Internet-Based Cognitive Behavioral Therapy for Depression: A Systematic Review and Individual Patient Data Network Meta-analysis

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Internet-Based Cognitive Behavioral Therapy for Depression : A Systematic Review and Individual Patient Data Network Meta-analysis

Karyotaki, Eirini (author): University of Bern, Switzerland;Vrije Universiteit Amsterdam, Netherlands;Harvard Medical School, USA

Efthimiou, Orestis (author): University of Bern, Switzerland;University of Oxford, UK

Miguel, Clara (author): Vrije Universiteit Amsterdam, Netherlands;Amsterdam Public Health Research Institute, Netherlands

Bermpohl, Frederic Maas Genannt (author): University of Wuppertal, Germany

Furukawa, Toshi A (author): University of Wuppertal, Germany;Kyoto University Graduate School of Medicine/School of Public Health, Japan

Cuijpers, Pim (author): Vrije Universiteit Amsterdam, Netherlands;Amsterdam Public Health Research Institute, Netherlands

Riper, Heleen (author): Vrije Universiteit Amsterdam, Netherlands;Amsterdam Public Health Research Institute, Netherlands;GGZ inGeest, Netherlands

Patel, Vikram (author): Harvard Medical School, Sweden

Mira, Adriana (author): MINECO, Spain;Valencia University, Spain

Gemmil, Alan W. (author): Heidelberg Repatriation Hospital, Australia

Yeung, Albert S. (author): Harvard University, USA

Lange, Alfred (author): University of Amsterdam, Netherlands

Williams, Alishia D. (author): University of New South Wales, Australia

Mackinnon, Andrew (author): University of New South Wales, Australia; University of Melbourne, Australia

Geraedts, Anna (author): HumanTotalCare, Netherlands

van Straten, Annemieke (author): Vrije Universiteit Amsterdam, Netherlands;Amsterdam Public Health Research Institute, Netherlands

Meyer, Björn (author): Gaia AG, Germany;University of London, UK

Björkelund, Cecilia, 1948 (author): Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa,Institute of Medicine, School of Public Health and Community Medicine

Knaevelsrud, Christine (author): Freie Universität Berlin, Germany

Beevers, Christopher G. (author): The University of Texas at Austin, USA

Botella, Cristina (author): Jaume I University, Spain;Instituto Salud Carlos III, Spain

Strunk, Daniel R. (author): The Ohio State University, USA

Mohr, David C. (author): Northwestern University, USA

Ebert, David D. (author): Friedrich-Alexander-University Erlangen-Nürnberg, Germany

Kessler, David (author): University of Bristol, UK;National Institute for Health Research Bristol Biomedical Research Centre, UK

Richards, Derek (author): Trinity College Dublin School of Psychology, Ireland;SilverCloud Health, Ireland

Littlewood, Elizabeth (author): University of York, UK

Forsell, Erik (author): Karolinska Institutet, Sweden;Region Stockholm, Sweden

Feng, Fan (author): Massachusetts General Hospital, USA

Wang, Fang (author): China Academy of Chinese Medical Sciences, China

Andersson, Gerhard (author): Karolinska Institutet, Sweden;Region Stockholm, Sweden;Linköping University, Sweden

Hadjistavropoulos, Heather (author): University of Regina, Canada

Christensen, Heleen (author): University of New South Wales, Australia

Ezawa, Iony D. (author): The Ohio State University, USA

Choi, Isabella (author): University of Sydney, Australia

Rosso, Isabelle M (author): McLean Hospital, USA;Harvard Medical School, USA

Klein, Jan Philipp (author): Lübeck University, Germany

Shumake, Jason (author): The University of Texas at Austin, USA

Garcia-Campayo, Javier (author): Miguel Servet University Hospital, Spain;RedIAPP, Spain

Milgrom, Jeannette (author): Heidelberg Repatriation Hospital, Australia

Smith, Jessica (author): Imperial College London, UK

Montero-Marin, Jesus (author): University of Oxford, UK

Newby, Jill M. (author): University of New South Wales, Australia

Bretón-López, Juana (author): Jaume I University, Spain;Instituto Salud Carlos III, Spain

Schneider, Justine (author): University of Nottingham, UK

Vernmark, Kristofer (author): Linköping University, Sweden;Psykologpartners, Sweden

Bücker, Lara (author): University Medical Center Hamburg-Eppendorf, Germany

Sheeber, Lisa B. (author): Oregon Research Institute, USA

Warmerdam, Lisanne (author): National Health Care Institute, Netherlands

Farrer, Louise (author): The Australian National University, Australia

Heinrich, Manuel (author): Freie Universität Berlin, Germany

Huibers, Marcus J. H. (author): Vrije Universiteit Amsterdam, Netherlands;Amsterdam Public Health Research Institute, Netherlands

Kivi, Marie (author): Gothenburg University,Göteborgs universitet,Psykologiska institutionen,Department of Psychology

Kraepelien, Martin (author): Karolinska Institutet, Sweden;Region Stockholm, Sweden

