawa, Iony D., Choi, Isabella, Rosso, Isabelle M., Klein, Jan Philipp, Shumake, Jason, Garcia-Campayo, Javier, Milgrom, Jeannette, Smith, Jessica, Montero-Marin, Jesus, Newby, Jill M., Bretón-López, Juana, Schneider, Justine, Vernmark, Kristofer, Bücker, Lara, Sheeber, Lisa B., Warmerdam, Lisanne, Farrer, Louise, Heinrich, Manuel, Huibers, Marcus J.H., Kivi, Marie, Kraepelien, Martin, Forand, Nicholas R., Pugh, Nicky, Lindefors, Nils, Lintvedt, Ove, Zagorscak, Pavle, Carlbring, Per, Phillips, Rachel, Johansson, Robert, Kessler, Ronald C., Brabyn, Sally, Perini, Sarah, Rauch, Scott L., Gilbody, Simon, Moritz, Steffen, Berger, Thomas, Pop, Victor, Kaldo, Viktor, Spek, Viola, and Forsell, Yvonne

Abstract

Importance: Personalized treatment choices would increase the effectiveness of internet-based cognitive behavioral therapy (iCBT) for depression to the extent that patients differ in interventions that better suit them. Objective: To provide personalized estimates of short-term and long-term relative efficacy of guided and unguided iCBT for depression using patient-level information. Data Sources: We searched PubMed, Embase, PsycInfo, and Cochrane Library to identify randomized clinical trials (RCTs) published up to January 1, 2019. Study Selection: Eligible RCTs were those comparing guided or unguided iCBT against each other or against any control intervention in individuals with depression. Available individual patient data (IPD) was collected from all eligible studies. Depression symptom severity was assessed after treatment, 6 months, and 12 months after randomization. Data Extraction and Synthesis: We conducted a systematic review and IPD network meta-analysis and estimated relative treatment effect sizes across different patient characteristics through IPD network meta-regression. Main Outcomes and Measures: Patient Health Questionnaire-9 (PHQ-9) scores. Results: Of 42 eligible RCTs, 39 studies comprising 9751 participants with depression contributed IPD to the IPD network meta-analysis, of which 8107 IPD were synthesized. Overall, both guided and unguided iCBT were associated with more effectiveness as measured by PHQ-9 scores than control treatments over the short term and the long term. Guided iCBT was associated with more effectiveness than unguided iCBT (mean difference [MD] in posttreatment PHQ-9 scores, -0.8; 95% CI, -1.4 to -0.2), but we found no evidence of a difference at 6 or 12 months following randomization. Baseline depression was found to be the most important modifier of the relative association for efficacy of guided vs unguided iCBT. Differences between unguided and guided iCBT in people with baseline symptoms of subthreshold depression (P

Published
2021
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2. Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data

Author

Furukawa, Toshi A., Suganuma, Aya, Ostinelli, Edoardo G., Andersson, Gerhard, Beevers, Christopher G., Shumake, Jason, Berger, Thomas, Boele, Florien Willemijn, Buntrock, Claudia, Carlbring, Per, Choi, Isabella, Christensen, Helen, Mackinnon, Andrew, Dahne, Jennifer, Huibers, Marcus J. H., Ebert, David D., Farrer, Louise, Forand, Nicholas R., Strunk, Daniel R., Ezawa, Iony D., Forsell, Erik, Kaldo, Viktor, Geraedts, Anna, Gilbody, Simon, Littlewood, Elizabeth, Brabyn, Sally, Hadjistavropoulos, Heather D., Schneider, Luke H., Johansson, Robert, Kenter, Robin, Kivi, Marie, Bjorkelund, Cecilia, Kleiboer, Annet, Riper, Heleen, Klein, Jan Philipp, Schroder, Johanna, Meyer, Bjorn, Moritz, Steffen, Bucker, Lara, Lintvedt, Ove, Johansson, Peter, Lundgren, Johan, Milgrom, Jeannette, Gemmill, Alan W., Mohr, David C., Montero-Marin, Jesus, Garcia-Campayo, Javier, Nobis, Stephanie, Zarski, Anna-Carlotta, O'Moore, Kathleen, Williams, Alishia D., Newby, Jill M., Perini, Sarah, Phillips, Rachel, Schneider, Justine, Pots, Wendy, Pugh, Nicole E., Richards, Derek, Rosso, Isabelle M., Rauch, Scott L., Sheeber, Lisa B., Smith, Jessica, Spek, Viola, Pop, Victor J., Unlu, Burcin, van Bastelaar, Kim M. P., van Luenen, Sanne, Garnefski, Nadia, Kraaij, Vivian, Vernmark, Kristofer, Warmerdam, Lisanne, van Straten, Annemieke, Zagorscak, Pavle, Knaevelsrud, Christine, Heinrich, Manuel, Miguel, Clara, Cipriani, Andrea, Efthimiou, Orestis, Karyotaki, Eirini, Cuijpers, Pim, Furukawa, Toshi A., Suganuma, Aya, Ostinelli, Edoardo G., Andersson, Gerhard, Beevers, Christopher G., Shumake, Jason, Berger, Thomas, Boele, Florien Willemijn, Buntrock, Claudia, Carlbring, Per, Choi, Isabella, Christensen, Helen, Mackinnon, Andrew, Dahne, Jennifer, Huibers, Marcus J. H., Ebert, David D., Farrer, Louise, Forand, Nicholas R., Strunk, Daniel R., Ezawa, Iony D., Forsell, Erik, Kaldo, Viktor, Geraedts, Anna, Gilbody, Simon, Littlewood, Elizabeth, Brabyn, Sally, Hadjistavropoulos, Heather D., Schneider, Luke H., Johansson, Robert, Kenter, Robin, Kivi, Marie, Bjorkelund, Cecilia, Kleiboer, Annet, Riper, Heleen, Klein, Jan Philipp, Schroder, Johanna, Meyer, Bjorn, Moritz, Steffen, Bucker, Lara, Lintvedt, Ove, Johansson, Peter, Lundgren, Johan, Milgrom, Jeannette, Gemmill, Alan W., Mohr, David C., Montero-Marin, Jesus, Garcia-Campayo, Javier, Nobis, Stephanie, Zarski, Anna-Carlotta, O'Moore, Kathleen, Williams, Alishia D., Newby, Jill M., Perini, Sarah, Phillips, Rachel, Schneider, Justine, Pots, Wendy, Pugh, Nicole E., Richards, Derek, Rosso, Isabelle M., Rauch, Scott L., Sheeber, Lisa B., Smith, Jessica, Spek, Viola, Pop, Victor J., Unlu, Burcin, van Bastelaar, Kim M. P., van Luenen, Sanne, Garnefski, Nadia, Kraaij, Vivian, Vernmark, Kristofer, Warmerdam, Lisanne, van Straten, Annemieke, Zagorscak, Pavle, Knaevelsrud, Christine, Heinrich, Manuel, Miguel, Clara, Cipriani, Andrea, Efthimiou, Orestis, Karyotaki, Eirini, and Cuijpers, Pim

