Do guided internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis
Open accessAbstract
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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Video conferencing is a viable medium to provide support in absence of face-to-face meetings.
“evidence both prior to the pandemic and more recently suggests this may be a viable medium to provide support in the absence of face-to-face meetings (Karyotaki et al., 2018; Viswanathan et al., 2020).”
From ACTing towards better living during COVID-19: The effects of Acceptance and Commitment therapy for individuals affected by COVID-19 (2022) · cites this paper as Karyotaki et al., 2018
The Introduction (page unavailable) describes guided internet-based depression interventions with support by email, phone, or e-chat, and the Conclusions endorse them as a treatment option. This supports providing help without face-to-face meetings, but the paper does not establish that video conferencing specifically is a viable medium. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThis evidence supports previous studies that online therapy is efficient and provides increased access to treatment for people experiencing anxiety and depression.
“This evidence supports previous studies that have found that online therapy is efficient and provides increased access to treatment for people experiencing anxiety and depression [6,7].”
From Efficacy of a six-week-long therapist-guided online therapy versus self-help internet-based therapy for COVID-19–induced anxiety and depression: Open-label, pragmatic, randomized controlled trial (2021) · cites this paper as [7]
The Conclusions (page unavailable in our copy) say guided internet-based interventions are effective for depression and may help bridge the gap between demand for psychological treatment and available services. The paper does not establish effectiveness or increased access for people with anxiety, and it does not establish efficiency as a separate outcome. (LLM, conf=0.88)
Experimental — accuracy not yet measuredOnline psychotherapy or e-therapy guided by a psychotherapist has shown favorable outcomes, particularly in cases of anxiety or clinical depression.
“However, contrary to this popular belief, online psychotherapy or e-therapy guided by a psychotherapist has shown favorable outcomes, particularly in cases of anxiety or clinical depression [6,7].”
From Efficacy of a six-week-long therapist-guided online therapy versus self-help internet-based therapy for COVID-19–induced anxiety and depression: Open-label, pragmatic, randomized controlled trial (2021) · cites this paper as [7]
The Conclusions (page not provided) report substantial improvements in response and remission with guided internet-based treatments for depression. They also say guidance in the included studies came from professionals or paraprofessionals, so a psychotherapist was not required. The paper does not report treatment outcomes for anxiety; that part of the claim is not supported by this source. (LLM, conf=0.88)
Experimental — accuracy not yet measuredEffects may be more pronounced for specific individuals, raising the need for moderator analyses.
“In addition, effects may be more pronounced for specific individuals, raising the need for moderator analyses in e.g. individual patient data meta-analyses (Karyotaki et al., 2018).”
From The effect of e-mental health interventions on academic performance in university and college students: A meta-analysis of randomized controlled trials (2020) · cites this paper as Karyotaki et al., 2018
Guided iCBT can be as effective as face-to-face individual, group, or other delivery formats of CBT of similar length.
“It is now well established that guided iCBT can be as effective as face-to-face individual, group, or other delivery formats of CBT of similar length.10–12”
Internet-based CBT can be provided at low cost and has been proven effective in patients with depression.
“A solution could be internet-based CBT (iCBT), which can be provided at low cost and has been proven effective in patients with depression [7,8].”
From An Internet-Based Cognitive Behavioral Therapy Program Adapted to Patients With Cardiovascular Disease and Depression: Randomized Controlled Trial (2019) · cites this paper as [7]
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“However, given that (a) acceptance of an intervention by the target population is always a necessary prerequisite for utilizing interventions (Andrade et al., 2014; Baumeister et al., 2014; Ebert et al., 2015), (b) studies indicate that different patients may prefer different types of treatment modalities (i.”
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Self-citationThe concept and definition of low intensity cognitive behaviour therapy
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Self-citationDepression and Suicide Risk Screening
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“This evidence supports previous studies that have found that online therapy is efficient and provides increased access to treatment for people experiencing anxiety and depression [6,7].”
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“(30) included 24 RCTs (4,889 participants) and compared guided ICBT with a control group.”
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“Previous research has shown that iCBT has moderate effects in reducing symptoms of adult depression and anxiety when delivered with some form of therapeutic support (Karyotaki et al., 2018; Karyotaki et al., 2021; Pauley, Cuijpers, Papola, Miguel, & Karyotaki, 2021).”
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“The other side of the coin is the potential of using digital facilities to deliver web-based interventions which have been shown to be effective in reducing stress [15] and improving mental health in those affected by serious disorders such as depression [16, 17].”
BackgroundSelf-citationUpdated taxonomy of digital mental health interventions: a conceptual framework
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Self-citationGamblingLess: A Randomised Trial Comparing Guided and Unguided Internet-Based Gambling Interventions
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Self-citationInterdisciplinary perspectives on digital technologies for global mental health
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Self-citationInternet-delivered mental health treatment systems in Scandinavia – A usability evaluation
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Towards eHealth to support the health journey of headache patients: a scoping review
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Mental disorders and cardiovascular disease: what should we be looking out for?
