Eirini Karyotaki1,2,3, Orestis Efthimiou1,4, Clara Miguel2,5, Frederic Maas Genannt Bermpohl6, Toshi A Furukawa6,7, Pim Cuijpers2,5, Heleen Riper2,5,8, Vikram Patel3, Adriana Mira9,10, Alan W Gemmil11, Albert S Yeung12, Alfred Lange13, Alishia D Williams14, Andrew Mackinnon15,16, Anna Geraedts17, Annemieke van Straten2,5, Björn Meyer18,19, Cecilia Björkelund20, Christine Knaevelsrud21, Christopher G Beevers22, Cristina Botella23,24, Daniel R Strunk25, David C Mohr26, David D Ebert27, David Kessler28,29, Derek Richards30,31, Elizabeth Littlewood32, Erik Forsell33, Fan Feng34, Fang Wang35, Gerhard Andersson33,36, Heather Hadjistavropoulos37, Heleen Christensen15, Iony D Ezawa25, Isabella Choi38, Isabelle M Rosso39,40, Jan Philipp Klein41, Jason Shumake22, Javier Garcia-Campayo42,43, Jeannette Milgrom11, Jessica Smith44, Jesus Montero-Marin45, Jill M Newby14,15, Juana Bretón-López23,24, Justine Schneider46, Kristofer Vernmark36,47, Lara Bücker48, Lisa B Sheeber49, Lisanne Warmerdam50, Louise Farrer51, Manuel Heinrich21, Marcus J H Huibers2,5, Marie Kivi52, Martin Kraepelien33, Nicholas R Forand53,54, Nicky Pugh37, Nils Lindefors33, Ove Lintvedt55, Pavle Zagorscak21, Per Carlbring56, Rachel Phillips57, Robert Johansson56, Ronald C Kessler58, Sally Brabyn31, Sarah Perini59, Scott L Rauch39, Simon Gilbody32,60, Steffen Moritz48, Thomas Berger61, Victor Pop62, Viktor Kaldo33,63, Viola Spek62, Yvonne Forsell64. 1. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. 2. Department of Clinical Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. 3. Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts. 4. Department of Psychiatry, University of Oxford, Oxford, England. 5. Amsterdam Public Health Research Institute, Amsterdam, the Netherlands. 6. Department of Clinical Psychology and Psychotherapy, University of Wuppertal, Wuppertal, Germany. 7. Department of Health Promotion and Human Behavior, Department of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan. 8. Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, Amsterdam, the Netherlands. 9. PROMOSAM Excellence in Research Program, MINECO, Valencia, Spain. 10. Department of Personality, Evaluation and Psychological Treatment, Valencia University, Valencia, Spain. 11. Parent-Infant Research Institute, Department of Clinical and Health Psychology, Heidelberg Repatriation Hospital, Austin Health, Ivanhoe, Victoria, Australia. 12. Depression Clinical and Research Program, Massachusetts General Hospital, Harvard University, Boston, Massachusetts. 13. Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands. 14. Department of Psychology, University of New South Wales, Sydney, New South Wales, Australia. 15. Prince of Wales Hospital, Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia. 16. Center for Mental Health, University of Melbourne, Melbourne, Victoria, Australia. 17. HumanTotalCare, Utrecht, the Netherlands. 18. Research Department, Gaia AG, Hamburg, Germany. 19. Department of Psychology, City, University of London, London, England. 20. Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg School of Public Health and Community Medicine, Gothenburg, Sweden. 21. Department for Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany. 22. Department of Psychology and Institute for Mental Health Research, The University of Texas at Austin. 23. Department of Basic Psychology, Clinic and Psychobiology, Jaume I University, Castellon, Spain. 24. CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain. 25. Department of Psychology, The Ohio State University, Columbus, Ohio. 26. Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, Illinois. 27. Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany. 28. Centre for Academic Primary Care, Bristol Medical School (Population Health Sciences), University of Bristol, Bristol, England. 29. National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, England. 30. E-mental Health Research Group, Trinity College Dublin School of Psychology, Dublin, Ireland. 31. Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland. 32. Department of Health Sciences, University of York, York, England. 33. Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden. 34. Benson Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Harvard University, Boston, Massachusetts. 35. Department of Psychology and Sleep Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China. 36. Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. 37. Department of Psychology, University of Regina, Regina, Saskatchewan, Canada. 38. Central Clinical School, Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia. 39. McLean Hospital, Belmont, Massachusetts. 40. Harvard Medical School, Boston, Massachusetts. 41. Department of Psychiatry and Psychotherapy, Luebeck University, Luebeck, Germany. 42. Aragon Institute for Health Research (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain. 43. Primary Care Prevention and Health Promotion Research Network, RedIAPP, Madrid, Spain. 44. Imperial Clinical Trials Unit, Imperial College London, London, England. 45. Warneford Hospital, Department of Psychiatry, University of Oxford, Oxford, England. 46. Institute of Mental Health, University of Nottingham, Nottingham, England. 47. Psykologpartners, Linkoping, Sweden. 48. Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 49. Oregon Research Institute, Eugene, Oregon. 50. National Health Care Institute, Diemen, the Netherlands. 51. Centre for Mental Health Research, The Australian National University, Canberra, Australia. 52. Department of Psychology and AgeCap, University of Gothenburg, Gothenburg, Sweden. 53. Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio. 54. Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York. 55. Norwegian Center for E-health research, Tromsø, Norway. 56. Department of Psychology, Stockholm University, Stockholm, Sweden. 57. Faculty of Medicine, Imperial College London School of Public Health, London, England. 58. Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts. 59. The Clinical Psychology Centre, Sydney, New South Wales, Australia. 60. Hull York Medical School, University of York, York, England. 61. Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland. 62. Department of Clinical and Medical Health Psychology, Tilburg University, Tilburg, the Netherlands. 63. Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden. 64. Section of Epidemiology and Public Health Intervention Research, Department of Global Public Health, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Sweden.
Abstract
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.
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.
Authors: Lisa B Sheeber; John R Seeley; Edward G Feil; Betsy Davis; Erik Sorensen; Derek B Kosty; Peter M Lewinsohn Journal: J Consult Clin Psychol Date: 2012-06-04
Authors: Vikram Patel; Shekhar Saxena; Crick Lund; Graham Thornicroft; Florence Baingana; Paul Bolton; Dan Chisholm; Pamela Y Collins; Janice L Cooper; Julian Eaton; Helen Herrman; Mohammad M Herzallah; Yueqin Huang; Mark J D Jordans; Arthur Kleinman; Maria Elena Medina-Mora; Ellen Morgan; Unaiza Niaz; Olayinka Omigbodun; Martin Prince; Atif Rahman; Benedetto Saraceno; Bidyut K Sarkar; Mary De Silva; Ilina Singh; Dan J Stein; Charlene Sunkel; JÜrgen UnÜtzer Journal: Lancet Date: 2018-10-09 Impact factor: 79.321