Abstract

Background Internet cognitive behavioural therapy (iCBT) is a viable delivery format of CBT for depression. However, iCBT programmes include training in a wide array of cognitive and behavioural skills via different delivery methods, and it remains unclear which of these components are more efficacious and for whom. Methods We did a systematic review and individual participant data component network meta-analysis (cNMA) of iCBT trials for depression. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomised controlled trials (RCTs) published from database inception to Jan 1, 2019, that compared any form of iCBT against another or a control condition in the acute treatment of adults (aged ≥18 years) with depression. Studies with inpatients or patients with bipolar depression were excluded. We sought individual participant data from the original authors. When these data were unavailable, we used aggregate data. Two independent researchers identified the included components. The primary outcome was depression severity, expressed as incremental mean difference (iMD) in the Patient Health Questionnaire-9 (PHQ-9) scores when a component is added to a treatment. We developed a web app that estimates relative efficacies between any two combinations of components, given baseline patient characteristics. This study is registered in PROSPERO, CRD42018104683. Findings We identified 76 RCTs, including 48 trials contributing individual participant data (11 704 participants) and 28 trials with aggregate data (6474 participants). The participants' weighted mean age was 42·0 years and 12 406 (71%) of 17 521 reported were women. There was suggestive evidence that behavioural activation might be beneficial (iMD −1·83 [95% credible interval (CrI) −2·90 to −0·80]) and that relaxation might be harmful (1·20 [95% CrI 0·17 to 2·27]). Baseline severity emerged as the strongest prognostic factor for endpoint depression. Combining human and au

Published
2021
Full Text
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3. Internet-Based Cognitive Behavioral Therapy for Depression : A Systematic Review and Individual Patient Data Network Meta-analysis

Author

Karyotaki, Eirini, Efthimiou, Orestis, Miguel, Clara, Bermpohl, Frederic Maas Genannt, Furukawa, Toshi A, Cuijpers, Pim, Riper, Heleen, Patel, Vikram, Mira, Adriana, Gemmil, Alan W., Yeung, Albert S., Lange, Alfred, Williams, Alishia D., Mackinnon, Andrew, Geraedts, Anna, van Straten, Annemieke, Meyer, Björn, Björkelund, Cecilia, Knaevelsrud, Christine, Beevers, Christopher G., Botella, Cristina, Strunk, Daniel R., Mohr, David C., Ebert, David D., Kessler, David, Richards, Derek, Littlewood, Elizabeth, Forsell, Erik, Feng, Fan, Wang, Fang, Andersson, Gerhard, Hadjistavropoulos, Heather, Christensen, Heleen, Ezawa, Iony D., Choi, Isabella, Rosso, Isabelle M, Klein, Jan Philipp, Shumake, Jason, Garcia-Campayo, Javier, Milgrom, Jeannette, Smith, Jessica, Montero-Marin, Jesus, Newby, Jill M., Bretón-López, Juana, Schneider, Justine, Vernmark, Kristofer, Bücker, Lara, Sheeber, Lisa B., Warmerdam, Lisanne, Farrer, Louise, Heinrich, Manuel, Huibers, Marcus J. H., Kivi, Marie, Kraepelien, Martin, Forand, Nicholas R., Pugh, Nicky, Lindefors, Nils, Lintvedt, Ove, Zagorscak, Pavle, Carlbring, Per, Phillips, Rachel, Johansson, Robert, Kessler, Ronald C., Brabyn, Sally, Perini, Sarah, Rauch, Scott L., Gilbody, Simon, Moritz, Steffen, Berger, Thomas, Pop, Victor, Kaldo, Viktor, Spek, Viola, Forsell, Yvonne, Karyotaki, Eirini, Efthimiou, Orestis, Miguel, Clara, Bermpohl, Frederic Maas Genannt, Furukawa, Toshi A, Cuijpers, Pim, Riper, Heleen, Patel, Vikram, Mira, Adriana, Gemmil, Alan W., Yeung, Albert S., Lange, Alfred, Williams, Alishia D., Mackinnon, Andrew, Geraedts, Anna, van Straten, Annemieke, Meyer, Björn, Björkelund, Cecilia, Knaevelsrud, Christine, Beevers, Christopher G., Botella, Cristina, Strunk, Daniel R., Mohr, David C., Ebert, David D., Kessler, David, Richards, Derek, Littlewood, Elizabeth, Forsell, Erik, Feng, Fan, Wang, Fang, Andersson, Gerhard, Hadjistavropoulos, Heather, Christensen, Heleen, Ezawa, Iony D., Choi, Isabella, Rosso, Isabelle M, Klein, Jan Philipp, Shumake, Jason, Garcia-Campayo, Javier, Milgrom, Jeannette, Smith, Jessica, Montero-Marin, Jesus, Newby, Jill M., Bretón-López, Juana, Schneider, Justine, Vernmark, Kristofer, Bücker, Lara, Sheeber, Lisa B., Warmerdam, Lisanne, Farrer, Louise, Heinrich, Manuel, Huibers, Marcus J. H., Kivi, Marie, Kraepelien, Martin, Forand, Nicholas R., Pugh, Nicky, Lindefors, Nils, Lintvedt, Ove, Zagorscak, Pavle, Carlbring, Per, Phillips, Rachel, Johansson, Robert, Kessler, Ronald C., Brabyn, Sally, Perini, Sarah, Rauch, Scott L., Gilbody, Simon, Moritz, Steffen, Berger, Thomas, Pop, Victor, Kaldo, Viktor, Spek, Viola, and Forsell, Yvonne

