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Ebert DD, Donkin L, Andersson G, Andrews G, Berger T, Carlbring P, Rozenthal A, Choi I, Laferton JAC, Johansson R, Kleiboer A, Lange A, Lehr D, Reins JA, Funk B, Newby J, Perini S, Riper H, Ruwaard J, Sheeber L, Snoek FJ, Titov N, Ince BÜ, van Bastelaar K, Vernmark K, van Straten A, Warmerdam L, Salsman N, Cuijpers P. Does Internet-based guided-self-help for depression cause harm? An individual participant data meta-analysis on deterioration rates and its moderators in randomized controlled trials. Psychol Med 2016; 46:2679-2693. [PMID: 27649340 PMCID: PMC5560500 DOI: 10.1017/s0033291716001562] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Almost nothing is known about the potential negative effects of Internet-based psychological treatments for depression. This study aims at investigating deterioration and its moderators within randomized trials on Internet-based guided self-help for adult depression, using an individual patient data meta-analyses (IPDMA) approach. METHOD Studies were identified through systematic searches (PubMed, PsycINFO, EMBASE, Cochrane Library). Deterioration in participants was defined as a significant symptom increase according to the reliable change index (i.e. 7.68 points in the CES-D; 7.63 points in the BDI). Two-step IPDMA procedures, with a random-effects model were used to pool data. RESULTS A total of 18 studies (21 comparisons, 2079 participants) contributed data to the analysis. The risk for a reliable deterioration from baseline to post-treatment was significantly lower in the intervention v. control conditions (3.36 v. 7.60; relative risk 0.47, 95% confidence interval 0.29-0.75). Education moderated effects on deterioration, with patients with low education displaying a higher risk for deterioration than patients with higher education. Deterioration rates for patients with low education did not differ statistically significantly between intervention and control groups. The benefit-risk ratio for patients with low education indicated that 9.38 patients achieve a treatment response for each patient experiencing a symptom deterioration. CONCLUSIONS Internet-based guided self-help is associated with a mean reduced risk for a symptom deterioration compared to controls. Treatment and symptom progress of patients with low education should be closely monitored, as some patients might face an increased risk for symptom deterioration. Future studies should examine predictors of deterioration in patients with low education.
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Affiliation(s)
- D. D. Ebert
- Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - L. Donkin
- The Brain and Mind Research Institute, University of Sydney, NSW, Australia
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
| | - G. Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - G. Andrews
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent’s Hospital, Darlinghurst, NSW, Australia
| | - T. Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - P. Carlbring
- Department of Psychology, Stockholm University, Sweden
| | - A. Rozenthal
- Department of Psychology, Stockholm University, Sweden
| | - I. Choi
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | | | - R. Johansson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - A. Kleiboer
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
| | - A. Lange
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - D. Lehr
- Leuphana University Lüneburg, Germany
| | | | - B. Funk
- Leuphana University Lüneburg, Germany
| | - J. Newby
- Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent’s Hospital, Darlinghurst, NSW, Australia
| | - S. Perini
- Centre for Emotional Health, Macquarie University, Australia
| | - H. Riper
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
| | - J. Ruwaard
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
| | - L. Sheeber
- Oregon Research Institute, Eugene, Oregon, USA
| | - F. J. Snoek
- Department of Medical Psychology, VU University Medical Center Amsterdam, The Netherlands
- Academic Medical Center/University of Amsterdam, The Netherlands
| | - N. Titov
- eCentreClinic and MindSpot Clinic, Department of Psychology, Macquarie University, Australia
| | - B. Ünlü Ince
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
| | - K. van Bastelaar
- Department of Medical Psychology, VU University Medical Center Amsterdam, The Netherlands
| | - K. Vernmark
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Psykologpartners, Private Practice, Linköping, Sweden
| | - A. van Straten
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
| | - L. Warmerdam
