JMIR Publications

ABSTRACT

Background:

Evidence on technology-based psychological interventions (TBIs) for the treatment of depression is rapidly growing and covers a broad scope of research. Despite extensive research in this field, guideline recommendations are still limited to the general effectiveness of TBIs.

Objective:

The main purpose of this work was to structure evidence on TBIs considering different application areas (eg, TBIs for acute treatment and their implementation in health care [eg, stand-alone interventions]) and treatment characteristics (eg, therapeutic rationale of TBIs) to provide a comprehensive evidence base and to identify research gaps on TBIs for diagnosed depression. Moreover, we investigated the report of negative events in included studies in this review to enable subsequent safety assessment of TBIs.

Methods:

Randomized controlled trials (RCTs) on adults with diagnosed unipolar depression receiving any kind of psychotherapeutic treatment, which was at least partly delivered by a technical medium were eligible for inclusion in our preregistered systematic review. We searched trials in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, PSYNDEX, CINAHL (until the end of January 2018), clinical trial registers, and sources of grey literature (until the end of January 2019). We conducted selection of studies and data extraction by two independent authors.

Results:

Database searches resulted in 13,077 records, of which 179 publications were included representing 70 completed studies and 27 studies awaiting classification (ie, preregistered studies, study protocols). Almost all (93%; n=65) of completed studies addressed the acute treatment phase, being largely either implemented as stand-alone interventions (73%; n=51) or blended treatment approaches (16%; n=11). Studies on TBIs for aftercare (6%; n=4) and for bridging waiting periods (1%; n = 1) were scarce. Most TBI study arms were guided (54%, n=49), delivered via the internet (74%; n=67), and based on cognitive behavioral treatment approaches (79%; n=71). Almost all studies (94%; n=66) reported information on negative events – considering also dropouts from treatment as a negative event. However, reports on negative events were heterogeneous and largely unsystematic.

Conclusions:

Research has placed little attention in studies evaluating TBIs for aftercare and for bridging waiting periods in people with depression, even though TBIs are seen as highly promising in these application areas, thus high quality studies are urgently needed. Additionally, the variety of therapeutic rationales on TBIs has been barely represented by identified studies hindering the consideration of patient preferences when planning treatment. Lastly, future studies should make use of specific guidelines supporting to systematically assess and report negative events. Clinical Trial: PROSPERO – International prospective register of systematic reviews: CRD42016050413