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Effectiveness von a tailored, integrative Internet beteiligung (deprexis) zum depression: update meta-analysis
Effectiveness des a tailored, integrative Internet intervention (deprexis) weil das depression: update meta-analysis Conal Twomey, Gary O’Reilly, oliver Bültmann, Björn meyer
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Digitally delivered interventions for depression vary in many aspects, consisting of their therapeutic orientation, depth von content, interactivity, individual tailoring, inclusion of multimedia, cost, and effectiveness. However, your effectiveness is rarely examined bei intervention-specific meta-analyses. In earlier meta-analysis des eight randomized regulated trials (RCT) demonstrated the effectiveness des a tailored, integrative digital eingriff (deprexis), which is delivered via die Internet. This updated meta-analysis of twelve deprexis-specific RCT with a total des N = 2901 entrants confirmed ns effectiveness of deprexis for depression reduction hinweisen post-intervention (g = 0.51, 95% CI: 0.40–0.62, I2 = 26%). Results were analogous when study quality, screening and randomization procedure to be taken right into account. Clinician guidance, developer-involvement, setting (community vs. Clinical), and initial symptom severity walk not schutz statistically significant effects on ns effect size, and there was no evidence of publication bias. Thus, this findings demonstrate that deprexis kann sein facilitate clinically relevant reduction des depressive symptoms over 8–12 weeks across a broad variety of initial symptom severity, und that die intervention kann be merged with other creates of depression treatment. There is now a need kommen sie study die intervention’s implementation in routine treatment settings and its permanent effectiveness und cost-effectiveness an diverse cultural und linguistic settings.


Citation: Twomey C, O’Reilly G, Bültmann O, Meyer ns (2020) Effectiveness des a tailored, integrative Internet intervention (deprexis) for depression: to update meta-analysis. oibrecords.com ONE 15(1): e0228100. Https://doi.org/10.1371/journal.pone.0228100

Editor: Daniel Vigo, simon Fraser University, united STATES

Received: September 12, 2019; Accepted: January 7, 2020; Published: januar 30, 2020

Data Availability: The säule underlying die results presented in the study have been published and are available bei the respective tagebuch articles of the twelve separation, personal, instance randomized regulated trials included in this meta-analysis.

Funding: Funding Statement: Gaia AG, Hamburg, provided support in the form of salaries zum authors , however did not oase any additional role an the examine design, data collection and analysis, decision kommen sie publish, or preparation of the manuscript. The specific roles of these authors room articulated in the ‘author contributions’ section.

Competing interests: contending Interests Statement: Two von the writer (B.M. And O.B.) room employed by Gaia AG, Hamburg, the company that developed, owns und operates ns Internet beteiligung examined an this article. This does not alter our adherence to oibrecords.com ONE policies on share data und materials.


Introduction

The globalen treatment gap for depression ranges indigenous 72% bei high-income countries zu 93% in low-income countries, und initiatives kommen sie scale nach oben effective treatments room likely zu be cost-effective since untreated depression is often relevant with negative health and increased handicap risk <1>. Internet-based depression treatments room promising an this regard since they tun können be scaled nach oben easily, und recent meta-analyses have shown that even self-guided internet interventions kann sein achieve clinically relevant effects top top depressive symptom reduction (g = 0.27, NNT = 6.58) <2>, which may be augmented wie man additional clinician support is provided <3>.

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Despite together encouraging findings, caution zu sein warranted zum several reasons, and sweeping conclusions suggesting that all internet interventions for depression are efficient would be misguided. Des note, meta-analytic evidence showing the such interventions are efficient on average does notfall mean that these interventions room all equally reliable or, indeed, that any kind of one beteiligung is effective weist all. Internet interventions for depression differ substantially an their accessibility, therapeutic orientation, depth of content, interactivity, individual tailoring, inclusion von multimedia, self-monitoring tools, homework assignments, and cost <4>. Worryingly, many such interventions for depression are not evidence-based since they are never evaluated in randomized clinical trials (RCTs); this was ns case for 20 out des 32 figured out programs in a recent review <4>.

Given this an extensive heterogeneity among internet interventions weil das depression, one could expect that they deshalb differ an terms des their effectiveness, return head-to-head trials are rare. An one large trial that had two internet interventions for depression (Beating the Blues and MoodGYM), neither des them was effective when added kommen sie primary care in the vereinigt Kingdom <5>. A recent meta-analysis des self-guided depression-focussed internet interventions succumbed a modest average effect des Hedges’ g = 0.27 across all programmes, but the effects of individual interventions ranged native -0.13 zu 0.89, and there was significant moderate zu high heterogeneity, saying that this interventions were notfall equally effective.

To examine die effectiveness of specific internet interventions zum depression, 2 intervention-specific meta-analyses oase recently to be completed. The zuerst of these reported an average effect des g = 0.36 for MoodGYM, bei Australian eingriff based top top cognitive behaviour therapy (CBT). Also though this typical effect is above the recently proposed threshold des clinical relevance von d = 0.24 <6>, the effect shrank kommen sie a non-significant level of g = 0.17 ~ adjusting weil das publication bias. Furthermore, verweise analyses said that the eingriff was an ext effective in trials set bei Australia compared kommen sie Europe-based trials, und larger effects were found wie man face-to-face guidance was provided, compared kommen sie remote guidance (telephone or email). Of note, 11 von the 12 contained trials check the interferenz with some form of angestellter guidance, making that impossible to disentangle whether the interferenz effects might be attributed zu guidance or kommen sie the online programme, because of this <7>.

A second intervention-specific meta-analysis freshly reported an average effect von g = 0.54 zum deprexis, an integrative depression-focussed Internet interferenz developed in Germany. This interferenz differs in many ways from MoodGYM yet is also broadly based upon CBT principles. Unequal MoodGYM, deprexis so contains interaction modules ~ above topics together as optimistic psychology, interpersonal skills, or coping with an overwhelming childhood memories; more detailed descriptions room provided in several other write-ups <8–11>. The deprexis beteiligung is so unique in the sense that the engages users in ‘simulated dialogues’, such the users kann sein continuously pick from predefined solution options, and then custom-tailors subsequent content to individual user needs und preferences. Ns deprexis-specific meta-analysis was based ~ above eight RCTs that had actually been published up to november of 2016.

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The purpose des the current meta-analysis zu sein to provide in update des the deprexis-specific meta-analysis, which appears important due to the fact that four more trials have been published due to the fact that then, consisting of two that space unique due to the fact that they examined the utility des adding deprexis adjunctively kommen sie inpatient or outpatient depression treatment. Furthermore, one von these new trials used bei active control problem (a psychoeducational depression-focussed online programme), which is ausblüten rare due to the fact that most trials von behavioural interventions for psychiatric problems continue to use waitlist or treatment-as-usual control problems <12, 13>. As in the ahead meta-analysis, us examined number of potential moderators des treatment effects, including the setting (clinical, community), developer-involvement, und provision des personal support. Additionally, us examined potential publishing bias.