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
| | - N. Salsman
- School of Psychology, Xavier University, Cincinnati, USA
| | - P. Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, VU University Amsterdam, the Netherlands
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Karyotaki E, Kleiboer A, Smit F, Turner DT, Pastor AM, Andersson G, Berger T, Botella C, Breton JM, Carlbring P, Christensen H, de Graaf E, Griffiths K, Donker T, Farrer L, Huibers MJH, Lenndin J, Mackinnon A, Meyer B, Moritz S, Riper H, Spek V, Vernmark K, Cuijpers P. Predictors of treatment dropout in self-guided web-based interventions for depression: an 'individual patient data' meta-analysis. Psychol Med 2015; 45:2717-2726. [PMID: 25881626 DOI: 10.1017/s0033291715000665] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND It is well known that web-based interventions can be effective treatments for depression. However, dropout rates in web-based interventions are typically high, especially in self-guided web-based interventions. Rigorous empirical evidence regarding factors influencing dropout in self-guided web-based interventions is lacking due to small study sample sizes. In this paper we examined predictors of dropout in an individual patient data meta-analysis to gain a better understanding of who may benefit from these interventions. METHOD A comprehensive literature search for all randomized controlled trials (RCTs) of psychotherapy for adults with depression from 2006 to January 2013 was conducted. Next, we approached authors to collect the primary data of the selected studies. Predictors of dropout, such as socio-demographic, clinical, and intervention characteristics were examined. RESULTS Data from 2705 participants across ten RCTs of self-guided web-based interventions for depression were analysed. The multivariate analysis indicated that male gender [relative risk (RR) 1.08], lower educational level (primary education, RR 1.26) and co-morbid anxiety symptoms (RR 1.18) significantly increased the risk of dropping out, while for every additional 4 years of age, the risk of dropping out significantly decreased (RR 0.94). CONCLUSIONS Dropout can be predicted by several variables and is not randomly distributed. This knowledge may inform tailoring of online self-help interventions to prevent dropout in identified groups at risk.
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Affiliation(s)
- E Karyotaki
- Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands
| | - A Kleiboer
- Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands
| | - F Smit
- Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands
| | - D T Turner
- Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands
| | - A M Pastor
- Department of Psychology and Technology,Jaume University,Castellon,Spain
| | - G Andersson
- Department of Behavioural Sciences and Learning,Sweden Institute for Disability Research,Linköping; University,Sweden
| | - T Berger
- Department of Clinical Psychology and Psychotherapy,University of Bern,Bern,Switzerland
| | - C Botella
- Department of Psychology and Technology,Jaume University,Castellon,Spain
| | - J M Breton
- Department of Psychology and Technology,Jaume University,Castellon,Spain
| | - P Carlbring
- Department of Psychology,Stockholm University,Stockholm,Sweden
| | - H Christensen
- Black Dog Institute and University of New South Wales,Prince of Wales Hospital,Sydney,Australia
| | - E de Graaf
- Department of Clinical Psychological Science,Faculty of Psychology,Maastricht University,The Netherlands
| | - K Griffiths
- National Institute of Mental Health Research,The Australian National University,Sydney,Australia
| | - T Donker
- Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands
| | - L Farrer
- National Institute of Mental Health Research,The Australian National University,Sydney,Australia
| | - M J H Huibers
- Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands
| | - J Lenndin
- Department of Behavioural Sciences and Learning,Linkoping University,Linkoping,Sweden
| | - A Mackinnon
- Centre for Youth Mental Health Research,University of Melbourne,Melbourne,Australia
| | - B Meyer
- Research Department,Gaia AG,Hamburg,Germany
| | - S Moritz
- Department of Psychiatry and Psychotherapy,University Medical Centre Hamburg-Eppendorf,Hamburg,Germany
| | - H Riper
- Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands
| | - V Spek
- Avans Hogeschool,University of Tilburg,Tilburg,The Netherlands
| | - K Vernmark
- Department of Behavioural Sciences and Learning,Linkoping University,Linkoping,Sweden
| | - P Cuijpers
- Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands
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