JMIR Publications

ABSTRACT

Background:

Evidence on technology-based psychological interventions (TBIs) for the acute treatment of depression is rapidly growing. Despite extensive research in this field, there is a lack in research determining effectiveness and acceptance of TBIs in people with a formally diagnosed depressive disorder considering different application formats.

Objective:

To investigate effectiveness and acceptance of TBIs in people with diagnosed depression with particular focus on application formats (stand-alone interventions, blended treatments, collaborative and/or stepped care interventions).

Methods:

Randomized controlled trials (RCTs) in adults with diagnosed unipolar depressive disorders receiving any kind of psychotherapeutic treatment which was at least partly delivered by a technical medium were eligible for inclusion. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, PSYNDEX, CINAHL (January 2018), clinical trial registers, and sources of grey literature (January 2019). Two independent authors decided about study inclusion and extracted data. We performed random effects meta-analyses to synthesize data.

Results:

Database searches resulted in 13,077 records of which 65 completed studies were included. TBIs delivered as stand-alone interventions showed positive effects on post-treatment depression severity when compared to treatment as usual (SMD -0.37, 95% CI -0.65 to -0.09, k=8; I²=76%), attention placebo (SMD -0.54, 95% CI -0.78 to -0.29; k=10; I²=71%) and waiting list controls (SMD -0.86, 95% CI -1.00 to -0.71; k=17; I²=32%). Superior long-term effects on depression severity were shown when TBIs were compared to treatment as usual (SMD -0.15, 95% CI -0.29 to -0.01; k=4; I²=0%) attention placebo (SMD -0.25, 95% CI -0.44 to -0.06; k=6; I²=31%) and waiting list controls (SMD -0.74, 95% CI -1.00 to -0.71; k=3; I²=79%). TBIs being delivered as blended treatments yielded beneficial effects on post-treatment depression severity (SMD -0.21, 95% CI -0.39 to -0.04; k=10; I²=49%) compared to sole face-to-face treatments. Additionally, TBIs being delivered within collaborative care trials were more effective in reducing post-treatment (SMD -0.21, 95% CI -0.36 to -0.04 k=2; I²=0%) and long-term depression severity (SMD -0.23, 95% CI -0.23 to -0.07; k=2; I²=0%) compared to usual care. Dropout rates from treatment did not differ between intervention and control groups in any comparison (all Ps ≥ 0.28).

Conclusions:

We found that TBIs are not only effective when delivered as stand-alone interventions, but also when they were delivered as blended treatments, or in collaborative care trials for people with diagnosed depression. Our results may be useful to inform routine care, since we focused specifically on different application formats, formally diagnosed patients and long-term effectiveness of TBIs. Clinical Trial: PROSPERO registration: CRD42016050413 Study protocol: 10.1136/bmjopen-2018-028042