An individual participant data meta-analysis of predictors of adherence to internet-based interventions for depression

Lingyao Tong; Olga-Maria Panagiotopoulou; Clara Miguel; Mathias Harrer; Arpana Amarnath; Marketa Ciharova; Alan W. Gemmill; Alicia Salamanca-Sanabria; Alishia Williams; Ana Fonseca; Anna Carlotta Zarski; Anna Geraedts; Annemieke van Straten; Anu Raevuori; Arnoud Arntz; Arka Ghosh; Björn Meyer; Caroline Allenhof; Christian Aljoscha Lukas; Christine Knaevelsrud; Christopher Williams; Ciyong Lu; Claudi Bockting; David Daniel Ebert; Derek Richards; Edward G. Feil; Elizabeth L. Addington; Erik Forsell; Fenglin Cao; Fernando L. Vázquez; Florien Willemijn Boele; Frances Kay-Lambkin; Fredrik Holländare; Gerhard Andersson; Harald Baumeister; Heather D. Hadjistavropoulos; Heleen Riper; Isabella Choi; Jan Philipp Klein; Jeannette Milgrom; Jeffrey Lambert; Jennifer Dahne; Jesse C. Stewart; Jessica Smith; Jesus Montero-Marin; Jill Newby; Jinane Abi Ramia; Jo Annika Reins; Johan Lundgren; Judith Tedlie Moskowitz; Kathryn L. Jackson; Kjersti Lillevoll; Kristofer Vernmark; Lasse B. Sander; Lina Braun; Lisanne Warmerdam; Liz Littlewood; Manuel Heinrich; Margalida Gili; Mark Deady; Martin Kraepelien; Matthias Berking; Michael P. Schaub; Monica Buhrman; Nicholas R. Forand; Nickolai Titov; Nicole Pugh; Nils Lindefors; Nitin Gupta; Pavle Zagorscak; Per Carlbring; Peter Johansson; Rabih El Chammay; Retha Arjadi; Rianne van der Zanden; Ricardo Araya; Rico Krämer; Robert Johansson; Robin Maria Francisca Kenter; Rosa Boeschoten; Samir K. Gupta; Sandra Schlicker; Sarah Perini; Simon Gilbody; Stephan Köhler; Stephanie Nobis; Thomas Berger; Ulrich Hegerl; Vanessa Blanco; Viktor Kaldo; Viktor Pop; Viola Spek; Wendy Pots; Yaoyao Sun; Yvonne Forsell; Pim Cuijpers; Eirini Karyotaki

doi:10.1038/s44220-026-00707-4

An individual participant data meta-analysis of predictors of adherence to internet-based interventions for depression

Lingyao Tong
, Olga-Maria Panagiotopoulou
, Clara Miguel
, Mathias Harrer
, Arpana Amarnath
, Marketa Ciharova
, Alan W. Gemmill
, Alicia Salamanca-Sanabria
, Alishia Williams
, Ana Fonseca
, Anna Carlotta Zarski
, Anna Geraedts
, Annemieke van Straten
, Anu Raevuori
, Arnoud Arntz
, Arka Ghosh
, Björn Meyer
, Caroline Allenhof
, Christian Aljoscha Lukas
, Christine Knaevelsrud