Authors: Gerhard Andersson; Nickolai Titov; Blake F Dear; Alexander Rozental; Per Carlbring Journal: World Psychiatry Date: 2019-02 Impact factor: 49.548
Authors: Kristofer Vernmark; Jan Lenndin; Jonas Bjärehed; Mattias Carlsson; Johan Karlsson; Jörgen Oberg; Per Carlbring; Thomas Eriksson; Gerhard Andersson Journal: Behav Res Ther Date: 2010-02-02
Authors: Björn Meyer; Thomas Berger; Franz Caspar; Christopher G Beevers; Gerhard Andersson; Mario Weiss Journal: J Med Internet Res Date: 2009-05-11 Impact factor: 5.428
Authors: Jonathan I Bisson; Cono Ariti; Katherine Cullen; Neil Kitchiner; Catrin Lewis; Neil P Roberts; Natalie Simon; Kim Smallman; Katy Addison; Vicky Bell; Lucy Brookes-Howell; Sarah Cosgrove; Anke Ehlers; Deborah Fitzsimmons; Paula Foscarini-Craggs; Shaun R S Harris; Mark Kelson; Karina Lovell; Maureen McKenna; Rachel McNamara; Claire Nollett; Tim Pickles; Rhys Williams-Thomas Journal: BMJ Date: 2022-06-16
Authors: Alan W Gemmill; Jessica Lee Oliva; Jennifer Ericksen; Charlene Holt; Christopher J Holt; Jeannette Milgrom Journal: BMC Psychiatry Date: 2022-07-16 Impact factor: 4.144
Authors: Maria J E Schouten; Jack J M Dekker; Tamara Q de Bruijn; David D Ebert; Lisanne M Koomen; Sjoerd L A Kosterman; Heleen Riper; Michael P Schaub; Anna E Goudriaan; Matthijs Blankers Journal: BMC Psychiatry Date: 2021-05-22 Impact factor: 3.630
Authors: Sherif M Badawy; Kaleab Z Abebe; Charlotte A Reichman; Grace Checo; Megan E Hamm; Jennifer Stinson; Chitra Lalloo; Patrick Carroll; Santosh L Saraf; Victor R Gordeuk; Payal Desai; Nirmish Shah; Darla Liles; Cassandra Trimnell; Charles R Jonassaint Journal: JMIR Res Protoc Date: 2021-05-14
Authors: Toshi A Furukawa; Aya Suganuma; Edoardo G Ostinelli; Gerhard Andersson; Christopher G Beevers; Jason Shumake; Thomas Berger; Florien Willemijn Boele; Claudia Buntrock; Per Carlbring; Isabella Choi; Helen Christensen; Andrew Mackinnon; Jennifer Dahne; Marcus J H Huibers; David D Ebert; Louise Farrer; Nicholas R Forand; Daniel R Strunk; Iony D Ezawa; Erik Forsell; Viktor Kaldo; Anna Geraedts; Simon Gilbody; Elizabeth Littlewood; Sally Brabyn; Heather D Hadjistavropoulos; Luke H Schneider; Robert Johansson; Robin Kenter; Marie Kivi; Cecilia Björkelund; Annet Kleiboer; Heleen Riper; Jan Philipp Klein; Johanna Schröder; Björn Meyer; Steffen Moritz; Lara Bücker; Ove Lintvedt; Peter Johansson; Johan Lundgren; Jeannette Milgrom; Alan W Gemmill; David C Mohr; Jesus Montero-Marin; Javier Garcia-Campayo; Stephanie Nobis; Anna-Carlotta Zarski; Kathleen O'Moore; Alishia D Williams; Jill M Newby; Sarah Perini; Rachel Phillips; Justine Schneider; Wendy Pots; Nicole E Pugh; Derek Richards; Isabelle M Rosso; Scott L Rauch; Lisa B Sheeber; Jessica Smith; Viola Spek; Victor J Pop; Burçin Ünlü; Kim M P van Bastelaar; Sanne van Luenen; Nadia Garnefski; Vivian Kraaij; Kristofer Vernmark; Lisanne Warmerdam; Annemieke van Straten; Pavle Zagorscak; Christine Knaevelsrud; Manuel Heinrich; Clara Miguel; Andrea Cipriani; Orestis Efthimiou; Eirini Karyotaki; Pim Cuijpers Journal: Lancet Psychiatry Date: 2021-05-03 Impact factor: 77.056
Authors: Antonia Raya-Tena; María Isabel Fernández-San-Martin; Jaume Martin-Royo; Rocío Casañas; Glòria Sauch-Valmaña; Cèlia Cols-Sagarra; Elena Navas-Mendez; Roser Masa-Font; Marc Casajuana-Closas; Quintí Foguet-Boreu; Eva María Fernández-Linares; Jacobo Mendioroz-Peña; Susana González-Tejón; Luis Miguel Martín-López; María Francisca Jiménez-Herrera Journal: Int J Environ Res Public Health Date: 2021-03-13 Impact factor: 3.390