Do guided internet-based interventions result in clinically relevant changes for patients with depression? An individual participant data meta-analysis.
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
Author Information
Eirini Karyotaki: Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands. Electronic address: e.karyotaki@vu.nl.
David Daniel Ebert: Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
Liesje Donkin: The Brain and Mind Research Institute, University of Sydney, NSW 2050, Australia.
Heleen Riper: Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands.
Jos Twisk: Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands.
Simone Burger: Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands.
Alexander Rozental: Institute of Child Health, University College London, United Kingdom; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
Alfred Lange: Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands.
Alishia D Williams: Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.
Anna Carlotta Zarski: Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
Anna Geraedts: HumanTotalCare, Utrecht, the Netherlands.
Annemieke van Straten: Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands.
Annet Kleiboer: Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands.
Björn Meyer: Research Department, Gaia AG, Hamburg, Germany; Department of Psychology, City, University of London, London, United Kingdom.
Burçin B Ünlü Ince: Informatics Institute, Middle East Technical University, Ankara, Turkey.
Claudia Buntrock: Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
Dirk Lehr: Institute of Psychology, Leuphana University Lüneburg, Germany.
Frank J Snoek: Department of Medical Psychology, VU Medical Center, Academic Medical Center, Public Health Research institute, Amsterdam, the Netherlands.
Gavin Andrews: Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia.
Gerhard Andersson: Department of Behavioral Sciences and Learning, Linköping University, Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institute for Disability Research, Stockholm, Sweden.
Isabella Choi: Brain and Mind Centre, University of Sydney, Sydney, Australia.
Jeroen Ruwaard: Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands.
Jan Philipp Klein: Department of Psychiatry and Psychotherapy, Luebeck University, Luebeck, Germany.
Jill M Newby: Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia; The MRC Cognition and Brain Sciences Unit, Cambridge, United Kingdom; School of Psychology, the University of New South Wales, Sydney, Australia.
Johanna Schröder: Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Institute for Sex Research and Forensic Psychiatry, Hamburg, Germany.
Johannes A C Laferton: Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
Kim Van Bastelaar: Department of Medical Psychology, VU Medical Center, Amsterdam, the Netherlands.
Kotaro Imamura: Department of Mental Health, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyō-ku, Tokyo, Japan.
Kristofer Vernmark: Department of Behavioural Sciences and Learning, Linkoping University, Linkoping, Sweden.
Leif Boß: Institute of Psychology, Leuphana University Lüneburg, Germany.
Lisa B Sheeber: Oregon Research Institute, Eugene, OR, USA.
Marie Kivi: Department of Psychology, University of Gothenburg, Göteborg, Sweden.
Matthias Berking: Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
Nickolai Titov: MindSpot Clinic and eCentreClinic, Department of Psychology, Macquarie University, Australia.
Per Carlbring: Department of Psychology, Stockholm University, Stockholm, Sweden; Department of Psychology, University of Southern Denmark, Denmark.
Robert Johansson: Department of Behavioral Sciences and Learning, Linköping University, and Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
Robin Kenter: Department of Clinical Psychology, University of Bergen, Bergen, Norway.
Sarah Perini: Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, New South Wales, Australia.
Steffen Moritz: Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands.
Stephanie Nobis: Division of Online Health Training, Innovation Incubator, Leuphana University Lüneburg, Germany.
Thomas Berger: Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
Viktor Kaldo: Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden; Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
Yvonne Forsell: Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
Nils Lindefors: Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
Martin Kraepelien: Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
Cecilia Björkelund: Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Norito Kawakami: Department of Mental Health, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyō-ku, Tokyo, Japan.
Pim Cuijpers: Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands.
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.