Christopher Williams, Ciyong Lu, Claudi Bockting, David Daniel Ebert, Derek Richards, Edward G. Feil, Elizabeth L. Addington, Erik Forsell, Fenglin Cao, Fernando L. Vázquez, Florien Willemijn Boele, Frances Kay-Lambkin, Fredrik Holländare, Gerhard Andersson, Harald Baumeister, Heather D. Hadjistavropoulos, Heleen Riper, Isabella Choi, Jan Philipp Klein, Jeannette Milgrom, Jeffrey Lambert, Jennifer Dahne, Jesse C. Stewart, Jessica Smith, Jesus Montero-Marin, Jill Newby, Jinane Abi Ramia, Jo Annika Reins, Johan Lundgren, Judith Tedlie Moskowitz, Kathryn L. Jackson, Kjersti Lillevoll, Kristofer Vernmark, Lasse B. Sander, Lina Braun, Lisanne Warmerdam, Liz Littlewood, Manuel Heinrich, Margalida Gili, Mark Deady, Martin Kraepelien, Matthias Berking, Michael P. Schaub, Monica Buhrman, Nicholas R. Forand, Nickolai Titov, Nicole Pugh, Nils Lindefors, Nitin Gupta, Pavle Zagorscak, Per Carlbring, Peter Johansson, Rabih El Chammay, Retha Arjadi, Rianne van der Zanden, Ricardo Araya, Rico Krämer, Robert Johansson, Robin Maria Francisca Kenter, Rosa Boeschoten, Samir K. Gupta, Sandra Schlicker, Sarah Perini, Simon Gilbody, Stephan Köhler, Stephanie Nobis, Thomas Berger, Ulrich Hegerl, Vanessa Blanco, Viktor Kaldo, Viktor Pop, Viola Spek, Wendy Pots, Yaoyao Sun, Yvonne Forsell, Pim Cuijpers, Eirini Karyotaki

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Internet-based psychological interventions can effectively reduce depressive symptoms in adults, but adherence remains challenging. In this preregistered individual participant data meta-analysis, we examined predictors of treatment adherence. We searched PubMed, Embase and PsycINFO on 6 February 2024 for randomized trials of internet-based interventions among adults with elevated depressive symptoms. We conducted a one-stage logit-link multilevel beta regression, with adherence defined as the proportion of completed modules post-intervention. This study included 71 trials (85 treatment arms, 8,082 participants). Lower adherence was associated with younger age (β = 0.005, standard error (SE) 0.002, P = 0.028), male gender (β = −0.163, SE 0.053, P = 0.002), lower education (β = −0.133, SE 0.05, P = 0.008) and employment (β = −0.113, SE 0.054, P = 0.037). No significant interactions were found between individual predictors and intervention format (guided versus self-guided). Higher adherence was associated with lower post-intervention depression severity, adjusting for baseline severity (β = −0.30, SE 0.04, P

Original language	English
Pages (from-to)	1452-1462
Journal	Nature Mental Health
Volume	4
Issue number	9
Early online date	6 Aug 2026
DOIs	https://doi.org/10.1038/s44220-026-00707-4
Publication status	Published - Sept 2026

Funding

A.R. was funded by the company (Meru Health Inc) by the Research Council of Finland (grant 259764). F.W.B. was funded by the Dutch Cancer Society, Alpe d’HuZes (VU 2010–4808). J.M.-M. was supported by a ‘Miguel Servet’ research contract from the Institute of Health Carlos III (ISCIII: CP21/00080) and received support from the Department of Psychiatry at the University of Oxford, UK, and the Spanish CIBER of Epidemiology and Public Health (CIBERESP CB22/02/00052; ISCIII). J.M. was funded by grants from the National Health and Medical Research Council (NHMRC) 1046875, Beyond Blue and Windemere. J.N. was funded by an Australian National Health and Medical Research Council grant (2008839) and Australian Medical Research Future Fund grant (1145382). R.M.F.K. was funded by a Norwegian Research Council (309264). E.K. was funded by a Veni grant from Dutch Research Council (Veni.195.215 6806). The other authors declare no relevant funding.

Funders	Funder number
Windemere
Meru Health Inc
KWF Kankerbestrijding
Beyond Blue
Nederlandse Organisatie voor Wetenschappelijk Onderzoek	Veni.195.215 6806
Instituto de Salud Carlos III	CP21/00080
Norges Forskningsråd	309264
Research Council of Finland	259764
National Health and Medical Research Council	1046875, 2008839
Alpe d’HuZes	VU 2010–4808
Medical Research Future Fund	1145382

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Tong, L., Panagiotopoulou, O.-M., Miguel, C., Harrer, M., Amarnath, A., Ciharova, M., Gemmill, A. W., Salamanca-Sanabria, A., Williams, A., Fonseca, A., Zarski, A. C., Geraedts, A., van Straten, A., Raevuori, A., Arntz, A., Ghosh, A., Meyer, B., Allenhof, C., Lukas, C. A., ... Karyotaki, E. (2026). An individual participant data meta-analysis of predictors of adherence to internet-based interventions for depression. Nature Mental Health, 4(9), 1452-1462. https://doi.org/10.1038/s44220-026-00707-4

