JMIR Publications

ABSTRACT

Background:

Depression is a worldwide mental disorder, which is one of the leading causes of disability. Despite the availability of evidence-based treatment options, only nearly half of the people with depression receive suitable treatment. Many people, suffering from depression, do not want to take medication or they do not have the motivation to seek psychotherapy treatment for many reasons, such as perceived stigma, unavailability of psychotherapists including long waiting lists for the beginning of treatment, probable prohibitive costs or geographic distance. Guided internet-based self-help programs may be a promising solution addressing these issues. This kind of intervention has proven to be effective in reducing depression symptoms on a short-term scale. However, as treatment often is a long-term rehabilitation process, it is therefore very important to examine not only short-term effects of iCBT self-help treatment but also the follow-up and/or long-term efficacy of this kind of interventions.

Objective:

This systematic review and meta-analysis aimed to identify studies that examined the follow-up or long-term efficacy of iCBT self-help programs with minimal weekly guidance for people with depression. It aimed to analyze the long-term efficacy of iCBT groups compared to control conditions as well as long-term efficacy within the iCBT treatment conditions. Additionally, it aimed to conduct subgroup analyses according to the follow-up timepoints for each outcome. Finally, it examined the long-term improvement in quality of life.

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register electronic searches, grey literature, reference lists and correspondence were used to search for published and unpublished RCTs that reported long-term and/or follow-up efficacy of computer- and/or internet-based CBT self-help treatments for depression with minimal guidance of up to 10 min. per week. The searching process took place between 2015 and 2022 (October). 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:

The search process resulted in a total of 2809 study abstracts, of which 15 studies (with 17 samples) met all inclusion criteria and were included in the long-term analysis. The results showed that the depression outcomes of all follow-up timepoints together in the treatment conditions favored over the control conditions with a medium effect size of 0.43. Analysis of long-term efficacy within the iCBT treatment conditions showed that the follow-up outcome of the treatment groups was favored over the post-treatment outcome with a small effect size of 0.20. Findings in improving quality of life also showed, that the iCBT conditions favored over the control conditions with a small effect size of 0.19.

Conclusions:

This systematic review and meta-analysis found that iCBT self-help interventions with weekly minimal guidance of up to 10 minutes had a superior long-term efficacy for individuals with depressive symptoms compared to control groups. The within group analysis of iCBT treatment conditions also showed statistically significant improvements in reducing depressive symptoms at follow-up compared to post-treatment measurements