Internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety or both: a systematic review with meta-analysis of randomised controlled trials
Objective Depression and anxiety are major public health problems. This study evaluated the effects of internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety, or both.Design Systematic review with meta-analysis.Data sources Medline (Ovid), Cochrane Libra...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2024-04-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/4/e075796.full |
| _version_ | 1797224564104626176 |
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| author | Erik Hedman-Lagerlöf Anne H Berman Erland Axelsson Elin Lindsäter Karoline Kolaas Jonna Hybelius |
| author_facet | Erik Hedman-Lagerlöf Anne H Berman Erland Axelsson Elin Lindsäter Karoline Kolaas Jonna Hybelius |
| author_sort | Erik Hedman-Lagerlöf |
| collection | DOAJ |
| description | Objective Depression and anxiety are major public health problems. This study evaluated the effects of internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety, or both.Design Systematic review with meta-analysis.Data sources Medline (Ovid), Cochrane Library (Wiley), the Web of Science Core Collection (Clarivate), and PsycInfo (EBSCO) were searched on 24 May 2021, with an update on 6 February 2023.Eligibility criteria Randomised controlled trials of internet-delivered transdiagnostic psychological treatments, open to both participants with primary depression and participants with primary anxiety. This review concerned all treatment frameworks, both guided and unguided formats and all age groups.Data extraction and synthesis In random-effects meta-analysis, we estimated pooled effects on depression symptoms and anxiety in terms of Hedges’ g with 95% CIs. Absolute and relative heterogeneity was quantified as the τ2 and I2.Results We included 57 trials with 21 795 participants. Nine trials (16%) recruited exclusively from routine care, and three (5%) delivered treatment via video. For adults, large within-group reductions were seen in depression (g=0.90; 95% CI 0.81 to 0.99) and anxiety (g=0.87; 95% CI 0.78 to 0.96). Compared with rudimentary passive controls, the added effects were moderate (depression: g=0.52; 95% CI 0.42 to 0.63; anxiety: g=0.45; 95% CI 0.34 to 0.56) and larger in trials that required all participants to meet full diagnostic criteria for depression or an anxiety disorder. Compared with attention/engagement controls, the added effects were small (depression: g=0.30; 95% CI 0.07 to 0.53; anxiety: g=0.21; 95% CI 0.01 to 0.42). Heterogeneity was substantial, and the certainty of the evidence was very low. Two trials concerned adolescents and reported mixed results. One trial concerned older adults and reported promising results.Conclusion Internet-delivered transdiagnostic treatments for depression and anxiety show small-to-moderate added effects, varying by control condition. Research is needed regarding routine care, the video format, children and adolescents and older adults.PROSPERO registration number CRD42021243172. |
| first_indexed | 2024-04-24T13:55:07Z |
| format | Article |
| id | doaj.art-d23f5e1ee17f4c74992ef66c9a2ad57c |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-24T13:55:07Z |
| publishDate | 2024-04-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-d23f5e1ee17f4c74992ef66c9a2ad57c2024-04-03T18:05:10ZengBMJ Publishing GroupBMJ Open2044-60552024-04-0114410.1136/bmjopen-2023-075796Internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety or both: a systematic review with meta-analysis of randomised controlled trialsErik Hedman-Lagerlöf0Anne H Berman1Erland Axelsson2Elin Lindsäter3Karoline Kolaas4Jonna Hybelius5Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, SwedenDepartment of Psychology, Uppsala University, Uppsala, SwedenLiljeholmen University Primary Health Care Center, Academic Primary Health Care Center, Stockholm, Sweden1 Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, SwedenCentre for Psychiatry Research, Karolinska Institute Department of Clinical Neuroscience, Stockholm, Stockholm, SwedenLiljeholmen University Primary Health Care Center, Region Stockholm, Academic Primary Care Centre, Stockholm, Stockholm, SwedenObjective Depression and anxiety are major public health problems. This study evaluated the effects of internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety, or both.Design Systematic review with meta-analysis.Data sources Medline (Ovid), Cochrane Library (Wiley), the Web of Science Core Collection (Clarivate), and PsycInfo (EBSCO) were searched on 24 May 2021, with an update on 6 February 2023.Eligibility criteria Randomised controlled trials of internet-delivered transdiagnostic psychological treatments, open to both participants with primary depression and participants with primary anxiety. This review concerned all treatment frameworks, both guided and unguided formats and all age groups.Data extraction and synthesis In random-effects meta-analysis, we estimated pooled effects on depression symptoms and anxiety in terms of Hedges’ g with 95% CIs. Absolute and relative heterogeneity was quantified as the τ2 and I2.Results We included 57 trials with 21 795 participants. Nine trials (16%) recruited exclusively from routine care, and three (5%) delivered treatment via video. For adults, large within-group reductions were seen in depression (g=0.90; 95% CI 0.81 to 0.99) and anxiety (g=0.87; 95% CI 0.78 to 0.96). Compared with rudimentary passive controls, the added effects were moderate (depression: g=0.52; 95% CI 0.42 to 0.63; anxiety: g=0.45; 95% CI 0.34 to 0.56) and larger in trials that required all participants to meet full diagnostic criteria for depression or an anxiety disorder. Compared with attention/engagement controls, the added effects were small (depression: g=0.30; 95% CI 0.07 to 0.53; anxiety: g=0.21; 95% CI 0.01 to 0.42). Heterogeneity was substantial, and the certainty of the evidence was very low. Two trials concerned adolescents and reported mixed results. One trial concerned older adults and reported promising results.Conclusion Internet-delivered transdiagnostic treatments for depression and anxiety show small-to-moderate added effects, varying by control condition. Research is needed regarding routine care, the video format, children and adolescents and older adults.PROSPERO registration number CRD42021243172.https://bmjopen.bmj.com/content/14/4/e075796.full |
| spellingShingle | Erik Hedman-Lagerlöf Anne H Berman Erland Axelsson Elin Lindsäter Karoline Kolaas Jonna Hybelius Internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety or both: a systematic review with meta-analysis of randomised controlled trials BMJ Open |
| title | Internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety or both: a systematic review with meta-analysis of randomised controlled trials |
| title_full | Internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety or both: a systematic review with meta-analysis of randomised controlled trials |
| title_fullStr | Internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety or both: a systematic review with meta-analysis of randomised controlled trials |
| title_full_unstemmed | Internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety or both: a systematic review with meta-analysis of randomised controlled trials |
| title_short | Internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety or both: a systematic review with meta-analysis of randomised controlled trials |
| title_sort | internet delivered transdiagnostic psychological treatments for individuals with depression anxiety or both a systematic review with meta analysis of randomised controlled trials |
| url | https://bmjopen.bmj.com/content/14/4/e075796.full |
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