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Efficacy, Safety, and Evaluation Criteria of mHealth Interventions for Depression: Systematic Review
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A randomized controlled trial on a self-guided Internet-based intervention for gambling problems
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Self-citationTelehealth Utilization During COVID-19 Among People with Diagnosed Mental Health Conditions
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Self-citation
- Authors
- Karyotaki, E., Ebert, D. D., Donkin, L., Riper, H., Twisk, J., Burger, S., Rozental, A., Lange, A., Williams, A. D., Zarski, A. C., Geraedts, A., van Straten, A., Kleiboer, A., Meyer, B., Ünlü Ince, B. B., Buntrock, C., Lehr, D., Snoek, F. J., Andrews, G., Andersson, G., Choi, I., Ruwaard, J., Klein, J. P., Newby, J. M., Schröder, J., Laferton, J. A. C., Van Bastelaar, K., Imamura, K., Vernmark, K., Boß, L., Sheeber, L. B., Kivi, M., Berking, M., Titov, N., Carlbring, P., Johansson, R., Kenter, R., Perini, S., Moritz, S., Nobis, S., Berger, T., Kaldo, V., Forsell, Y., Lindefors, N., Kraepelien, M., Björkelund, C., Kawakami, N., & Cuijpers, P.
- Affiliations
- Amsterdam Public Health (NL)
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- The University of Sydney (AU)
- Karolinska Institutet (SE)
- University of Amsterdam (NL)
- Utrecht University (NL)
- HumanTotalCare (Netherlands) (NL)
- University of London (GB)
- Leuphana University of Lüneburg (DE)
- Amsterdam UMC Location University of Amsterdam (NL)
- UNSW Sydney (AU)
- Linköping University (SE)
- University of Bern (CH)
- University of Lübeck (DE)
- MRC Cognition and Brain Sciences Unit (GB)
- University Medical Center Hamburg-Eppendorf (DE)
- City, University of London (GB)
- The University of Tokyo (JP)
- Oregon Research Institute (US)
- University of Gothenburg (SE)
- Stockholm University (SE)
- St Vincent's Hospital Sydney (AU)
- Linnaeus University (SE)
- Corresponding author
- Karyotaki, Eirini
- ORCID
- Karyotaki, Eirini
- Ebert, David Daniel
- Donkin, Liesje
- Riper, Heleen
- Twisk, Jos
- Burger, Simone
- Rozental, Alexander
- Lange, Alfred
- Zarski, Anna Carlotta
- van Straten, Annemieke
- Kleiboer, Annet
- Meyer, Björn
- Ünlü Ince, Burçin B.
- Buntrock, Claudia
- Lehr, Dirk
- Snoek, Frank J.
- Andrews, Gavin
- Andersson, Gerhard
- Choi, Isabella
- Ruwaard, Jeroen
- Klein, Jan Philipp
- Newby, Jill M.
- Schröder, Johanna
- Laferton, Johannes A.C.
- Imamura, Kotaro
- Vernmark, Kristofer
- Boß, Leif
- Sheeber, Lisa B.
- Kivi, Marie
- Berking, Matthias
- Titov, Nickolai
- Carlbring, Per
- Johansson, Robert
- Kenter, Robin
- Moritz, Steffen
- Nobis, Stephanie
- Berger, Thomas
- Kaldo, Viktor
- Forsell, Yvonne
- Lindefors, Nils
- Kraepelien, Martin
- Björkelund, Cecilia
- Kawakami, Norito
- Cuijpers, Pim
- Venue
- Clinical Psychology Review
- Publisher
- Elsevier BV
- Published
- 2018-07
- Volume
- 63
- Pages
- 80-92
- ISSN
- 0272-7358 (ISSN-L)
- OpenAlex
- W2809135251
- Cited by
- 303
- References
- 121
- Citations by year
- 2026: 17 · 2025: 23 · 2024: 39 · 2023: 47 · 2022: 37 · 2021: 56 · 2020: 44 · 2019: 37 · 2018: 3
- FWCI
- 4.75
- Type
- journal article
- Language
- en
- Open access
- green
- research.vu.nl
- Licence
- Locations
- Clinical Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
- VU Research Portal (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- UvA-DARE (University of Amsterdam) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- UCL Discovery (University College London) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Multilingual Matters (Channel View Publications) (submittedVersion)
- UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Japan Society for the Promotion of Science (16K15371, 17K15849)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- depression, online therapy, treatment response, remission, treatment moderators, age, ethnicity, depression severity, reliable change index
- MeSH terms
- Depressive Disorder, Humans, Psychotherapy, Self Care, Treatment Outcome, Internet
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