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

被引：122

作者：

Ebert, D. D. ^{[1
]}

Donkin, L. ^{[2
,3
]}

Andersson, G. ^{[4
,5
]}

Andrews, G. ^{[6
]}

Berger, T. ^{[7
]}

Carlbring, P. ^{[8
]}

Rozenthal, A. ^{[8
]}

Choi, I. ^{[9
]}

Laferton, J. A. C. ^{[10
]}

Johansson, R. ^{[4
,5
]}

Kleiboer, A. ^{[3
]}

Lange, A. ^{[11
]}

Lehr, D. ^{[12
]}

Reins, J. A. ^{[12
]}

Funk, B. ^{[12
]}

Newby, J. ^{[6
]}

Perini, S. ^{[13
]}

Riper, H. ^{[3
]}

Ruwaard, J. ^{[3
]}

Sheeber, L. ^{[14
]}

Snoek, F. J. ^{[15
,16
]}

Titov, N. ^{[17
,18
]}

Ince, B. Unlu ^{[3
]}

van Bastelaar, K. ^{[15
]}

Vernmark, K. ^{[4
]}

van Straten, A. ^{[3
]}

Warmerdam, L. ^{[3
]}

Salsman, N. ^{[19
]}

Cuijpers, P. ^{[3
]}

机构：

[1] Univ Erlangen Nurnberg, Erlangen, Germany

[2] Univ Sydney, Brain & Mind Res Inst, Sydney, NSW 2006, Australia

[3] Vrije Univ Amsterdam, Dept Clin Neuro & Dev Psychol, Amsterdam, Netherlands

[4] Linkoping Univ, Dept Behav Sci & Learning, Linkoping, Sweden

[5] Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden

[6] Univ New South Wales, St Vincents Hosp, Sch Psychiat, Clin Res Unit Anxiety & Depress, Darlinghurst, NSW, Australia

[7] Univ Bern, Dept Clin Psychol & Psychotherapy, Bern, Switzerland

[8] Stockholm Univ, Dept Psychol, Stockholm, Sweden

[9] Univ Sydney, Brain & Mind Ctr, Sydney, NSW, Australia

[10] Psychol Hsch Berlin, Berlin, Germany

[11] Univ Amsterdam, Dept Clin Psychol, Amsterdam, Netherlands

[12] Leuphana Univ Luneburg, Luneburg, Germany

[13] Macquarie Univ, Ctr Emot Hlth, N Ryde, NSW 2109, Australia

[14] Oregon Res Inst, Eugene, OR 97403 USA

[15] Vrije Univ Amsterdam, Med Ctr Amsterdam, Dept Med Psychol, Amsterdam, Netherlands

[16] Univ Amsterdam, Acad Med Ctr, NL-1012 WX Amsterdam, Netherlands

[17] Macquarie Univ, Dept Psychol, eCentreClin, N Ryde, NSW 2109, Australia

[18] Macquarie Univ, Dept Psychol, MindSpot Clin, N Ryde, NSW 2109, Australia

[19] Xavier Univ, Sch Psychol, Cincinnati, OH 45207 USA

来源：

PSYCHOLOGICAL MEDICINE | 2016年 / 46卷 / 13期

关键词：

Adverse events; depression; deterioration effect; Internet-based guided self-help; negative effects; COGNITIVE-BEHAVIORAL THERAPY; PSYCHOLOGICAL TREATMENTS; PSYCHIATRIC-DISORDERS; MENTAL-DISORDERS; PSYCHOTHERAPY; EFFICACY; BURDEN; PREVALENCE; INVENTORY; RECOVERY;

D O I：

10.1017/S0033291716001562

中图分类号：

B849 [应用心理学];

学科分类号：

040203 ;

摘要：

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.

引用

页码：2679 / 2693

页数：15

共 78 条

[1] Individual participant data meta-analyses should not ignore clustering [J].