JMIR Publications

ABSTRACT

Background:

There is a growing interest in developing scalable interventions, including internet-based cognitive-behavioral therapy (iCBT), to meet the increasing demand for mental health services. Given the growth in diversity worldwide, it is essential that the clinical trials of iCBT for depression include diverse samples or, at the very least, report information on the racial-ethnic composition of their samples. Unfortunately, the field lacks data on how well racial-ethnic diversity is currently reported and represented in the iCBT literature.

Objective:

Thus, the main objective of this systematic review was to examine the overall reporting of racial and ethnic identities in published clinical trials of iCBT for depression. We also aimed to review the representation of specific racial and ethnic minority groups and the inclusion of alternative background indicators such as migration status, and country of residence.

Methods:

Studies were included if they were a randomized control trial in which iCBT was compared to a waiting list, care-as-usual, active control, or another self-help iCBT treatment. The included papers also had a focus on acute treatment (e.g., 4 weeks – 6 months) of depression, delivered via the internet on a website or a smartphone app as guided or unguided self-help. Studies were initially identified from the METAPSY database and then extended to include papers up to 2022, with papers retrieved from EMBASE, PubMed, PsycInfo, and Cochrane. Risk of bias assessment suggested that reported studies had at least some risk of bias due to self-reporting as an outcome measure. On the other domains, studies appeared to be mostly at low risk ranging from 63.2% (missing outcome data) to 89.5% (deviation from intended interventions).

Results:

A total of 62 iCBT randomized control trials and 17,210 participants are summarized in this study. Only 27.4% of the trials reported race, and only 19.4% reported ethnicity. Reporting outside of the United States (U.S.) was very poor, with the U.S. accounting for 88.2% of studies that reported race and 81.8% for ethnicity. Overall, the most reported race was White (74.9%), followed by Black (7.5%) and Asian (5.7%). Furthermore, when translating this to individual participants, 13,587 (78.9%) participants had no reported race, and 14,810 (86%) had no reported ethnicity.

Conclusions:

It is important to note that the underrepresentation observed in this study does not necessarily indicate an underrepresentation in the actual study population. Furthermore, the scope of this review is limited to internet-delivered trials for depression. However, these findings highlight the poor reporting and representation of race and ethnicity in iCBT trials for depression found in the literature. This lack of diversity reporting may have significant implications for the scalability of these interventions. Further research is needed to address these limitations and gain a more comprehensive understanding. Clinical Trial: https://psyarxiv.com/kfnhm/