Heterogeneity of treatment effects in internet- and mobile-based interventions for depression : a systematic review and meta-analysis
Loading...
Date
2024-07-18
Authors
Terhorst, Yannik
Kaiser, Tim
Brakemeier, Eva-Lotta
Moshe, Isaac
Philippi, Paula
Cuijpers, Pim
Baumeister, Harald
Sander Lasse Bosse
Journal Title
Journal ISSN
Volume Title
Publication Type
Wissenschaftlicher Artikel
Published in
JAMA Network Open, 2024
Abstract
Importance While the effects of internet- and mobile-based interventions (IMIs) for depression have been extensively studied, no systematic evidence is available regarding the heterogeneity of treatment effects (HTEs), indicating to what extent patient-by-treatment interactions exist and personalized treatment models might be necessary.
Objective To investigate the HTEs in IMIs for depression as well as their efficacy and effectiveness.
Data Sources A systematic search in Embase, MEDLINE, Central, and PsycINFO for randomized clinical trials and supplementary reference searches was conducted on October 13, 2019, and updated March 25, 2022. The search string included various terms related to digital psychotherapy, depression, and randomized clinical trials.
Study Selection Titles, abstracts, and full texts were reviewed by 2 independent researchers. Studies of all populations with at least 1 intervention group receiving an IMI for depression and at least 1 control group were eligible, if they assessed depression severity as a primary outcome and followed a randomized clinical trial (RCT) design.
Data Extraction and Synthesis This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Risk of bias was evaluated using the Cochrane Risk of Bias Tool. HTE was investigated using logarithmic variance ratios (lnVR) and effect sizes using Hedges g. Three-level bayesian meta-regressions were conducted.
Main Outcomes and Measures Heterogeneity of treatment effects was the primary outcome of this study; magnitudes of treatment effect sizes were the secondary outcome. Depression severity was measured by different self-report and clinician-rated scales in the included RCTs.
Results The systematic review of 102 trials included 19 758 participants (mean [SD] age, 39.9 [10.58] years) with moderate depression severity (mean [SD] in Patient Health Questionnaire–9 score, 12.81 [2.93]). No evidence for HTE in IMIs was found (lnVR = −0.02; 95% credible interval [CrI], −0.07 to 0.03). However, HTE was higher in more severe depression levels (β̂ = 0.04; 95% CrI, 0.01 to 0.07). The effect size of IMI was medium (g = −0.56; 95% CrI, −0.46 to −0.66). An interaction effect between guidance and baseline severity was found (β̂ = −0.24, 95% CrI, −0.03 to −0.46).
Conclusions and Relevance In this systematic review and meta-analysis of RCTs, no evidence for increased patient-by-treatment interaction in IMIs among patients with subthreshold to mild depression was found. Guidance did not increase effect sizes in this subgroup. However, the association of baseline severity with HTE and its interaction with guidance indicates a more sensitive, guided, digital precision approach would benefit individuals with more severe symptoms. Future research in this population is needed to explore personalization strategies and fully exploit the potential of IMI.
Description
Faculties
Fakultät für Ingenieurwissenschaften, Informatik und Psychologie
Institutions
Institut für Psychologie und Pädagogik
Citation
DFG Project uulm
EU Project THU
Other projects THU
License
CC BY 4.0 International
Is version of
Has version
Supplement to
Has erratum
Erratum to
Has Part
Part of
DOI external
DOI external
10.1001/jamanetworkopen.2024.23241
Institutions
Periodical
Degree Program
DFG Project THU
item.page.thu.projectEU
item.page.thu.projectOther
Series
Keywords
Depression, Depression, Mental, DDC 150 / Psychology