Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/25679
Title: Internet-Based Cognitive Behavioral Therapy for Depression: A Systematic Review and Individual Patient Data Network Meta-analysis.
Austin Authors: Karyotaki, Eirini;Efthimiou, Orestis;Miguel, Clara;Bermpohl, Frederic Maas Genannt;Furukawa, Toshi A;Cuijpers, Pim;Riper, Heleen;Patel, Vikram;Mira, Adriana;Gemmill, Alan W ;Yeung, Albert S;Lange, Alfred;Williams, Alishia D;Mackinnon, Andrew;Geraedts, Anna;van Straten, Annemieke;Meyer, Björn;Björkelund, Cecilia;Knaevelsrud, Christine;Beevers, Christopher G;Botella, Cristina;Strunk, Daniel R;Mohr, David C;Ebert, David D;Kessler, David;Richards, Derek;Littlewood, Elizabeth;Forsell, Erik;Feng, Fan;Wang, Fang;Andersson, Gerhard;Hadjistavropoulos, Heather;Christensen, Heleen;Ezawa, Iony D;Choi, Isabella;Rosso, Isabelle M;Klein, Jan Philipp;Shumake, Jason;Garcia-Campayo, Javier;Milgrom, Jeannette ;Smith, Jessica;Montero-Marin, Jesus;Newby, Jill M;Bretón-López, Juana;Schneider, Justine;Vernmark, Kristofer;Bücker, Lara;Sheeber, Lisa B;Warmerdam, Lisanne;Farrer, Louise;Heinrich, Manuel;Huibers, Marcus J H;Kivi, Marie;Kraepelien, Martin;Forand, Nicholas R;Pugh, Nicky;Lindefors, Nils;Lintvedt, Ove;Zagorscak, Pavle;Carlbring, Per;Phillips, Rachel;Johansson, Robert;Kessler, Ronald C;Brabyn, Sally;Perini, Sarah;Rauch, Scott L;Gilbody, Simon;Moritz, Steffen;Berger, Thomas;Pop, Victor;Kaldo, Viktor;Spek, Viola;Forsell, Yvonne
Affiliation: Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
Research Department, Gaia AG, Hamburg, Germany
Department of Psychology, City, University of London, London, England
Department of Psychology, University of New South Wales, Sydney, New South Wales, Australia
PROMOSAM Excellence in Research Program, MINECO, Valencia, Spain
Department of Personality, Evaluation and Psychological Treatment, Valencia University, Valencia, Spain
Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, Amsterdam, the Netherlands
Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
Department of Clinical Psychology and Psychotherapy, University of Wuppertal, Wuppertal, Germany
Department of Health Promotion and Human Behavior, Department of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
Department of Psychiatry, University of Oxford, Oxford, England
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
Prince of Wales Hospital, Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
Center for Mental Health, University of Melbourne, Melbourne, Victoria, Australia
Parent-Infant Research Institute
Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
Psykologpartners, Linkoping, Sweden
Department of Basic Psychology, Clinic and Psychobiology, Jaume I University, Castellon, Spain
CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
Aragon Institute for Health Research (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain
McLean Hospital, Belmont, Massachusetts
Harvard Medical School, Boston, Massachusetts
E-mental Health Research Group, Trinity College Dublin School of Psychology, Dublin, Ireland
Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
Centre for Academic Primary Care, Bristol Medical School (Population Health Sciences), University of Bristol, Bristol, England
National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, England
Centre for Mental Health Research, The Australian National University, Canberra, Australia
Central Clinical School, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
Department of Health Sciences, University of York, York, England
Hull York Medical School, University of York, York, England
The Clinical Psychology Centre, Sydney, New South Wales, Australia
Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio
Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
Department of Clinical Psychology and Psychotherapy, University of Wuppertal, Wuppertal, Germany
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
Depression Clinical and Research Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
HumanTotalCare, Utrecht, the Netherlands
Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg School of Public Health and Community Medicine, Gothenburg, Sweden
Department for Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin
Department of Psychology, The Ohio State University, Columbus, Ohio
Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, Illinois
Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
Department of Health Sciences, University of York, York, England
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
Benson Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
Department of Psychology and Sleep Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
Department of Psychology, The Ohio State University, Columbus, Ohio
Department of Psychiatry and Psychotherapy, Luebeck University, Luebeck, Germany
Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin
Imperial Clinical Trials Unit, Imperial College London, London, England
Warneford Hospital, Department of Psychiatry, University of Oxford, Oxford, England
Institute of Mental Health, University of Nottingham, Nottingham, England
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Oregon Research Institute, Eugene, Oregon
National Health Care Institute, Diemen, the Netherlands
Department for Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
Department of Psychology and AgeCap, University of Gothenburg, Gothenburg, Sweden
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
Norwegian Center for E-health research, Tromsø, Norway
Department for Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
Department of Psychology, Stockholm University, Stockholm, Sweden
Faculty of Medicine, Imperial College London School of Public Health, London, England
Department of Psychology, Stockholm University, Stockholm, Sweden
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
McLean Hospital, Belmont, Massachusetts
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
Department of Clinical and Medical Health Psychology, Tilburg University, Tilburg, the Netherlands
Section of Epidemiology and Public Health Intervention Research, Department of Global Public Health, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Sweden
Clinical and Health Psychology
Issue Date: 20-Jan-2021
metadata.dc.date: 2021-01-20
Publication information: JAMA Psychiatry 2021; online first: 20 January
Abstract: 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. To provide personalized estimates of short-term and long-term relative efficacy of guided and unguided iCBT for depression using patient-level information. We searched PubMed, Embase, PsycInfo, and Cochrane Library to identify randomized clinical trials (RCTs) published up to January 1, 2019. 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. 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. Patient Health Questionnaire-9 (PHQ-9) scores. 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-0 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. 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.
URI: https://ahro.austin.org.au/austinjspui/handle/1/25679
DOI: 10.1001/jamapsychiatry.2020.4364
PubMed URL: 33471111
Type: Journal Article
Appears in Collections:Journal articles

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