Abstract

IMPORTANCE: Personalized treatment choices would increase the effectiveness of internet-based cognitive behavioral therapy (iCBT) for depression to the extent that patients differ in interventions that better suit them. OBJECTIVE: To provide personalized estimates of short-term and long-term relative efficacy of guided and unguided iCBT for depression using patient-level information. DATA SOURCES: We searched PubMed, Embase, PsycInfo, and Cochrane Library to identify randomized clinical trials (RCTs) published up to January 1, 2019. STUDY SELECTION: Eligible RCTs were those comparing guided or unguided iCBT against each other or against any control intervention in individuals with depression. Available individual patient data (IPD) was collected from all eligible studies. Depression symptom severity was assessed after treatment, 6 months, and 12 months after randomization. DATA EXTRACTION AND SYNTHESIS: We conducted a systematic review and IPD network meta-analysis and estimated relative treatment effect sizes across different patient characteristics through IPD network meta-regression. MAIN OUTCOMES AND MEASURES: Patient Health Questionnaire-9 (PHQ-9) scores. RESULTS: Of 42 eligible RCTs, 39 studies comprising 9751 participants with depression contributed IPD to the IPD network meta-analysis, of which 8107 IPD were synthesized. Overall, both guided and unguided iCBT were associated with more effectiveness as measured by PHQ-9 scores than control treatments over the short term and the long term. Guided iCBT was associated with more effectiveness than unguided iCBT (mean difference [MD] in posttreatment PHQ-9 scores, -0.8; 95% CI, -1.4 to -0.2), but we found no evidence of a difference at 6 or 12 months following randomization. Baseline depression was found to be the most important modifier of the relative association for efficacy of guided vs unguided iCBT. Differences between unguided and guided iCBT in people with baseline symptoms of subthreshold depression (PHQ

Published
2021
Full Text
View/download PDF

4. Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data

Author

Furukawa, Toshi A., Suganuma, Aya, Ostinelli, Edoardo G., Andersson, Gerhard, Beevers, Christopher G., Shumake, Jason, Berger, Thomas, Boele, Florien Willemijn, Buntrock, Claudia, Carlbring, Per, Choi, Isabella, Christensen, Helen, Mackinnon, Andrew, Dahne, Jennifer, Huibers, Marcus J. H., Ebert, David D., Farrer, Louise, Forand, Nicholas R., Strunk, Daniel R., Ezawa, Iony D., Forsell, Erik, Kaldo, Viktor, Geraedts, Anna, Gilbody, Simon, Littlewood, Elizabeth, Brabyn, Sally, Hadjistavropoulos, Heather D., Schneider, Luke H., Johansson, Robert, Kenter, Robin, Kivi, Marie, Bjorkelund, Cecilia, Kleiboer, Annet, Riper, Heleen, Klein, Jan Philipp, Schroder, Johanna, Meyer, Bjorn, Moritz, Steffen, Bucker, Lara, Lintvedt, Ove, Johansson, Peter, Lundgren, Johan, Milgrom, Jeannette, Gemmill, Alan W., Mohr, David C., Montero-Marin, Jesus, Garcia-Campayo, Javier, Nobis, Stephanie, Zarski, Anna-Carlotta, O'Moore, Kathleen, Williams, Alishia D., Newby, Jill M., Perini, Sarah, Phillips, Rachel, Schneider, Justine, Pots, Wendy, Pugh, Nicole E., Richards, Derek, Rosso, Isabelle M., Rauch, Scott L., Sheeber, Lisa B., Smith, Jessica, Spek, Viola, Pop, Victor J., Unlu, Burcin, van Bastelaar, Kim M. P., van Luenen, Sanne, Garnefski, Nadia, Kraaij, Vivian, Vernmark, Kristofer, Warmerdam, Lisanne, van Straten, Annemieke, Zagorscak, Pavle, Knaevelsrud, Christine, Heinrich, Manuel, Miguel, Clara, Cipriani, Andrea, Efthimiou, Orestis, Karyotaki, Eirini, Cuijpers, Pim, Furukawa, Toshi A., Suganuma, Aya, Ostinelli, Edoardo G., Andersson, Gerhard, Beevers, Christopher G., Shumake, Jason, Berger, Thomas, Boele, Florien Willemijn, Buntrock, Claudia, Carlbring, Per, Choi, Isabella, Christensen, Helen, Mackinnon, Andrew, Dahne, Jennifer, Huibers, Marcus J. H., Ebert, David D., Farrer, Louise, Forand, Nicholas R., Strunk, Daniel R., Ezawa, Iony D., Forsell, Erik, Kaldo, Viktor, Geraedts, Anna, Gilbody, Simon, Littlewood, Elizabeth, Brabyn, Sally, Hadjistavropoulos, Heather D., Schneider, Luke H., Johansson, Robert, Kenter, Robin, Kivi, Marie, Bjorkelund, Cecilia, Kleiboer, Annet, Riper, Heleen, Klein, Jan Philipp, Schroder, Johanna, Meyer, Bjorn, Moritz, Steffen, Bucker, Lara, Lintvedt, Ove, Johansson, Peter, Lundgren, Johan, Milgrom, Jeannette, Gemmill, Alan W., Mohr, David C., Montero-Marin, Jesus, Garcia-Campayo, Javier, Nobis, Stephanie, Zarski, Anna-Carlotta, O'Moore, Kathleen, Williams, Alishia D., Newby, Jill M., Perini, Sarah, Phillips, Rachel, Schneider, Justine, Pots, Wendy, Pugh, Nicole E., Richards, Derek, Rosso, Isabelle M., Rauch, Scott L., Sheeber, Lisa B., Smith, Jessica, Spek, Viola, Pop, Victor J., Unlu, Burcin, van Bastelaar, Kim M. P., van Luenen, Sanne, Garnefski, Nadia, Kraaij, Vivian, Vernmark, Kristofer, Warmerdam, Lisanne, van Straten, Annemieke, Zagorscak, Pavle, Knaevelsrud, Christine, Heinrich, Manuel, Miguel, Clara, Cipriani, Andrea, Efthimiou, Orestis, Karyotaki, Eirini, and Cuijpers, Pim

