Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Nov 13, 2019
Date Accepted: Jul 24, 2020
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Acceptability and Effectiveness of NHS Recommended E-therapies for Anxiety and Depression: A Meta-Analysis
ABSTRACT
Background:
The disconnect between the ability to swiftly development e-therapies for the treatment of anxiety and depression and the evaluation of their clinical efficacy, means that many e-therapies in routine use in the National Health Service (NHS) in the United Kingdom have skipped appropriate rigorous evaluation.
Objective:
To conduct a meta-analytic review of the clinical trial evidence of the acceptability and clinical effectiveness of e-therapies that have been recommended for usage in the NHS. PROSPERO registration: CRD42019130184.
Methods:
Systematic searches identified appropriate randomised controlled trials and anxiety and depression outcomes at end of treatment/follow-up were extracted and synthesised using a random-effects meta-analysis. Moderators of treatment effect were examined using sub-group and meta-regression analysis.
Results:
Twenty-four studies evaluating 7/51 NHS recommended e-therapies were qualitatively and quantitatively synthesised. Depression and anxiety outcomes for e-therapies were superior to controls (depression: standardised mean difference [SMD] 0.39, 95% confidence interval [CI] 0.25 to 0.52, N=5603; anxiety: SMD 0.42, CI 23 to 61, N=3475) and these small effects were maintained at follow-up. Dropout rates for e-therapies (30%) were significantly higher than for controls (19%). Limited moderators of treatment effect were identified.
Conclusions:
The ease of access and health economic promise of e-therapies combined with the small but significant beneficial treatment effects found here, indicate that e-therapies may be best utilised as a waitlist management device within routine service provision.
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