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Psychol Med. 2016 Oct;46(13):2679-93. doi: 10.1017/S0033291716001562.

Does Internet-based guided-self-help for depression cause harm? An individual participant data meta-analysis on deterioration rates and its moderators in randomized controlled trials.

Author information

1
Friedrich Alexander University Erlangen-Nuremberg,Erlangen,Germany.
2
The Brain and Mind Research Institute,University of Sydney,NSW,Australia.
3
Department of Behavioural Sciences and Learning,Linköping University,Linköping,Sweden.
4
Clinical Research Unit for Anxiety and Depression,School of Psychiatry,University of New South WalesatSt Vincent's Hospital,Darlinghurst,NSW,Australia.
5
Department of Clinical Psychology and Psychotherapy,University of Bern,Bern,Switzerland.
6
Department of Psychology,Stockholm University,Sweden.
7
Brain and Mind Centre,University of Sydney,Sydney,Australia.
8
Psychologische Hochschule Berlin.
9
Department of Clinical,Neuro and Developmental Psychology,VU University Amsterdam,the Netherlands.
10
Department of Clinical Psychology,University of Amsterdam,Amsterdam,The Netherlands.
11
Leuphana University Lüneburg,Germany.
12
Centre for Emotional Health,Macquarie University,Australia.
13
Oregon Research Institute,Eugene,Oregon,USA.
14
Department of Medical Psychology,VU University Medical Center Amsterdam,The Netherlands.
15
eCentreClinic and MindSpot Clinic,Department of Psychology,Macquarie University,Australia.
16
School of Psychology,Xavier University,Cincinnati,USA.

Abstract

BACKGROUND:

Almost nothing is known about the potential negative effects of Internet-based psychological treatments for depression. This study aims at investigating deterioration and its moderators within randomized trials on Internet-based guided self-help for adult depression, using an individual patient data meta-analyses (IPDMA) approach.

METHOD:

Studies were identified through systematic searches (PubMed, PsycINFO, EMBASE, Cochrane Library). Deterioration in participants was defined as a significant symptom increase according to the reliable change index (i.e. 7.68 points in the CES-D; 7.63 points in the BDI). Two-step IPDMA procedures, with a random-effects model were used to pool data.

RESULTS:

A total of 18 studies (21 comparisons, 2079 participants) contributed data to the analysis. The risk for a reliable deterioration from baseline to post-treatment was significantly lower in the intervention v. control conditions (3.36 v. 7.60; relative risk 0.47, 95% confidence interval 0.29-0.75). Education moderated effects on deterioration, with patients with low education displaying a higher risk for deterioration than patients with higher education. Deterioration rates for patients with low education did not differ statistically significantly between intervention and control groups. The benefit-risk ratio for patients with low education indicated that 9.38 patients achieve a treatment response for each patient experiencing a symptom deterioration.

CONCLUSIONS:

Internet-based guided self-help is associated with a mean reduced risk for a symptom deterioration compared to controls. Treatment and symptom progress of patients with low education should be closely monitored, as some patients might face an increased risk for symptom deterioration. Future studies should examine predictors of deterioration in patients with low education.

KEYWORDS:

Adverse events; Internet-based guided self-help; depression; deterioration effect; negative effects

PMID:
27649340
PMCID:
PMC5560500
DOI:
10.1017/S0033291716001562
[Indexed for MEDLINE]
Free PMC Article

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