Abstract

Background Internet cognitive behavioural therapy (iCBT) is a viable delivery format of CBT for depression. However, iCBT programmes include training in a wide array of cognitive and behavioural skills via different delivery methods, and it remains unclear which of these components are more efficacious and for whom. Methods We did a systematic review and individual participant data component network meta-analysis (cNMA) of iCBT trials for depression. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomised controlled trials (RCTs) published from database inception to Jan 1, 2019, that compared any form of iCBT against another or a control condition in the acute treatment of adults (aged ≥18 years) with depression. Studies with inpatients or patients with bipolar depression were excluded. We sought individual participant data from the original authors. When these data were unavailable, we used aggregate data. Two independent researchers identified the included components. The primary outcome was depression severity, expressed as incremental mean difference (iMD) in the Patient Health Questionnaire-9 (PHQ-9) scores when a component is added to a treatment. We developed a web app that estimates relative efficacies between any two combinations of components, given baseline patient characteristics. This study is registered in PROSPERO, CRD42018104683. Findings We identified 76 RCTs, including 48 trials contributing individual participant data (11 704 participants) and 28 trials with aggregate data (6474 participants). The participants' weighted mean age was 42·0 years and 12 406 (71%) of 17 521 reported were women. There was suggestive evidence that behavioural activation might be beneficial (iMD −1·83 [95% credible interval (CrI) −2·90 to −0·80]) and that relaxation might be harmful (1·20 [95% CrI 0·17 to 2·27]). Baseline severity emerged as the strongest prognostic factor for endpoint depression. Combining human and au

Published
2021
Full Text
View/download PDF

5. Internet-Based Cognitive Behavioral Therapy for Depression: A Systematic Review and Individual Patient Data Network Meta-analysis

Author

Karyotaki, Eirini, Efthimiou, Orestis, Miguel, Clara, Bermpohl, Frederic Maas Genannt, Furukawa, Toshi A., Cuijpers, Pim, Riper, Heleen, Patel, Vikram, Mira, Adriana, Gemmil, Alan W., Yeung, Albert S., Lange, Alfred, Williams, Alishia D., Mackinnon, Andrew, Geraedts, Anna, Van Straten, Annemieke, Meyer, Björn, Björkelund, Cecilia, Knaevelsrud, Christine, Beevers, Christopher G., Botella, Cristina, Strunk, Daniel R., Mohr, David C., Ebert, David D., Kessler, David, Richards, Derek, Littlewood, Elizabeth, Forsell, Erik, Feng, Fan, Wang, Fang, Andersson, Gerhard, Hadjistavropoulos, Heather, Christensen, Heleen, Ezawa, Iony D., Choi, Isabella, Rosso, Isabelle M., Klein, Jan Philipp, Shumake, Jason, Garcia-Campayo, Javier, Milgrom, Jeannette, Smith, Jessica, Montero-Marin, Jesus, Newby, Jill M., Bretón-López, Juana, Schneider, Justine, Vernmark, Kristofer, Bücker, Lara, Sheeber, Lisa B., Warmerdam, Lisanne, Farrer, Louise, Heinrich, Manuel, Huibers, Marcus J.H., Kivi, Marie, Kraepelien, Martin, Forand, Nicholas R., Pugh, Nicky, Lindefors, Nils, Lintvedt, Ove, Zagorscak, Pavle, Carlbring, Per, Phillips, Rachel, Johansson, Robert, Kessler, Ronald C., Brabyn, Sally, Perini, Sarah, Rauch, Scott L., Gilbody, Simon, Moritz, Steffen, Berger, Thomas, Pop, Victor, Kaldo, Viktor, Spek, Viola, Forsell, Yvonne, Karyotaki, Eirini, Efthimiou, Orestis, Miguel, Clara, Bermpohl, Frederic Maas Genannt, Furukawa, Toshi A., Cuijpers, Pim, Riper, Heleen, Patel, Vikram, Mira, Adriana, Gemmil, Alan W., Yeung, Albert S., Lange, Alfred, Williams, Alishia D., Mackinnon, Andrew, Geraedts, Anna, Van Straten, Annemieke, Meyer, Björn, Björkelund, Cecilia, Knaevelsrud, Christine, Beevers, Christopher G., Botella, Cristina, Strunk, Daniel R., Mohr, David C., Ebert, David D., Kessler, David, Richards, Derek, Littlewood, Elizabeth, Forsell, Erik, Feng, Fan, Wang, Fang, Andersson, Gerhard, Hadjistavropoulos, Heather, Christensen, Heleen, Ezawa, Iony D., Choi, Isabella, Rosso, Isabelle M., Klein, Jan Philipp, Shumake, Jason, Garcia-Campayo, Javier, Milgrom, Jeannette, Smith, Jessica, Montero-Marin, Jesus, Newby, Jill M., Bretón-López, Juana, Schneider, Justine, Vernmark, Kristofer, Bücker, Lara, Sheeber, Lisa B., Warmerdam, Lisanne, Farrer, Louise, Heinrich, Manuel, Huibers, Marcus J.H., Kivi, Marie, Kraepelien, Martin, Forand, Nicholas R., Pugh, Nicky, Lindefors, Nils, Lintvedt, Ove, Zagorscak, Pavle, Carlbring, Per, Phillips, Rachel, Johansson, Robert, Kessler, Ronald C., Brabyn, Sally, Perini, Sarah, Rauch, Scott L., Gilbody, Simon, Moritz, Steffen, Berger, Thomas, Pop, Victor, Kaldo, Viktor, Spek, Viola, and Forsell, Yvonne

