Evidence map›Paper›PMID 27649340›Full record

SynthesisPsychological medicine2016

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.

D D Ebert, L Donkin, G Andersson, G Andrews, T Berger, P Carlbring, A Rozenthal, I Choi, J A C Laferton, R Johansson and 19 more

Abstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Psychological medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 70 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
70citing papers in PubMed, 11 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

70 citing papers in PubMed, 11 syntheses or guidelines pooled it.

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10 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

29 authors.

D D EbertFriedrich Alexander University Erlangen-Nuremberg,Erlangen,Germany.
L DonkinThe Brain and Mind Research Institute,University of Sydney,NSW,Australia.
G AnderssonDepartment of Behavioural Sciences and Learning,Linköping University,Linköping,Sweden.
G AndrewsClinical Research Unit for Anxiety and Depression,School of Psychiatry,University of New South WalesatSt Vincent's Hospital,Darlinghurst,NSW,Australia.
T BergerDepartment of Clinical Psychology and Psychotherapy,University of Bern,Bern,Switzerland.
P CarlbringDepartment of Psychology,Stockholm University,Sweden.
A RozenthalDepartment of Psychology,Stockholm University,Sweden.
I ChoiBrain and Mind Centre,University of Sydney,Sydney,Australia.
J A C LafertonPsychologische Hochschule Berlin.
R JohanssonDepartment of Behavioural Sciences and Learning,Linköping University,Linköping,Sweden.
A KleiboerDepartment of Clinical,Neuro and Developmental Psychology,VU University Amsterdam,the Netherlands.
A LangeDepartment of Clinical Psychology,University of Amsterdam,Amsterdam,The Netherlands.
D LehrLeuphana University Lüneburg,Germany.
J A ReinsLeuphana University Lüneburg,Germany.
B FunkLeuphana University Lüneburg,Germany.
J NewbyClinical Research Unit for Anxiety and Depression,School of Psychiatry,University of New South WalesatSt Vincent's Hospital,Darlinghurst,NSW,Australia.
S PeriniCentre for Emotional Health,Macquarie University,Australia.
H RiperDepartment of Clinical,Neuro and Developmental Psychology,VU University Amsterdam,the Netherlands.
J RuwaardDepartment of Clinical,Neuro and Developmental Psychology,VU University Amsterdam,the Netherlands.
L SheeberOregon Research Institute,Eugene,Oregon,USA.
F J SnoekDepartment of Medical Psychology,VU University Medical Center Amsterdam,The Netherlands.
N TitoveCentreClinic and MindSpot Clinic,Department of Psychology,Macquarie University,Australia.
B Ünlü InceDepartment of Clinical,Neuro and Developmental Psychology,VU University Amsterdam,the Netherlands.
K van BastelaarDepartment of Medical Psychology,VU University Medical Center Amsterdam,The Netherlands.
K VernmarkDepartment of Behavioural Sciences and Learning,Linköping University,Linköping,Sweden.
A van StratenDepartment of Clinical,Neuro and Developmental Psychology,VU University Amsterdam,the Netherlands.
L WarmerdamDepartment of Clinical,Neuro and Developmental Psychology,VU University Amsterdam,the Netherlands.
N SalsmanSchool of Psychology,Xavier University,Cincinnati,USA.
P CuijpersDepartment of Clinical,Neuro and Developmental Psychology,VU University Amsterdam,the Netherlands.

Funding

Depressed Mothers' Parenting of Adolescents: Social-cognitive & Neural MechanismsR01HD081362 · NICHD · OREGON RESEARCH INSTITUTE · PI ALLEN, NICHOLAS B, SHEEBER, LISA B · 2015 to 2019
$3.1M
NICHD NIH HHS R01 HD081362
6 · The paper itself

Abstract

backgroundAlmost 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.

methodStudies 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.

resultsA 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.

conclusionsInternet-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.

Indexed as

InternetOutcome Assessment, Health CareRandomized Controlled Trials as TopicHumansMajor Depressive DisorderSelf CareAdverse eventsdepressiondeterioration effectInternet-based guided self-helpnegative effects

Identifiers

PMID27649340
PMCPMC5560500

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.