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title = "An individual participant data meta-analysis of predictors of adherence to internet-based interventions for depression",

abstract = "Internet-based psychological interventions can effectively reduce depressive symptoms in adults, but adherence remains challenging. In this preregistered individual participant data meta-analysis, we examined predictors of treatment adherence. We searched PubMed, Embase and PsycINFO on 6 February 2024 for randomized trials of internet-based interventions among adults with elevated depressive symptoms. We conducted a one-stage logit-link multilevel beta regression, with adherence defined as the proportion of completed modules post-intervention. This study included 71 trials (85 treatment arms, 8,082 participants). Lower adherence was associated with younger age (β = 0.005, standard error (SE) 0.002, P = 0.028), male gender (β = −0.163, SE 0.053, P = 0.002), lower education (β = −0.133, SE 0.05, P = 0.008) and employment (β = −0.113, SE 0.054, P = 0.037). No significant interactions were found between individual predictors and intervention format (guided versus self-guided). Higher adherence was associated with lower post-intervention depression severity, adjusting for baseline severity (β = −0.30, SE 0.04, P ",

author = "Lingyao Tong and Olga-Maria Panagiotopoulou and Clara Miguel and Mathias Harrer and Arpana Amarnath and Marketa Ciharova and Gemmill, \{Alan W.\} and Alicia Salamanca-Sanabria and Alishia Williams and Ana Fonseca and Zarski, \{Anna Carlotta\} and Anna Geraedts and \{van Straten\}, Annemieke and Anu Raevuori and Arnoud Arntz and Arka Ghosh and Bj{\"o}rn Meyer and Caroline Allenhof and Lukas, \{Christian Aljoscha\} and Christine Knaevelsrud and Christopher Williams and Ciyong Lu and Claudi Bockting and Ebert, \{David Daniel\} and Derek Richards and Feil, \{Edward G.\} and Addington, \{Elizabeth L.\} and Erik Forsell and Fenglin Cao and V{\'a}zquez, \{Fernando L.\} and Boele, \{Florien Willemijn\} and Frances Kay-Lambkin and Fredrik Holl{\"a}ndare and Gerhard Andersson and Harald Baumeister and Hadjistavropoulos, \{Heather D.\} and Heleen Riper and Isabella Choi and Klein, \{Jan Philipp\} and Jeannette Milgrom and Jeffrey Lambert and Jennifer Dahne and Stewart, \{Jesse C.\} and Jessica Smith and Jesus Montero-Marin and Jill Newby and \{Abi Ramia\}, Jinane and Reins, \{Jo Annika\} and Johan Lundgren and Moskowitz, \{Judith Tedlie\} and Jackson, \{Kathryn L.\} and Kjersti Lillevoll and Kristofer Vernmark and Sander, \{Lasse B.\} and Lina Braun and Lisanne Warmerdam and Liz Littlewood and Manuel Heinrich and Margalida Gili and Mark Deady and Martin Kraepelien and Matthias Berking and Schaub, \{Michael P.\} and Monica Buhrman and Forand, \{Nicholas R.\} and Nickolai Titov and Nicole Pugh and Nils Lindefors and Nitin Gupta and Pavle Zagorscak and Per Carlbring and Peter Johansson and \{El Chammay\}, Rabih and Retha Arjadi and \{van der Zanden\}, Rianne and Ricardo Araya and Rico Kr{\"a}mer and Robert Johansson and Kenter, \{Robin Maria Francisca\} and Rosa Boeschoten and Gupta, \{Samir K.\} and Sandra Schlicker and Sarah Perini and Simon Gilbody and Stephan K{\"o}hler and Stephanie Nobis and Thomas Berger and Ulrich Hegerl and Vanessa Blanco and Viktor Kaldo and Viktor Pop and Viola Spek and Wendy Pots and Yaoyao Sun and Yvonne Forsell and Pim Cuijpers and Eirini Karyotaki",