Abstract

Importance: Personalized treatment choices would increase the effectiveness of internet-based cognitive behavioral therapy (iCBT) for depression to the extent that patients differ in interventions that better suit them. Objective: To provide personalized estimates of short-term and long-term relative efficacy of guided and unguided iCBT for depression using patient-level information. Data Sources: We searched PubMed, Embase, PsycInfo, and Cochrane Library to identify randomized clinical trials (RCTs) published up to January 1, 2019. Study Selection: Eligible RCTs were those comparing guided or unguided iCBT against each other or against any control intervention in individuals with depression. Available individual patient data (IPD) was collected from all eligible studies. Depression symptom severity was assessed after treatment, 6 months, and 12 months after randomization. Data Extraction and Synthesis: We conducted a systematic review and IPD network meta-analysis and estimated relative treatment effect sizes across different patient characteristics through IPD network meta-regression. Main Outcomes and Measures: Patient Health Questionnaire-9 (PHQ-9) scores. Results: Of 42 eligible RCTs, 39 studies comprising 9751 participants with depression contributed IPD to the IPD network meta-analysis, of which 8107 IPD were synthesized. Overall, both guided and unguided iCBT were associated with more effectiveness as measured by PHQ-9 scores than control treatments over the short term and the long term. Guided iCBT was associated with more effectiveness than unguided iCBT (mean difference [MD] in posttreatment PHQ-9 scores, -0.8; 95% CI, -1.4 to -0.2), but we found no evidence of a difference at 6 or 12 months following randomization. Baseline depression was found to be the most important modifier of the relative association for efficacy of guided vs unguided iCBT. Differences between unguided and guided iCBT in people with baseline symptoms of subthreshold depression (P

Published
2021
Full Text
View/download PDF

6. Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression : a systematic review and component network meta-analysis using individual participant data

Author

Furukawa, Toshi A, Suganuma, Aya, Ostinelli, Edoardo G, Andersson, Gerhard, Beevers, Christopher G, Shumake, Jason, Berger, Thomas, Boele, Florien Willemijn, Buntrock, Claudia, Carlbring, Per, Choi, Isabella, Christensen, Helen, Mackinnon, Andrew, Dahne, Jennifer, Huibers, Marcus J H, Ebert, David D, Farrer, Louise, Forand, Nicholas R, Strunk, Daniel R, Ezawa, Iony D, Forsell, Erik, Kaldo, Viktor, Geraedts, Anna, Gilbody, Simon, Littlewood, Elizabeth, Brabyn, Sally, Hadjistavropoulos, Heather D, Schneider, Luke H, Johansson, Robert, Kenter, Robin, Kivi, Marie, Björkelund, Cecilia, Kleiboer, Annet, Riper, Heleen, Klein, Jan Philipp, Schröder, Johanna, Meyer, Björn, Moritz, Steffen, Bücker, Lara, Lintvedt, Ove, Johansson, Peter, Lundgren, Johan, Milgrom, Jeannette, Gemmill, Alan W, Mohr, David C, Montero-Marin, Jesus, Garcia-Campayo, Javier, Nobis, Stephanie, Zarski, Anna-Carlotta, O'Moore, Kathleen, Williams, Alishia D, Newby, Jill M, Perini, Sarah, Phillips, Rachel, Schneider, Justine, Pots, Wendy, Pugh, Nicole E, Richards, Derek, Rosso, Isabelle M, Rauch, Scott L, Sheeber, Lisa B, Smith, Jessica, Spek, Viola, Pop, Victor J, Ünlü, Burçin, van Bastelaar, Kim M P, van Luenen, Sanne, Garnefski, Nadia, Kraaij, Vivian, Vernmark, Kristofer, Warmerdam, Lisanne, van Straten, Annemieke, Zagorscak, Pavle, Knaevelsrud, Christine, Heinrich, Manuel, Miguel, Clara, Cipriani, Andrea, Efthimiou, Orestis, Karyotaki, Eirini, Cuijpers, Pim, Furukawa, Toshi A, Suganuma, Aya, Ostinelli, Edoardo G, Andersson, Gerhard, Beevers, Christopher G, Shumake, Jason, Berger, Thomas, Boele, Florien Willemijn, Buntrock, Claudia, Carlbring, Per, Choi, Isabella, Christensen, Helen, Mackinnon, Andrew, Dahne, Jennifer, Huibers, Marcus J H, Ebert, David D, Farrer, Louise, Forand, Nicholas R, Strunk, Daniel R, Ezawa, Iony D, Forsell, Erik, Kaldo, Viktor, Geraedts, Anna, Gilbody, Simon, Littlewood, Elizabeth, Brabyn, Sally, Hadjistavropoulos, Heather D, Schneider, Luke H, Johansson, Robert, Kenter, Robin, Kivi, Marie, Björkelund, Cecilia, Kleiboer, Annet, Riper, Heleen, Klein, Jan Philipp, Schröder, Johanna, Meyer, Björn, Moritz, Steffen, Bücker, Lara, Lintvedt, Ove, Johansson, Peter, Lundgren, Johan, Milgrom, Jeannette, Gemmill, Alan W, Mohr, David C, Montero-Marin, Jesus, Garcia-Campayo, Javier, Nobis, Stephanie, Zarski, Anna-Carlotta, O'Moore, Kathleen, Williams, Alishia D, Newby, Jill M, Perini, Sarah, Phillips, Rachel, Schneider, Justine, Pots, Wendy, Pugh, Nicole E, Richards, Derek, Rosso, Isabelle M, Rauch, Scott L, Sheeber, Lisa B, Smith, Jessica, Spek, Viola, Pop, Victor J, Ünlü, Burçin, van Bastelaar, Kim M P, van Luenen, Sanne, Garnefski, Nadia, Kraaij, Vivian, Vernmark, Kristofer, Warmerdam, Lisanne, van Straten, Annemieke, Zagorscak, Pavle, Knaevelsrud, Christine, Heinrich, Manuel, Miguel, Clara, Cipriani, Andrea, Efthimiou, Orestis, Karyotaki, Eirini, and Cuijpers, Pim

