Efficacy of self-guided internet based cognitive behavioral therapy in the treatment of depressive symptoms

A meta analysis of individual participant data

E. Karyotaki, Heleen Riper, Jos W. R. Twisk, A.W. Hoogendoorn, M.A. Kleiboer, Adriana Mira, A. Mackinnon, B. Meyer, C. Botella, Elizabeth Littlewood, G. Andersson, H. Christensen, J. Klein, Johanna Schröder, Juana Breton-Lopez, Justin Scheider, J. Griffiths, L. Farrer, M. J. H. Huibers, Rachel Phillips & 6 others S. Gilbody, S. Moritz, T. Berger, V.J.M. Pop, V.R.M. Spek, P. Cuijpers

Research output: Contribution to journalArticleScientificpeer-review

Abstract

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.
Original languageEnglish
Pages (from-to)351-359
JournalJAMA Psychiatry
Volume74
Issue number4
DOIs
Publication statusPublished - 2017

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Karyotaki, E. ; Riper, Heleen ; Twisk, Jos W. R. ; Hoogendoorn, A.W. ; Kleiboer, M.A. ; Mira, Adriana ; Mackinnon, A. ; Meyer, B. ; Botella, C. ; Littlewood, Elizabeth ; Andersson, G. ; Christensen, H. ; Klein, J. ; Schröder, Johanna ; Breton-Lopez, Juana ; Scheider, Justin ; Griffiths, J. ; Farrer, L. ; Huibers, M. J. H. ; Phillips, Rachel ; Gilbody, S. ; Moritz, S. ; Berger, T. ; Pop, V.J.M. ; Spek, V.R.M. ; Cuijpers, P. / Efficacy of self-guided internet based cognitive behavioral therapy in the treatment of depressive symptoms : A meta analysis of individual participant data. In: JAMA Psychiatry. 2017 ; Vol. 74, No. 4. pp. 351-359.
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title = "Efficacy of self-guided internet based cognitive behavioral therapy in the treatment of depressive symptoms: A meta analysis of individual participant data",
abstract = "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.",
author = "E. Karyotaki and Heleen Riper and Twisk, {Jos W. R.} and A.W. Hoogendoorn and M.A. Kleiboer and Adriana Mira and A. Mackinnon and B. Meyer and C. Botella and Elizabeth Littlewood and G. Andersson and H. Christensen and J. Klein and Johanna Schr{\"o}der and Juana Breton-Lopez and Justin Scheider and J. Griffiths and L. Farrer and Huibers, {M. J. H.} and Rachel Phillips and S. Gilbody and S. Moritz and T. Berger and V.J.M. Pop and V.R.M. Spek and P. Cuijpers",
year = "2017",
doi = "10.1001/jamapsychiatry.2017.0044",
language = "English",
volume = "74",
pages = "351--359",
journal = "JAMA Psychiatry",
issn = "2168-6238",
publisher = "American Medical Association",
number = "4",

}

Karyotaki, E, Riper, H, Twisk, JWR, Hoogendoorn, AW, Kleiboer, MA, Mira, A, Mackinnon, A, Meyer, B, Botella, C, Littlewood, E, Andersson, G, Christensen, H, Klein, J, Schröder, J, Breton-Lopez, J, Scheider, J, Griffiths, J, Farrer, L, Huibers, MJH, Phillips, R, Gilbody, S, Moritz, S, Berger, T, Pop, VJM, Spek, VRM & Cuijpers, P 2017, 'Efficacy of self-guided internet based cognitive behavioral therapy in the treatment of depressive symptoms: A meta analysis of individual participant data', JAMA Psychiatry, vol. 74, no. 4, pp. 351-359. https://doi.org/10.1001/jamapsychiatry.2017.0044

Efficacy of self-guided internet based cognitive behavioral therapy in the treatment of depressive symptoms : A meta analysis of individual participant data. / Karyotaki, E.; Riper, Heleen; Twisk, Jos W. R.; Hoogendoorn, A.W.; Kleiboer, M.A.; Mira, Adriana; Mackinnon, A.; Meyer, B.; Botella, C.; Littlewood, Elizabeth; Andersson, G.; Christensen, H.; Klein, J.; Schröder, Johanna; Breton-Lopez, Juana; Scheider, Justin; Griffiths, J.; Farrer, L.; Huibers, M. J. H.; Phillips, Rachel; Gilbody, S. ; Moritz, S.; Berger, T.; Pop, V.J.M.; Spek, V.R.M.; Cuijpers, P.

In: JAMA Psychiatry, Vol. 74, No. 4, 2017, p. 351-359.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Efficacy of self-guided internet based cognitive behavioral therapy in the treatment of depressive symptoms

T2 - A meta analysis of individual participant data

AU - Karyotaki, E.

AU - Riper, Heleen

AU - Twisk, Jos W. R.

AU - Hoogendoorn, A.W.

AU - Kleiboer, M.A.

AU - Mira, Adriana

AU - Mackinnon, A.

AU - Meyer, B.

AU - Botella, C.

AU - Littlewood, Elizabeth

AU - Andersson, G.

AU - Christensen, H.

AU - Klein, J.

AU - Schröder, Johanna

AU - Breton-Lopez, Juana

AU - Scheider, Justin

AU - Griffiths, J.

AU - Farrer, L.

AU - Huibers, M. J. H.

AU - Phillips, Rachel

AU - Gilbody, S.

AU - Moritz, S.

AU - Berger, T.

AU - Pop, V.J.M.

AU - Spek, V.R.M.

AU - Cuijpers, P.

PY - 2017

Y1 - 2017

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.

U2 - 10.1001/jamapsychiatry.2017.0044

DO - 10.1001/jamapsychiatry.2017.0044

M3 - Article

VL - 74

SP - 351

EP - 359

JO - JAMA Psychiatry

JF - JAMA Psychiatry

SN - 2168-6238

IS - 4

ER -