year = "2026",

month = sep,

doi = "10.1038/s44220-026-00707-4",

language = "English",

volume = "4",

pages = "1452--1462",

journal = "Nature Mental Health",

issn = "2731-6076",

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Tong, L, Panagiotopoulou, O-M, Miguel, C , Harrer, M , Amarnath, A , Ciharova, M, Gemmill, AW, Salamanca-Sanabria, A, Williams, A, Fonseca, A, Zarski, AC, Geraedts, A, van Straten, A, Raevuori, A, Arntz, A, Ghosh, A, Meyer, B, Allenhof, C, Lukas, CA, Knaevelsrud, C, Williams, C, Lu, C, Bockting, C, Ebert, DD, Richards, D, Feil, EG, Addington, EL, Forsell, E, Cao, F, Vázquez, FL, Boele, FW, Kay-Lambkin, F, Holländare, F, Andersson, G, Baumeister, H, Hadjistavropoulos, HD, Riper, H, Choi, I, Klein, JP, Milgrom, J, Lambert, J, Dahne, J, Stewart, JC, Smith, J, Montero-Marin, J, Newby, J, Abi Ramia, J, Reins, JA, Lundgren, J, Moskowitz, JT, Jackson, KL, Lillevoll, K, Vernmark, K, Sander, LB, Braun, L, Warmerdam, L, Littlewood, L, Heinrich, M, Gili, M, Deady, M, Kraepelien, M, Berking, M, Schaub, MP, Buhrman, M, Forand, NR, Titov, N, Pugh, N, Lindefors, N, Gupta, N, Zagorscak, P, Carlbring, P, Johansson, P, El Chammay, R, Arjadi, R, van der Zanden, R, Araya, R, Krämer, R, Johansson, R, Kenter, RMF, Boeschoten, R, Gupta, SK, Schlicker, S, Perini, S, Gilbody, S, Köhler, S, Nobis, S, Berger, T, Hegerl, U, Blanco, V, Kaldo, V, Pop, V, Spek, V, Pots, W, Sun, Y, Forsell, Y, Cuijpers, P & Karyotaki, E 2026, 'An individual participant data meta-analysis of predictors of adherence to internet-based interventions for depression', Nature Mental Health, vol. 4, no. 9, pp. 1452-1462. https://doi.org/10.1038/s44220-026-00707-4

TY - JOUR

T1 - An individual participant data meta-analysis of predictors of adherence to internet-based interventions for depression

AU - Tong, Lingyao

AU - Panagiotopoulou, Olga-Maria

AU - Miguel, Clara

AU - Harrer, Mathias

AU - Amarnath, Arpana

AU - Ciharova, Marketa

AU - Gemmill, Alan W.

AU - Salamanca-Sanabria, Alicia

AU - Williams, Alishia

AU - Fonseca, Ana

AU - Zarski, Anna Carlotta

AU - Geraedts, Anna

AU - van Straten, Annemieke

AU - Raevuori, Anu

AU - Arntz, Arnoud

AU - Ghosh, Arka

AU - Meyer, Björn

AU - Allenhof, Caroline

AU - Lukas, Christian Aljoscha

AU - Knaevelsrud, Christine

AU - Williams, Christopher

AU - Lu, Ciyong

AU - Bockting, Claudi

AU - Ebert, David Daniel

AU - Richards, Derek

AU - Feil, Edward G.

AU - Addington, Elizabeth L.

AU - Forsell, Erik

AU - Cao, Fenglin

AU - Vázquez, Fernando L.

AU - Boele, Florien Willemijn

AU - Kay-Lambkin, Frances

AU - Holländare, Fredrik

AU - Andersson, Gerhard

AU - Baumeister, Harald

AU - Hadjistavropoulos, Heather D.

AU - Riper, Heleen

AU - Choi, Isabella

AU - Klein, Jan Philipp

AU - Milgrom, Jeannette

AU - Lambert, Jeffrey

AU - Dahne, Jennifer

AU - Stewart, Jesse C.