Abstract

BACKGROUND: Internet cognitive behavioural therapy (iCBT) is a viable delivery format of CBT for depression. However, iCBT programmes include training in a wide array of cognitive and behavioural skills via different delivery methods, and it remains unclear which of these components are more efficacious and for whom. METHODS: We did a systematic review and individual participant data component network meta-analysis (cNMA) of iCBT trials for depression. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomised controlled trials (RCTs) published from database inception to Jan 1, 2019, that compared any form of iCBT against another or a control condition in the acute treatment of adults (aged ≥18 years) with depression. Studies with inpatients or patients with bipolar depression were excluded. We sought individual participant data from the original authors. When these data were unavailable, we used aggregate data. Two independent researchers identified the included components. The primary outcome was depression severity, expressed as incremental mean difference (iMD) in the Patient Health Questionnaire-9 (PHQ-9) scores when a component is added to a treatment. We developed a web app that estimates relative efficacies between any two combinations of components, given baseline patient characteristics. This study is registered in PROSPERO, CRD42018104683. FINDINGS: We identified 76 RCTs, including 48 trials contributing individual participant data (11 704 participants) and 28 trials with aggregate data (6474 participants). The participants' weighted mean age was 42·0 years and 12 406 (71%) of 17 521 reported were women. There was suggestive evidence that behavioural activation might be beneficial (iMD -1·83 [95% credible interval (CrI) -2·90 to -0·80]) and that relaxation might be harmful (1·20 [95% CrI 0·17 to 2·27]). Baseline severity emerged as the strongest prognostic factor for endpoint depression. Combining human and automated encouragement reduc, Funding: Japan Society for the Promotion of ScienceMinistry of Education, Culture, Sports, Science and Technology, Japan (MEXT)Japan Society for the Promotion of Science [17K19808]; National Institute for Health Research (NIHR) Oxford Cognitive Health Clinical Research FacilityNational Institute for Health Research (NIHR); NIHR Oxford Health Biomedical Research Centre [BRC-1215-20005]; National Institute on Drug Abuse (NIDA)United States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute on Drug Abuse (NIDA) [K23 DA045766]; Canadian Institutes of Health ResearchCanadian Institutes of Health Research (CIHR) [152917]; National Institute of Mental HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USANIH National Institute of Mental Health (NIMH) [P50 MH119029, R01 MH111610]; NIHR Oxford Cognitive Health Clinical Research Facility; NIHR Research Professorship [RP-201708ST2-006]; NIHR Oxford and Thames Valley Applied Research Collaboration; Swiss National Science FoundationSwiss National Science Foundation (SNSF)European Commission [180083]; Netherlands Organisation for Health Research and DevelopmentNetherlands Organization for Health Research and Development [019.182SG.001]

Published
2021
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7. Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression : a systematic review and component network meta-analysis using individual data

Author

Furukawa, Toshi A., Suganuma, Aya, Ostinelli, Edoardo G., Andersson, Gerhard, Beevers, Christopher G., Shumake, Jason, Berger, Thomas, Boele, Florien Willemijn, Buntrock, Claudia, Carlbring, Per, Choi, Isabella, Christensen, Helen, Mackinnon, Andrew, Dahne, Jennifer, Huibers, Marcus J. H., Ebert, David D., Farrer, Louise, Forand, Nicholas R., Strunk, Daniel R., Ezawa, Iony D., Forsell, Erik, Kaldo, Viktor, Geraedts, Anna, Gilbody, Simon, Littlewood, Elizabeth, Brabyn, Sally, Hadjistavropoulos, Heather D., Schneider, Luke H., Johansson, Robert, Kenter, Robin, Kivi, Marie, Bjorkelund, Cecilia, Kleiboer, Annet, Riper, Heleen, Klein, Jan Philipp, Schroder, Johanna, Meyer, Bjorn, Moritz, Steffen, Bucker, Lara, Lintvedt, Ove, Johansson, Peter, Lundgren, Johan, Milgrom, Jeannette, Gemmill, Alan W., Mohr, David C., Montero-Marin, Jesus, Garcia-Campayo, Javier, Nobis, Stephanie, Zarski, Anna-Carlotta, O'Moore, Kathleen, Williams, Alishia D., Newby, Jill M., Perini, Sarah, Phillips, Rachel, Schneider, Justine, Pots, Wendy, Pugh, Nicole E., Richards, Derek, Rosso, Isabelle M., Rauch, Scott L., Sheeber, Lisa B., Smith, Jessica, Spek, Viola, Pop, Victor J., Unlu, Burcin, van Bastelaar, Kim M. P., van Luenen, Sanne, Garnefski, Nadia, Kraaij, Vivian, Vernmark, Kristofer, Warmerdam, Lisanne, van Straten, Annemieke, Zagorscak, Pavle, Knaevelsrud, Christine, Heinrich, Manuel, Miguel, Clara, Cipriani, Andrea, Efthimiou, Orestis, Karyotaki, Eirini, Cuijpers, Pim, Furukawa, Toshi A., Suganuma, Aya, Ostinelli, Edoardo G., Andersson, Gerhard, Beevers, Christopher G., Shumake, Jason, Berger, Thomas, Boele, Florien Willemijn, Buntrock, Claudia, Carlbring, Per, Choi, Isabella, Christensen, Helen, Mackinnon, Andrew, Dahne, Jennifer, Huibers, Marcus J. H., Ebert, David D., Farrer, Louise, Forand, Nicholas R., Strunk, Daniel R., Ezawa, Iony D., Forsell, Erik, Kaldo, Viktor, Geraedts, Anna, Gilbody, Simon, Littlewood, Elizabeth, Brabyn, Sally, Hadjistavropoulos, Heather D., Schneider, Luke H., Johansson, Robert, Kenter, Robin, Kivi, Marie, Bjorkelund, Cecilia, Kleiboer, Annet, Riper, Heleen, Klein, Jan Philipp, Schroder, Johanna, Meyer, Bjorn, Moritz, Steffen, Bucker, Lara, Lintvedt, Ove, Johansson, Peter, Lundgren, Johan, Milgrom, Jeannette, Gemmill, Alan W., Mohr, David C., Montero-Marin, Jesus, Garcia-Campayo, Javier, Nobis, Stephanie, Zarski, Anna-Carlotta, O'Moore, Kathleen, Williams, Alishia D., Newby, Jill M., Perini, Sarah, Phillips, Rachel, Schneider, Justine, Pots, Wendy, Pugh, Nicole E., Richards, Derek, Rosso, Isabelle M., Rauch, Scott L., Sheeber, Lisa B., Smith, Jessica, Spek, Viola, Pop, Victor J., Unlu, Burcin, van Bastelaar, Kim M. P., van Luenen, Sanne, Garnefski, Nadia, Kraaij, Vivian, Vernmark, Kristofer, Warmerdam, Lisanne, van Straten, Annemieke, Zagorscak, Pavle, Knaevelsrud, Christine, Heinrich, Manuel, Miguel, Clara, Cipriani, Andrea, Efthimiou, Orestis, Karyotaki, Eirini, and Cuijpers, Pim

