JMIR Publications

ABSTRACT

Background:

Depression is a worldwide disease. Studies show that the rate of depression during the COVID-19 breakout seems to have considerably increased. Cognitive behavioural therapy (CBT)-based self-help treatment allows patients with mild to moderate depression symptoms to improve their depression or to bridge the waiting- or pandemic period until they receive further clinical treatment.

Objective:

This systematic review and meta-analysis aims to explore the efficacy and acceptability of computer-delivered and/or internet-based CBT self-help interventions with minimal guidance (up to 10 minutes) for depression. In addition, comparing the effectiveness of treatment by the type of minimal guidance: (1) by e-mail, (2) by telephone calls, (3) by e-mail and telephone together, or (4) face-to-face in reducing depression symptoms at post-treatment was the second aim.

Methods:

The Cochrane depression, anxiety, and neurosis review group’s specialized register electronic searches, grey literature, reference lists and correspondence were used to search for published and unpublished RCTs that reported efficacy of computer- and/or internet-based CBT self-help treatments for depression with minimal guidance up to 10 minutes per week. Methodological quality of included studies was evaluated with Cochrane Collaboration tools for assessing risk of bias. The meta-analysis was accomplished using the RevMen software.

Results:

In total, 2620 study abstracts were checked for eligibility. Out of these, 17 studies (18 samples) with a total of 3134 participants were included. The results showed that concerning efficacy, the treatment group is superior to the control group with a medium to large effect size of 0.60. Also, treatment groups with combined guidance by e-mail and telephone calls together had greater effects (SMD -0.74) than groups with other types of minimal guidance (guided by e-mail SMD -0.63; guided face to-face SMD – 0.66; guided by telephone calls SMD -0.33). Moreover, there were higher drop-out rates in the treatment condition (RR 1.35) than in the control groups.

Conclusions:

The results of this meta-analysis support the efficacy of computer- and/or internet-based CBT self-help programs with minimal weekly guidance for improving depression symptoms at post-treatment for adults and adolescents. In addition, the results are pointing towards two practical implications. Firstly, depressed patients can use self-help treatment with minimal guidance at home to improve their symptoms or to bridge the waiting time – or pandemic period – before they receive professional face-to-face treatment. Secondly, it can help clinicians to make the decision about using CBT-based self-help treatments for patients that do not need urgent professional treatment, or to combine it with face-to-face therapy.