AU - Smith, Jessica

AU - Montero-Marin, Jesus

AU - Newby, Jill

AU - Abi Ramia, Jinane

AU - Reins, Jo Annika

AU - Lundgren, Johan

AU - Moskowitz, Judith Tedlie

AU - Jackson, Kathryn L.

AU - Lillevoll, Kjersti

AU - Vernmark, Kristofer

AU - Sander, Lasse B.

AU - Braun, Lina

AU - Warmerdam, Lisanne

AU - Littlewood, Liz

AU - Heinrich, Manuel

AU - Gili, Margalida

AU - Deady, Mark

AU - Kraepelien, Martin

AU - Berking, Matthias

AU - Schaub, Michael P.

AU - Buhrman, Monica

AU - Forand, Nicholas R.

AU - Titov, Nickolai

AU - Pugh, Nicole

AU - Lindefors, Nils

AU - Gupta, Nitin

AU - Zagorscak, Pavle

AU - Carlbring, Per

AU - Johansson, Peter

AU - El Chammay, Rabih

AU - Arjadi, Retha

AU - van der Zanden, Rianne

AU - Araya, Ricardo

AU - Krämer, Rico

AU - Johansson, Robert

AU - Kenter, Robin Maria Francisca

AU - Boeschoten, Rosa

AU - Gupta, Samir K.

AU - Schlicker, Sandra

AU - Perini, Sarah

AU - Gilbody, Simon

AU - Köhler, Stephan

AU - Nobis, Stephanie

AU - Berger, Thomas

AU - Hegerl, Ulrich

AU - Blanco, Vanessa

AU - Kaldo, Viktor

AU - Pop, Viktor

AU - Spek, Viola

AU - Pots, Wendy

AU - Sun, Yaoyao

AU - Forsell, Yvonne

AU - Cuijpers, Pim

AU - Karyotaki, Eirini

PY - 2026/9

Y1 - 2026/9

N2 - Internet-based psychological interventions can effectively reduce depressive symptoms in adults, but adherence remains challenging. In this preregistered individual participant data meta-analysis, we examined predictors of treatment adherence. We searched PubMed, Embase and PsycINFO on 6 February 2024 for randomized trials of internet-based interventions among adults with elevated depressive symptoms. We conducted a one-stage logit-link multilevel beta regression, with adherence defined as the proportion of completed modules post-intervention. This study included 71 trials (85 treatment arms, 8,082 participants). Lower adherence was associated with younger age (β = 0.005, standard error (SE) 0.002, P = 0.028), male gender (β = −0.163, SE 0.053, P = 0.002), lower education (β = −0.133, SE 0.05, P = 0.008) and employment (β = −0.113, SE 0.054, P = 0.037). No significant interactions were found between individual predictors and intervention format (guided versus self-guided). Higher adherence was associated with lower post-intervention depression severity, adjusting for baseline severity (β = −0.30, SE 0.04, P

AB - Internet-based psychological interventions can effectively reduce depressive symptoms in adults, but adherence remains challenging. In this preregistered individual participant data meta-analysis, we examined predictors of treatment adherence. We searched PubMed, Embase and PsycINFO on 6 February 2024 for randomized trials of internet-based interventions among adults with elevated depressive symptoms. We conducted a one-stage logit-link multilevel beta regression, with adherence defined as the proportion of completed modules post-intervention. This study included 71 trials (85 treatment arms, 8,082 participants). Lower adherence was associated with younger age (β = 0.005, standard error (SE) 0.002, P = 0.028), male gender (β = −0.163, SE 0.053, P = 0.002), lower education (β = −0.133, SE 0.05, P = 0.008) and employment (β = −0.113, SE 0.054, P = 0.037). No significant interactions were found between individual predictors and intervention format (guided versus self-guided). Higher adherence was associated with lower post-intervention depression severity, adjusting for baseline severity (β = −0.30, SE 0.04, P

U2 - 10.1038/s44220-026-00707-4

DO - 10.1038/s44220-026-00707-4

M3 - Article

SN - 2731-6076

VL - 4

SP - 1452

EP - 1462

JO - Nature Mental Health

JF - Nature Mental Health

IS - 9

ER -

An individual participant data meta-analysis of predictors of adherence to internet-based interventions for depression

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