Abstract

Findings We identified 76 RCTs, including 48 trials contributing individual participant data (11 704 participants) and 28 trials with aggregate data (6474 participants). The participants' weighted mean age was 42.0 years and 12 406 (71%) of 17 521 reported were women. There was suggestive evidence that behavioural activation might be beneficial (iMD -1.83 [95% credible interval (CrI) -2.90 to -0.80]) and that relaxation might be harmful (1.20 [95% CrI 0.17 to 2.27]). Baseline severity emerged as the strongest prognostic factor for endpoint depression. Combining human and automated encouragement reduced dropouts from treatment (incremental odds ratio, 0.32 [95% CrI 0.13 to 0.93]). The risk of bias was low for the randomisation process, missing outcome data, or selection of reported results in most of the included studies, uncertain for deviation from intended interventions, and high for measurement of outcomes. There was moderate to high heterogeneity among the studies and their components. 511

Published
2021
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8. Do guided internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis

Author

Karyotaki, Eirini, Ebert, David Daniel, Donkin, Liesje, Riper, Heleen, Twisk, Jos, Burger, Simone, Rozental, Alexander, Lange, Alfred, Williams, Alishia D., Zarski, Anna Carlotta, Geraedts, Anna, van Straten, Annemieke, Kleiboer, Annet, Meyer, Bjoern, Ince, Burgin B. Unlu, Buntrock, Claudia, Lehr, Dirk, Snoek, Frank J., Andrews, Gavin, Andersson, Gerhard, Choi, Isabella, Ruwaard, Jeroen, Klein, Jan Philipp, Newby, Jill M., Schroder, Johanna, Laferton, Johannes A. C., Van Bastelaar, Kim, Imamura, Kotaro, Vernmark, Kristofer, Boss, Leif, Sheeber, Lisa B., Kivi, Marie, Berking, Matthias, Tito, Nickolai, Carlbring, Per, Johansson, Robert, Kenter, Robin, Perini, Sarah, Moritz, Steffen, Nobis, Stephanie, Berger, Thomas, Kaldo, Viktor, Forsell, Yvonne, Lindefors, Nils, Kraepelien, Martin, Bjorkelund, Cecilia, Kawakami, Norito, Cuijpers, Pim, Karyotaki, Eirini, Ebert, David Daniel, Donkin, Liesje, Riper, Heleen, Twisk, Jos, Burger, Simone, Rozental, Alexander, Lange, Alfred, Williams, Alishia D., Zarski, Anna Carlotta, Geraedts, Anna, van Straten, Annemieke, Kleiboer, Annet, Meyer, Bjoern, Ince, Burgin B. Unlu, Buntrock, Claudia, Lehr, Dirk, Snoek, Frank J., Andrews, Gavin, Andersson, Gerhard, Choi, Isabella, Ruwaard, Jeroen, Klein, Jan Philipp, Newby, Jill M., Schroder, Johanna, Laferton, Johannes A. C., Van Bastelaar, Kim, Imamura, Kotaro, Vernmark, Kristofer, Boss, Leif, Sheeber, Lisa B., Kivi, Marie, Berking, Matthias, Tito, Nickolai, Carlbring, Per, Johansson, Robert, Kenter, Robin, Perini, Sarah, Moritz, Steffen, Nobis, Stephanie, Berger, Thomas, Kaldo, Viktor, Forsell, Yvonne, Lindefors, Nils, Kraepelien, Martin, Bjorkelund, Cecilia, Kawakami, Norito, and Cuijpers, Pim

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.

Published
2018
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9. Do guided internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis

Author

Karyotaki, Eirini, Ebert, David Daniel, Donkin, Liesje, Riper, Heleen, Twisk, Jos, Burger, Simone, Rozental, Alexander, Lange, Alfred, Williams, Alishia D., Zarski, Anna Carlotta, Geraedts, Anna, van Straten, Annemieke, Kleiboer, Annet, Meyer, Bjoern, Ince, Burgin B. Unlu, Buntrock, Claudia, Lehr, Dirk, Snoek, Frank J., Andrews, Gavin, Andersson, Gerhard, Choi, Isabella, Ruwaard, Jeroen, Klein, Jan Philipp, Newby, Jill M., Schroder, Johanna, Laferton, Johannes A. C., Van Bastelaar, Kim, Imamura, Kotaro, Vernmark, Kristofer, Boss, Leif, Sheeber, Lisa B., Kivi, Marie, Berking, Matthias, Tito, Nickolai, Carlbring, Per, Johansson, Robert, Kenter, Robin, Perini, Sarah, Moritz, Steffen, Nobis, Stephanie, Berger, Thomas, Kaldo, Viktor, Forsell, Yvonne, Lindefors, Nils, Kraepelien, Martin, Bjorkelund, Cecilia, Kawakami, Norito, Cuijpers, Pim, Karyotaki, Eirini, Ebert, David Daniel, Donkin, Liesje, Riper, Heleen, Twisk, Jos, Burger, Simone, Rozental, Alexander, Lange, Alfred, Williams, Alishia D., Zarski, Anna Carlotta, Geraedts, Anna, van Straten, Annemieke, Kleiboer, Annet, Meyer, Bjoern, Ince, Burgin B. Unlu, Buntrock, Claudia, Lehr, Dirk, Snoek, Frank J., Andrews, Gavin, Andersson, Gerhard, Choi, Isabella, Ruwaard, Jeroen, Klein, Jan Philipp, Newby, Jill M., Schroder, Johanna, Laferton, Johannes A. C., Van Bastelaar, Kim, Imamura, Kotaro, Vernmark, Kristofer, Boss, Leif, Sheeber, Lisa B., Kivi, Marie, Berking, Matthias, Tito, Nickolai, Carlbring, Per, Johansson, Robert, Kenter, Robin, Perini, Sarah, Moritz, Steffen, Nobis, Stephanie, Berger, Thomas, Kaldo, Viktor, Forsell, Yvonne, Lindefors, Nils, Kraepelien, Martin, Bjorkelund, Cecilia, Kawakami, Norito, and Cuijpers, Pim

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.

