Efficacy of Self-guided Internet-Based Cognitive Behavioral Therapy in the Treatment of Depressive Symptoms. A Meta-analysis of Individual Participant Data

TY - JOUR

T1 - Efficacy of Self-guided Internet-Based Cognitive Behavioral Therapy in the Treatment of Depressive Symptoms. A Meta-analysis of Individual Participant Data

AU - Karyotaki, Eirini

AU - Riper, Heleen

AU - Twisk, Jos

AU - Hoogendoorn, Adriaan

AU - Kleiboer, Annet

AU - Mira, Adriana

AU - Mackinnon, Andrew

AU - Meyer, Björn

AU - Botella, Cristina

AU - Littlewood, Elizabeth

AU - Andersson, Gerhard

AU - Christensen, Helen

AU - Klein, Jan P

AU - Schröder, Johanna

AU - Bretón-López, Juana

AU - Scheider, Justine

AU - Griffiths, Kathy

AU - Farrer, Louise

AU - Huibers, Marcus J H

AU - Phillips, Rachel

AU - Gilbody, Simon

AU - Moritz, Steffen

AU - Berger, Thomas

AU - Pop, Victor

AU - Spek, Viola

AU - Cuijpers, Pim

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Importance: Self-guided internet-based cognitive behavioral therapy (iCBT) has the potential to increase access and availability of evidence-based therapy and reduce the cost of depression treatment.Objectives: To estimate the effect of self-guided iCBT in treating adults with depressive symptoms compared with controls and evaluate the moderating effects of treatment outcome and response.Data Sources: A total of 13 384 abstracts were retrieved through a systematic literature search in PubMed, Embase, PsycINFO, and Cochrane Library from database inception to January 1, 2016.Study Selection: Randomized clinical trials in which self-guided iCBT was compared with a control (usual care, waiting list, or attention control) in individuals with symptoms of depression.Data Extraction and Synthesis: Primary authors provided individual participant data from 3876 participants from 13 of 16 eligible studies. Missing data were handled using multiple imputations. Mixed-effects models with participants nested within studies were used to examine treatment outcomes and moderators.Main Outcomes and Measures: Outcomes included the Beck Depression Inventory, Center for Epidemiological Studies-Depression Scale, and 9-item Patient Health Questionnaire scores. Scales were standardized across the pool of the included studies.Results: Of the 3876 study participants, the mean (SD) age was 42.0 (11.7) years, 2531 (66.0%) of 3832 were female, 1368 (53.1%) of 2574 completed secondary education, and 2262 (71.9%) of 3146 were employed. Self-guided iCBT was significantly more effective than controls on depressive symptoms severity (β = -0.21; Hedges g  = 0.27) and treatment response (β = 0.53; odds ratio, 1.95; 95% CI, 1.52-2.50; number needed to treat, 8). Adherence to treatment was associated with lower depressive symptoms (β = -0.19; P = .001) and greater response to treatment (β = 0.90; P < .001). None of the examined participant and study-level variables moderated treatment outcomes.Conclusions and Relevance: Self-guided iCBT is effective in treating depressive symptoms. The use of meta-analyses of individual participant data provides substantial evidence for clinical and policy decision making because self-guided iCBT can be considered as an evidence-based first-step approach in treating symptoms of depression. Several limitations of the iCBT should be addressed before it can be disseminated into routine care.

AB - Importance: Self-guided internet-based cognitive behavioral therapy (iCBT) has the potential to increase access and availability of evidence-based therapy and reduce the cost of depression treatment.Objectives: To estimate the effect of self-guided iCBT in treating adults with depressive symptoms compared with controls and evaluate the moderating effects of treatment outcome and response.Data Sources: A total of 13 384 abstracts were retrieved through a systematic literature search in PubMed, Embase, PsycINFO, and Cochrane Library from database inception to January 1, 2016.Study Selection: Randomized clinical trials in which self-guided iCBT was compared with a control (usual care, waiting list, or attention control) in individuals with symptoms of depression.Data Extraction and Synthesis: Primary authors provided individual participant data from 3876 participants from 13 of 16 eligible studies. Missing data were handled using multiple imputations. Mixed-effects models with participants nested within studies were used to examine treatment outcomes and moderators.Main Outcomes and Measures: Outcomes included the Beck Depression Inventory, Center for Epidemiological Studies-Depression Scale, and 9-item Patient Health Questionnaire scores. Scales were standardized across the pool of the included studies.Results: Of the 3876 study participants, the mean (SD) age was 42.0 (11.7) years, 2531 (66.0%) of 3832 were female, 1368 (53.1%) of 2574 completed secondary education, and 2262 (71.9%) of 3146 were employed. Self-guided iCBT was significantly more effective than controls on depressive symptoms severity (β = -0.21; Hedges g  = 0.27) and treatment response (β = 0.53; odds ratio, 1.95; 95% CI, 1.52-2.50; number needed to treat, 8). Adherence to treatment was associated with lower depressive symptoms (β = -0.19; P = .001) and greater response to treatment (β = 0.90; P < .001). None of the examined participant and study-level variables moderated treatment outcomes.Conclusions and Relevance: Self-guided iCBT is effective in treating depressive symptoms. The use of meta-analyses of individual participant data provides substantial evidence for clinical and policy decision making because self-guided iCBT can be considered as an evidence-based first-step approach in treating symptoms of depression. Several limitations of the iCBT should be addressed before it can be disseminated into routine care.

KW - Adult

KW - Cognitive Therapy

KW - Depressive Disorder

KW - Female

KW - Humans

KW - Internet

KW - Male

KW - Randomized Controlled Trials as Topic

KW - Therapy, Computer-Assisted

KW - Treatment Outcome

KW - Journal Article

KW - Meta-Analysis

U2 - 10.1001/jamapsychiatry.2017.0044

DO - 10.1001/jamapsychiatry.2017.0044

M3 - SCORING: Journal article

C2 - 28241179

VL - 74

SP - 351

EP - 359

JO - JAMA PSYCHIAT

JF - JAMA PSYCHIAT

SN - 2168-622X

IS - 4

ER -