Review articleInternet- and mobile-based depression interventions for people with diagnosed depression: A systematic review and meta-analysis
Introduction
Depressive disorders, are highly prevalent with 12- month prevalence rates ranging between 5.8% and 10.7% (Baumeister and Härter, 2007). Depression is associated with substantial impairment (Saarni et al., 2007; Üstün et al., 2004), high economic costs (Berto et al., 2000; Greenberg and Birnbaum, 2005) and has been identified as major reason for illness-related disability worldwide (Vos et al., 2013).
Treatment for depression, particularly psychotherapy and psychopharmacotherapy, has been shown to be effective for people with depression (Cuijpers et al., 2012, Cuijpers et al., 2010b, Khan et al., 2012). However, the majority of affected individuals remain untreated either because they do not seek help or do not have the ability to receive adequate treatment. There are many possible reasons, e.g. fear of stigmatization, low perceived need, desire to handle the problem on one's own, want of confidence in health care system (Andrade et al., 2014, Roness et al., 2005, Saxena et al., 2007).
Providing Internet- and mobile based interventions (IMI) may be a promising strategy overcoming some of the aforementioned obstacles and thereby improving mental health care. Some previous meta-analyses investigated the effectiveness of internet- or computer-based interventions for depression (Andersson and Cuijpers, 2009, Andrews et al., 2010, Cowpertwait and Clarke, 2013, Richards and Richardson, 2012, Spek et al., 2007). Pooled standardized mean differences of Cohen's d = 0.32 (Spek et al., 2007) to Hedges' g = 0.78 (Andrews et al., 2010) for the interventions compared to waitlist, treatment as usual and placebos and mainly waitlist have been reported. Thereby, larger effect sizes have been consistently reported for guided interventions compared to unguided interventions (Baumeister et al., 2014b, Cowpertwait and Clarke, 2013, Richards and Richardson, 2012).
However, notwithstanding the extensive evidence base on the effectiveness of depression IMI with several systematic reviews published during the last years, former reviews lack some important information which the present systematic review aims to overcome: First and most importantly, all except for one of the earlier reviews (Andrews et al., 2010) focused on people with depressive symptoms rather than those with a diagnosed depression. The latter is what most health care systems require to be present for depression care being provided. Accordingly, treatment guidelines such as the UK National Institute for Health and Clinical excellence (NICE) (2009) or the German S3 guideline for depression (DGPPN et al., 2015) prefer evidence from randomized clinical trials that focused on clinical depression samples. Second, previous reviews only focused on the short-term effectiveness or were inconclusive regarding long-term effects. Third, since the last comprehensive review many new trials have been published so an updated synthesis of the evidence seems warranted. Fourth, no review up to date has investigated the effects of IMIs on specific clinical relevant outcomes in depression treatment beside depression severity, such as treatment response and depression remission.
The present systematic review aims to overcome these limitation and will investigate the short- and long-term effectiveness of IMIs in adults compared to non active (no treatment, waitlist, attention placebo) or active control on depression severity, treatment response, remission, anxiety and quality of life in adults with secured clinically diagnosis of Major Depressive Disorder. In summary the following review questions are addressed:
- 1.
Are IMI for depression effective in adults with a diagnosed depression?
- a)
Are IMIs more effective than no-treatment, (attention/psychological) placebo or waitlist conditions?
- b)
Are IMIs as effective as non-internet- and non-mobile-based interventions?
- c)
Are some IMIs more or less effective than other IMIs?
- a)
- 2.
Are there confounding variables that impact the effectiveness of IMIs for depression in adults with a diagnosed depression?
Section snippets
Protocol and registration
Review methods, eligibility criteria and strategy for data analysis were determined in advance and reported in a study protocol available at (https://osf.io/7aw2m). The systematic review and meta-analysis was registered at PROSPERO (registration number: CRD42016039679).
Eligibility criteria
The present review included randomized controlled clinical trials published before June 2016 examining adult samples with a reliably diagnosed depressive disorder (i.e. major depression and/or persistent depressive
Study selection
The database search yielded 4858 records. 108 studies remained for full text analysis after removing duplicates and exclusion due to title and abstract. 19 studies fulfilled all eligibility criteria. The study selection process and reasons for exclusion are described in detail in Fig. 1.
Study characteristics
In sum, 1650 persons from randomized trials were included. The mean age was 41.4 years (SD = 6.6), 70% were female. Ten of the studies evaluated an IMI vs. WL comparison (Berger et al., 2011, Carlbring et al.,
Discussion
The present systematic review and meta-analysis summarizes the available evidence regarding internet- and mobile-based interventions for depression in people with a reliable diagnosis of major depressive disorder and/or dysthymia. The 19 included studies comprise a great variety of interventions, populations, control groups, health care systems and research groups which allows a comprehensive insight into the field of research.
IMIs showed a large beneficial effect on depression severity at the
Acknowledgments
No acknowledgments
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