Efficacy of web-based self-management interventions for depressive symptoms: a meta-analysis of randomized controlled trials

Abstract

Background The incidence of depression is increasing worldwide. Depression can lead to poor physical health and even suicide. However, in high-income countries, only about 50% of the people with depression receive appropriate therapy, and the detection rate of depression in low- and middle-income countries is relatively lower. Web-based self-management enables remote treatment and solves the problem of insufficient psychological treatment resources. Many past studies have evaluated the effectiveness of web-based self-management of depression, but there has been no synthesis of evidence. Therefore, this study conducted a meta-analysis of the effectiveness of web-based self-management for depressive symptoms. Method Six electronic databases (Cochrane Central Register of Controlled Trials, PubMed, Web of Science, Embase, CINAHL, and PsycINFO) were searched in September 2020. All literature referring to the effects of web-based self-management on depression were shortlisted by performing the medical subject headings (MeSH) search combined with a text word search. Results A total of 18 eligible randomized controlled trials were identified, and the results from 3055 participants were consolidated. The web-based self-management group exhibited a greater reduction in depressive symptoms than the control group (g = − 0.46; 95% CI: 0.62,0.30), and there was no evidence of publication bias. Subgroup analysis revealed that patients with moderate-to-severe depression benefited from web-based self-management interventions. In terms of interventions, those based on cognitive behavioral therapy (CBT) were highly effective. We noted that the longer the intervention time, the better was the improvement in the status of depression. Furthermore, it was established that participants who communicated with therapists and showed greater adherence to the intervention experienced significant improvement in their symptoms. The results of the intervention group were better than those of the waiting-list, treatment-as-usual, and online psychoeducation groups. Conclusions Web-based self-management is a promising therapy for depression. Future research should aim to refine these aspects of the intervention to achieve a beneficial impact.

Providing Human Support for the Use of Digital Mental Health Interventions: Systematic Meta-review

“…Two meta-analyses found that unsupported DMHIs were significantly more effective than supported DMHIs [ 60 , 66 ]. When focusing exclusively on studies of individuals with elevated symptoms of depression [ 6 , 40 , 41 , 43 , 71 ], supported DMHIs were more effective in reducing depressive symptoms than unsupported DMHIs (with 3 studies showing significant findings and 2 failing to find significant differences).…”

“…A total of 17 studies were rated as low quality, 14 as medium quality, and 1 as high quality based on the AMSTAR 2 quality assessment scale. See Multimedia Appendix 2 [4][5][6][7]38,[40][41][42][43][44][45]47,[57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72][73] for a list of percentages achieved for each meta-analysis included.…”

“…The effect of human support may also vary based on the support provider. Some studies rely on support by a clinician or therapist [40][41][42], whereas others deploy paraprofessional support providers such as research or clinical staff, technicians, or e-coaches [7,[43][44][45][46]. Finally, results may vary on the basis of meta-analysis quality [47].…”

“…No therapist guidance group ("group not communicating with the therapist") Therapist guidance group ("group communicating with the therapist"); virtual health indicator guidance group ("group communicating with the virtual health care provider") Pang et al [41] Self-help Feedback provided, rather than just technical support Stratton et al [70], 2017 Self-guided Clinician was in some way involved in the dissemination of information to the study participants, whether through discussion forums, email, telephone, etc Sztein et al [6], 2018 Not guided (although may have included automated text messages or emails) Therapist-guided (included phone calls, personalized written messages and feedback, tailored emails, face-to-face meetings, and automated text messages or emails) Thompson et al [42], 2021…”

“…A total of 19 meta-analyses examined the effect sizes of DMHIs on depression symptoms. Nine of those meta-analyses suggested that supported DMHIs result in significantly lower depression symptoms compared with unsupported DMHIs [7,[40][41][42][43][44][45][46]59]. Two meta-analyses found that unsupported DMHIs were significantly more effective than supported DMHIs [60,66].…”