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, Annet Kleiboer, Bjoern Meyer, Burgin B. Unlu Ince, Claudia Buntrock, Dirk Lehr, Frank J. Snoek, Gavin Andrews, Gerhard Andersson & 28 others Isabella Choi, Jeroen Ruwaard, Jan Philipp Klein, Jill M. Newby, Johanna Schroder, Johannes A. C. Laferton, Kim Van Bastelaar, Kotaro Imamura, Kristofer Vernmark, Leif Boss, Lisa B. Sheeber, Marie Kivi, Matthias Berking, Nickolai Tito, Per Carlbring, Robert Johansson, Robin Kenter, Sarah Perini, Steffen Moritz, Stephanie Nobis, Thomas Berger, Viktor Kaldo, Yvonne Forsell, Nils Lindefors, Martin Kraepelien, Cecilia Bjorkelund, Norito Kawakami, Pim Cuijpers

Research output: Contribution to JournalReview articleAcademicpeer-review

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.

Original languageEnglish
Pages (from-to)80-92
Number of pages13
JournalClinical Psychology Review
Volume63
Early online date19 Jun 2018
DOIs
Publication statusPublished - Jul 2018

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Keywords

  • Depression
  • Internet-based guided self-help
  • Meta-analysis
  • Psychotherapy

Cite this

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. / Do guided internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis. In: Clinical Psychology Review. 2018 ; Vol. 63. pp. 80-92.
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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",
author = "Eirini Karyotaki and Ebert, {David Daniel} and Liesje Donkin and Heleen Riper and Jos Twisk and Simone Burger and Alexander Rozental and Alfred Lange and Williams, {Alishia D.} and Zarski, {Anna Carlotta} and Anna Geraedts and {van Straten}, Annemieke and Annet Kleiboer and Bjoern Meyer and Ince, {Burgin B. Unlu} and Claudia Buntrock and Dirk Lehr and Snoek, {Frank J.} and Gavin Andrews and Gerhard Andersson and Isabella Choi and Jeroen Ruwaard and Klein, {Jan Philipp} and Newby, {Jill M.} and Johanna Schroder and Laferton, {Johannes A. C.} and {Van Bastelaar}, Kim and Kotaro Imamura and Kristofer Vernmark and Leif Boss and Sheeber, {Lisa B.} and Marie Kivi and Matthias Berking and Nickolai Tito and Per Carlbring and Robert Johansson and Robin Kenter and Sarah Perini and Steffen Moritz and Stephanie Nobis and Thomas Berger and Viktor Kaldo and Yvonne Forsell and Nils Lindefors and Martin Kraepelien and Cecilia Bjorkelund and Norito Kawakami and Pim Cuijpers",
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Karyotaki, E, Ebert, DD, Donkin, L, Riper, H, Twisk, J, Burger, S, Rozental, A, Lange, A, Williams, AD, Zarski, AC, Geraedts, A, van Straten, A, Kleiboer, A, Meyer, B, Ince, BBU, Buntrock, C, Lehr, D, Snoek, FJ, Andrews, G, Andersson, G, Choi, I, Ruwaard, J, Klein, JP, Newby, JM, Schroder, J, Laferton, JAC, Van Bastelaar, K, Imamura, K, Vernmark, K, Boss, L, Sheeber, LB, Kivi, M, Berking, M, Tito, N, Carlbring, P, Johansson, R, Kenter, R, Perini, S, Moritz, S, Nobis, S, Berger, T, Kaldo, V, Forsell, Y, Lindefors, N, Kraepelien, M, Bjorkelund, C, Kawakami, N & Cuijpers, P 2018, 'Do guided internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis' Clinical Psychology Review, vol. 63, pp. 80-92. https://doi.org/10.1016/j.cpr.2018.06.007

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

In: Clinical Psychology Review, Vol. 63, 07.2018, p. 80-92.

Research output: Contribution to JournalReview articleAcademicpeer-review

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T1 - Do guided internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis

AU - Karyotaki, Eirini

AU - Ebert, David Daniel

AU - Donkin, Liesje

AU - Riper, Heleen

AU - Twisk, Jos

AU - Burger, Simone

AU - Rozental, Alexander

AU - Lange, Alfred

AU - Williams, Alishia D.

AU - Zarski, Anna Carlotta

AU - Geraedts, Anna

AU - van Straten, Annemieke

AU - Kleiboer, Annet

AU - Meyer, Bjoern

AU - Ince, Burgin B. Unlu

AU - Buntrock, Claudia

AU - Lehr, Dirk

AU - Snoek, Frank J.

AU - Andrews, Gavin

AU - Andersson, Gerhard

AU - Choi, Isabella

AU - Ruwaard, Jeroen

AU - Klein, Jan Philipp

AU - Newby, Jill M.

AU - Schroder, Johanna

AU - Laferton, Johannes A. C.

AU - Van Bastelaar, Kim

AU - Imamura, Kotaro

AU - Vernmark, Kristofer

AU - Boss, Leif

AU - Sheeber, Lisa B.

AU - Kivi, Marie

AU - Berking, Matthias

AU - Tito, Nickolai

AU - Carlbring, Per

AU - Johansson, Robert

AU - Kenter, Robin

AU - Perini, Sarah

AU - Moritz, Steffen

AU - Nobis, Stephanie

AU - Berger, Thomas

AU - Kaldo, Viktor

AU - Forsell, Yvonne

AU - Lindefors, Nils

AU - Kraepelien, Martin

AU - Bjorkelund, Cecilia

AU - Kawakami, Norito

AU - Cuijpers, Pim

PY - 2018/7

Y1 - 2018/7

N2 - 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.

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KW - Internet-based guided self-help

KW - Meta-analysis

KW - Psychotherapy

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