Work

Internet-based Cognitive Behavioral Therapy for Depression : An Individual Patient Data Network Meta-Analysis

Year: 2021

Type: article

Study designs: Systematic Review, Meta-Analysis

Abstract: Key PointsQuestion: What are the patient-specific relative effects of guided versus unguided iCBT for depression over the short-and the long-term?Findings: Patients differ in response to guided versus unguided iCBT.Individuals with mild/subthreshold depression may have little or no benefit from therapeutic guidance, while guided iCBT is superior in moderate and severe depression.Both iCBT modalities outperformed the TAU regardless of depression severity.Meaning: Although guided has greater effects compared to unguided iCBT on average, many people with depression may still benefit from the iCBT without therapeutic guidance.Optimising treatment assignment would considerably expand treatment coverage worldwide.IMPORTANCE Personalized treatment choices would increase the effectiveness of internetbased Cognitive Behavioral Therapy (iCBT) for depression to the extent that patients differ in interventions that better suit them.OBJECTIVES We aimed to provide personalized estimates of short-and long-term relative efficacy of guided and unguided iCBT for depression, utilizing patient-level information.DATA SOURCES We searched PubMed, Embase, PsycINFO and Cochrane Library to identify randomized controlled trials (RCTs) published up to January 1 st , 2019.STUDY SELECTION Eligible RCTs were those comparing guided or unguided iCBT against each other or against any control intervention in individuals with depression.We sought individual patient data (IPD) from all eligible studies.Depression symptom severity was assessed post-treatment, six-and 12-months post-randomization. DATA EXTRACTION AND SYNTHESISWe conducted an IPD network meta-analysis (IPD-NMA) and estimated relative treatment effects across different patient characteristics through IPD network meta-regression. MAIN OUTCOME AND MEASURESPatient Health Questionnaire-9 scores (PHQ-9) RESULTS Of 42 eligible RCTs, 39 comprising 9,751 participants with depression contributed IPD to our IPD-NMA, of which we were able to synthesize 8107 IPD.Overall, both guided and unguided iCBT were more effective than controls over the short-and the long-term.Guided iCBT was more effective than unguided iCBT [mean difference (MD) in post-treatment PHQ-9 scores = -0.8,95% Confidence Interval (CI) -1.4 to -0.2], but we found no evidence of a difference at six-or 12-months post-randomization.Baseline depression was found to be the most important modifier of the relative efficacy of guided versus 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 resulted in overall better outcomes in patients with baseline PHQ-9 > 9. We developed an interactive web application generating estimated relative effects according to patients' characteristics:

Source: White Rose Research Online (University of Leeds, The University of Sheffield, University of York)