Forand, Nicholas R. (author): The Ohio State University Wexner Medical Center, USA;The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, USA

Pugh, Nicky (author): University of Regina, Canada

Lindefors, Nils (author): Karolinska Institutet, Sweden;Region Stockholm, Sweden

Lintvedt, Ove (author): Norwegian Center for E-health research, Norway

Zagorscak, Pavle (author): Freie Universität Berlin, Germany

Carlbring, Per (author): Stockholms universitet,Klinisk psykologi

Phillips, Rachel (author): Imperial College London School of Public Health, UK

Johansson, Robert (author): Stockholms universitet,Klinisk psykologi

Kessler, Ronald C. (author): Harvard Medical School, USA

Brabyn, Sally (author): SilverCloud Health, Ireland

Perini, Sarah (author): The Clinical Psychology Centre, Australia

Rauch, Scott L. (author): McLean Hospital, USA

Gilbody, Simon (author): University of York, UK;Hull York Medical School, UK

Moritz, Steffen (author): University Medical Center Hamburg-Eppendorf, Germany

Berger, Thomas (author): University of Bern, Switzerland

Pop, Victor (author): Tilburg University, Netherlands

Kaldo, Viktor, Professor (author): Linnéuniversitetet,Institutionen för psykologi (PSY),Karolinska Institutet, Sweden

Spek, Viola (author): Tilburg University, Netherlands

Forsell, Yvonne (author): Karolinska Institutet, Sweden;Region Stockholm, Sweden

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American Medical Association, 2021
2021
English.
In: JAMA psychiatry. - : American Medical Association. - 2168-6238 .- 2168-622X. ; 78:4, s. 361-371

Related links:: https://boris.unibe....; show more...; https://urn.kb.se/re...; https://doi.org/10.1...; http://kipublication...; https://gup.ub.gu.se...; https://urn.kb.se/re...; show less...

Research review (peer-reviewed)

Abstract Subject headings

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.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Psykiatri (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Psychiatry (hsv//eng)
SAMHÄLLSVETENSKAP -- Psykologi -- Tillämpad psykologi (hsv//swe)
SOCIAL SCIENCES -- Psychology -- Applied Psychology (hsv//eng)
MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Allmänmedicin (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- General Practice (hsv//eng)
SAMHÄLLSVETENSKAP -- Psykologi (hsv//swe)
SOCIAL SCIENCES -- Psychology (hsv//eng)

Keyword

Cognitive Behavioral Therapy
Depression Therapy
Depressive Disorder Therapy
Humans
Internet-Based Intervention
Network Meta-Analysis
Psychology
Psykologi
Psychology

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By the author/editor: Karyotaki, Eirin ...; Efthimiou, Orest ...; Miguel, Clara; Bermpohl, Freder ...; Furukawa, Toshi ...; Cuijpers, Pim; show more...; Riper, Heleen; Patel, Vikram; Mira, Adriana; Gemmil, Alan W.; Yeung, Albert S.; Lange, Alfred; Williams, Alishi ...; Mackinnon, Andre ...; Geraedts, Anna; van Straten, Ann ...; Meyer, Björn; Björkelund, Ceci ...; Knaevelsrud, Chr ...; Beevers, Christo ...; Botella, Cristin ...; Strunk, Daniel R ...; Mohr, David C.; Ebert, David D.; Kessler, David; Richards, Derek; Littlewood, Eliz ...; Forsell, Erik; Feng, Fan; Wang, Fang; Andersson, Gerha ...; Hadjistavropoulo ...; Christensen, Hel ...; Ezawa, Iony D.; Choi, Isabella; Rosso, Isabelle ...; Klein, Jan Phili ...; Shumake, Jason; Garcia-Campayo, ...; Milgrom, Jeannet ...; Smith, Jessica; Montero-Marin, J ...; Newby, Jill M.; Bretón-López, Ju ...; Schneider, Justi ...; Vernmark, Kristo ...; Bücker, Lara; Sheeber, Lisa B.; Warmerdam, Lisan ...; Farrer, Louise; Heinrich, Manuel; Huibers, Marcus ...; Kivi, Marie; Kraepelien, Mart ...; Forand, Nicholas ...; Pugh, Nicky; Lindefors, Nils; Lintvedt, Ove; Zagorscak, Pavle; Carlbring, Per; Phillips, Rachel; Johansson, Rober ...; Kessler, Ronald ...; Brabyn, Sally; Perini, Sarah; Rauch, Scott L.; Gilbody, Simon; Moritz, Steffen; Berger, Thomas; Pop, Victor; Kaldo, Viktor, P ...; Spek, Viola; Forsell, Yvonne; show less...

About the subject

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Psychiatry

SOCIAL SCIENCES: SOCIAL SCIENCES; and Psychology; and Applied Psycholo ...

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and General Practice

SOCIAL SCIENCES: SOCIAL SCIENCES; and Psychology

Articles in the publication: JAMA psychiatry

By the university: Linnaeus University; Karolinska Institutet; University of Gothenburg; Stockholm University

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