Internet-Based Cognitive Behavioral Therapy for Depression: A Systematic Review and Individual Patient Data Network Meta-analysis
Beteiligte Einrichtungen
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-9 scores 5-9) were small, while guided iCBT was associated with overall better outcomes in patients with baseline PHQ-9 greater than 9. Conclusions and Relevance: In this network meta-analysis with IPD, guided iCBT was associated with more effectiveness than unguided iCBT for individuals with depression, benefits were more substantial in individuals with moderate to severe depression. Unguided iCBT was associated with similar effectiveness among individuals with symptoms of mild/subthreshold depression. Personalized treatment selection is entirely possible and necessary to ensure the best allocation of treatment resources for depression.
Bibliografische Daten
| Originalsprache | Englisch |
|---|---|
| ISSN | 2168-622X |
| DOIs | |
| Status | Veröffentlicht - 01.04.2021 |
Anmerkungen des Dekanats
Funding Information:
reports grants from Swedish Social Insurance Agency Sweden during the conduct of the study. Dr Knaevelsrud reported grants from Techniker Krankenkasse (Public Health Care Company) during the conduct of the study and personal fees from Oberbergklinik and Servier outside the submitted work. Dr Beevers reported grants from the National Institutes of Health and personal fees from
Funding Information:
Funding/Support: Dr Karyotaki was supported by the Netherlands Organization for Health Research and Development (project 019.182SG.001). Dr Efthimiou was supported by project grant 180083 from the Swiss National Science Foundation.
Funding Information:
Association for Psychological Science outside the submitted work. Dr Mohr reported personal fees from Otsuka Pharmaceuticals, Apple Inc, Pear Therapeutics, One Mind Foundation, and other support from Adaptive Health Equity Interest outside the submitted work. Dr Ebert reported other support from GET.ON Insitute (HelloBetter Shareholder of digital therapeutic company); personal fees from Minddistrict Consultancy, Lantern Consultancy Fees, Sanofi Consultancy, and Novartis Consultancy Fees outside the submitted work; and holding IP rights to several digital therapeutics for the prevention and treatment of mental health disorders. Dr Richards reported other support from SilverCloud Health Salary outside the submitted work. Dr Hadjistavropoulos reported grants from Canadian Institutes of Health Research, Saskatchewan Health Research Foundation, and Rx&D Research Foundation during the conduct of the study. Dr Christensen reported potentially receiving royalties to MoodGYM if it is successful commercially and is Director of the Black Dog Institute, which creates e-health interventions. Dr Klein reported grants from German Ministry of Health II A 5-2512 FSB 052 during the conduct of the study; grants from Servier; personal fees from Springer, Beltz, Elsevier, and Hogrefe outside the submitted work; and payments for workshops on psychotherapy for chronic depression and on psychiatric emergencies. Dr Shumake reported grants from National Institute for Mental Health during the conduct of the study. Dr García-Campayo reports grants from Instituto de salud Carlos III during the conduct of the study. Dr Heinrich reported grants from Techniker Krankasse (Public Health Care Company) during the conduct of the study. Dr Zagorscak reported grants from Techniker Krankenkasse (Public Health Care Company) during the conduct of the study. Dr R. Kessler reported personal fees from Datastat Inc and personal fees from Sage Pharmaceuticals, and Takeda during the conduct of the study. Dr Rauch reported grants from USA MRAA during the conduct of the study. Dr Furukawa reported grants from Mitsubishi-Tanabe and personal fees from Mitsubishi-Tanabe, MSD, and Shionogi outside the submitted work; in addition, Dr Furukawa had a patent for 2018-177688 pending for smartphone CBT apps and a patent for copyrights licensed for Kokoro-app smartphone CBT app. No other disclosures were reported.
Publisher Copyright:
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