Published
2018
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10. Do guided internet-based interventions result in clinically relevant changes for patients with depression? : An individual participant data meta-analysis

Author

Karyotaki, Eirini, Ebert, David Daniel, Donkin, Liesje, Riper, Heleen, Twisk, Jos, Burger, Simone, Rozental, Alexander, Lange, Alfred, Williams, Alishia D., Zarski, Anna Carlotta, Geraedts, Anna, van Straten, Annemieke, Kleiboer, Annet, Meyer, Bjoern, Ince, Burgin B. Unlu, Buntrock, Claudia, Lehr, Dirk, Snoek, Frank J., Andrews, Gavin, Andersson, Gerhard, Choi, Isabella, Ruwaard, Jeroen, Klein, Jan Philipp, Newby, Jill M., Schroder, Johanna, Laferton, Johannes A. C., Van Bastelaar, Kim, Imamura, Kotaro, Vernmark, Kristofer, Boss, Leif, Sheeber, Lisa B., Kivi, Marie, Berking, Matthias, Tito, Nickolai, Carlbring, Per, Johansson, Robert, Kenter, Robin, Perini, Sarah, Moritz, Steffen, Nobis, Stephanie, Berger, Thomas, Kaldo, Viktor, Forsell, Yvonne, Lindefors, Nils, Kraepelien, Martin, Bjorkelund, Cecilia, Kawakami, Norito, Cuijpers, Pim, Karyotaki, Eirini, Ebert, David Daniel, Donkin, Liesje, Riper, Heleen, Twisk, Jos, Burger, Simone, Rozental, Alexander, Lange, Alfred, Williams, Alishia D., Zarski, Anna Carlotta, Geraedts, Anna, van Straten, Annemieke, Kleiboer, Annet, Meyer, Bjoern, Ince, Burgin B. Unlu, Buntrock, Claudia, Lehr, Dirk, Snoek, Frank J., Andrews, Gavin, Andersson, Gerhard, Choi, Isabella, Ruwaard, Jeroen, Klein, Jan Philipp, Newby, Jill M., Schroder, Johanna, Laferton, Johannes A. C., Van Bastelaar, Kim, Imamura, Kotaro, Vernmark, Kristofer, Boss, Leif, Sheeber, Lisa B., Kivi, Marie, Berking, Matthias, Tito, Nickolai, Carlbring, Per, Johansson, Robert, Kenter, Robin, Perini, Sarah, Moritz, Steffen, Nobis, Stephanie, Berger, Thomas, Kaldo, Viktor, Forsell, Yvonne, Lindefors, Nils, Kraepelien, Martin, Bjorkelund, Cecilia, Kawakami, Norito, and Cuijpers, Pim

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 intemet-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.

Published
2018
Full Text
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11. Do guided internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis

Author

Karyotaki, Eirini, Ebert, David Daniel, Donkin, Liesje, Riper, Heleen, Twisk, Jos, Burger, Simone, Rozental, Alexander, Lange, Alfred, Williams, Alishia D., Zarski, Anna Carlotta, Geraedts, Anna, van Straten, Annemieke, Kleiboer, Annet, Meyer, Bjoern, Ince, Burgin B. Unlu, Buntrock, Claudia, Lehr, Dirk, Snoek, Frank J., Andrews, Gavin, Andersson, Gerhard, Choi, Isabella, Ruwaard, Jeroen, Klein, Jan Philipp, Newby, Jill M., Schroder, Johanna, Laferton, Johannes A. C., Van Bastelaar, Kim, Imamura, Kotaro, Vernmark, Kristofer, Boss, Leif, Sheeber, Lisa B., Kivi, Marie, Berking, Matthias, Tito, Nickolai, Carlbring, Per, Johansson, Robert, Kenter, Robin, Perini, Sarah, Moritz, Steffen, Nobis, Stephanie, Berger, Thomas, Kaldo, Viktor, Forsell, Yvonne, Lindefors, Nils, Kraepelien, Martin, Bjorkelund, Cecilia, Kawakami, Norito, Cuijpers, Pim, Karyotaki, Eirini, Ebert, David Daniel, Donkin, Liesje, Riper, Heleen, Twisk, Jos, Burger, Simone, Rozental, Alexander, Lange, Alfred, Williams, Alishia D., Zarski, Anna Carlotta, Geraedts, Anna, van Straten, Annemieke, Kleiboer, Annet, Meyer, Bjoern, Ince, Burgin B. Unlu, Buntrock, Claudia, Lehr, Dirk, Snoek, Frank J., Andrews, Gavin, Andersson, Gerhard, Choi, Isabella, Ruwaard, Jeroen, Klein, Jan Philipp, Newby, Jill M., Schroder, Johanna, Laferton, Johannes A. C., Van Bastelaar, Kim, Imamura, Kotaro, Vernmark, Kristofer, Boss, Leif, Sheeber, Lisa B., Kivi, Marie, Berking, Matthias, Tito, Nickolai, Carlbring, Per, Johansson, Robert, Kenter, Robin, Perini, Sarah, Moritz, Steffen, Nobis, Stephanie, Berger, Thomas, Kaldo, Viktor, Forsell, Yvonne, Lindefors, Nils, Kraepelien, Martin, Bjorkelund, Cecilia, Kawakami, Norito, and Cuijpers, Pim

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 intemet-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.

Published
2018
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