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

Review article
Authors 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
Björn Meyer
Burçin B Ünlü Ince
Claudia Buntrock
Dirk Lehr
Frank J Snoek
Gavin Andrews
Gerhard Andersson
Isabella Choi
Jeroen Ruwaard
Jan Philipp Klein
Jill M Newby
Johanna Schröder
Johannes A C Laferton
Kim Van Bastelaar
Kotaro Imamura
Kristofer Vernmark
Leif Boß
Lisa B Sheeber
Marie Kivi
Matthias Berking
Nickolai Titov
Per Carlbring
Robert Johansson
Robin Kenter
Sarah Perini
Steffen Moritz
Stephanie Nobis
Thomas Berger
Viktor Kaldo
Yvonne Forsell
Nils Lindefors
Martin Kraepelien
Cecilia Björkelund
Norito Kawakami
Pim Cuijpers
Published in Clinical psychology review
Volume 63
Pages 80-92
ISSN 1873-7811
Publication year 2018
Published at Institute of Medicine, School of Public Health and Community Medicine
Department of Psychology
Pages 80-92
Language en
Keywords Depression, Internet-based guided self-help, Meta-analysis, Psychotherapy
Subject categories Applied Psychology, Psychiatry, Family Medicine


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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