Human contact in internet-based interventions for depression: A pre-registered replication and meta-analysis of randomized trials

Krieger, Tobias; Bur, Oliver Thomas; Weber, Lenny; Wolf, Markus; Berger, Thomas; Watzke, Birgit; Münder, Thomas

doi:10.1016/j.invent.2023.100617

Cited by 13 publications

(11 citation statements)

References 24 publications

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“…It is possible that even in the context of self‐guided treatments, initial contact with a therapist to discuss alternative options and personal suitability may be beneficial, especially amongst people with lower levels of digital and/or health literacy. Indeed, a recently published meta‐analysis of digital interventions for depression with varying degrees of contact (e.g., before, during and/or after the intervention) found that contact before and during the intervention exerted independent influences on symptom improvement and treatment engagement 19 . Further, guided interventions only outperformed unguided interventions when they included contact both before and during the intervention; that is, contact during a guided intervention was not by itself sufficient in producing superior outcomes compared to unguided interventions 19 .…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, a recently published meta‐analysis of digital interventions for depression with varying degrees of contact (e.g., before, during and/or after the intervention) found that contact before and during the intervention exerted independent influences on symptom improvement and treatment engagement 19 . Further, guided interventions only outperformed unguided interventions when they included contact both before and during the intervention; that is, contact during a guided intervention was not by itself sufficient in producing superior outcomes compared to unguided interventions 19 . In this sense, there appears to be a crucial role for pretreatment contact with a therapist that occurs synchronously in real time (e.g., defined in this review as a diagnostic interview via phone call, videoconferencing, text chat).…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, a recently published meta-analysis of digital interventions for depression with varying degrees of contact (e.g., before, during and/or after the intervention) found that contact before and during the intervention exerted independent influences on symptom improvement and treatment engagement. 19 Further, guided interventions only outperformed unguided interventions when they included contact both before and during the intervention;…”

Section: Theme 4: Personal Characteristics Needed To Support Uptakementioning

confidence: 99%

“…that is, contact during a guided intervention was not by itself sufficient in producing superior outcomes compared to unguided interventions. 19 In this sense, there appears to be a crucial role for pretreatment contact with a therapist that occurs synchronously in real time (e.g., defined in this review as a diagnostic interview via phone call, videoconferencing, text chat). Indeed, qualitative research with therapists working within a digital mental health service found that discussions with a therapist over the phone to discuss assessment results and treatment options facilitate informed decision-making around treatment uptake and guidance.…”

Section: Theme 4: Personal Characteristics Needed To Support Uptakementioning

confidence: 99%

“…15,16 In this way, selfguided digital mental health treatments may have greater scalability and cost-effectiveness potential than guided treatments, while still being highly acceptable, safe and effective at improving symptoms of depression and anxiety. 17,18 However, despite their promise, a recent meta-analysis of randomised-controlled trials (RCTs) 19 has demonstrated that people accessing completely self-guided digital treatments for depression (i.e., no human contact before or during the intervention) show less symptom improvement posttreatment, lower adherence and higher drop-out compared to people accessing fully guided digital treatments (i.e., human contact before and during the intervention). In light of this evidence, and the reported link between patient engagement in healthcare decision-making and later adherence to treatment plans, 20 it is important to understand people's decision-making around which treatment format they feel will be most appropriate and beneficial for them based on the evidence, realistic expectations of treatment, personal preferences and life circumstances.…”

Section: Introductionmentioning

confidence: 99%

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Uptake of a self‐guided digital treatment for depression and anxiety: A qualitative study exploring patient perspectives and decision‐making

Fisher,

Eugene Dit Rochesson,

Bisby

et al. 2024

Health Expectations

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BackgroundDespite the demonstrated efficacy and potential scalability of self‐guided digital treatments for common mental health conditions, there is substantial variability in their uptake and engagement. This study explored the decision‐making processes, influences and support needs of people taking up a self‐guided digital treatment for anxiety and/or depression.MethodsAustralian‐based adults (n = 20) were purposively sampled from a trial of self‐guided digital mental health treatment. One‐to‐one, semistructured interviews were conducted, based on the Ottawa Decision‐Support Framework. Interviews were transcribed verbatim and analysed thematically using framework methods. Baseline sociodemographic, clinical and decision‐making characteristics were also collected.ResultsAnalyses yielded four themes. Theme 1 captured participants' openness to try self‐guided digital treatment, despite limited deliberation on potential downsides or alternative options. Theme 2 highlighted that immediacy and ease of access were major drivers of uptake, which participants contrasted with gaps in access and continuity of care in face‐to‐face services, especially rurally. Theme 3 centred on participants as the main agents in their decision‐making, with family and health professional attitudes also reportedly influencing decision‐making. Theme 4 revealed participants' primary motivations for deciding to take up treatment (e.g., the potential to increase insight and coping skills), while also acknowledging that pre‐existing characteristics (e.g., health and digital literacy, insight) determined participants' personal suitability for self‐guided digital treatment.ConclusionFindings help to elucidate the decision‐making influences and processes amongst people who started a self‐guided treatment for depression and anxiety. Additional information and decision support resources appear warranted, which may also improve the accessibility of self‐guided treatments.Public or Patient ContributionPatients were interviewed about their views and experiences of decision‐making about accessing and taking up treatment. As such, patient contribution to the research was as study participants.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Theme 4: Personal Characteristics Needed To Support Uptakementioning

confidence: 99%

Section: Theme 4: Personal Characteristics Needed To Support Uptakementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Uptake of a self‐guided digital treatment for depression and anxiety: A qualitative study exploring patient perspectives and decision‐making

Fisher,

Eugene Dit Rochesson,

Bisby

et al. 2024

Health Expectations

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Comparative effectiveness of digital mental healthcare models for adults with epilepsy: A study protocol of a randomized controlled trial

Gandy,

Coleman,

Cutler

et al. 2024

Epilepsia Open

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ObjectiveMental health complaints are prevalent among people with epilepsy, yet there are major barriers that prevent access to psychological care, including high out‐of‐pocket costs and a lack of accessible specialized services. The purpose of the current study is to examine the comparative efficacy, acceptability, cost‐effectiveness, and long‐term outcomes of a digital psychological intervention when delivered under two models of care (i.e., guided vs. unguided) in supporting the mental health and functioning of adults with epilepsy.MethodApproximately 375 participants across Australia will be enrolled. Eligible participants will have a confirmed diagnosis of epilepsy, experience difficulties with their emotional health, be at least 18 years of age, and live in Australia. Participants will be randomized (2:2:1) to receive the Wellbeing Neuro Course, a 10‐week internet‐delivered program, with (i.e., guided) or without guidance by a mental health clinician (i.e., unguided), or be allocated to a treatment‐as‐usual waiting‐list control group. Participants will complete online questionnaires at pre‐, post‐treatment, and 3‐ and 12‐month follow‐up and consent to have their data linked to their medical records to capture healthcare system resource use and costs.AnalysisPrimary outcome measures will be symptoms of depression and anxiety. A cost‐utility analysis will be undertaken using the Australian healthcare system perspective and according to current economic evaluation guidelines. Resource use and costs to the healthcare system during the study period will be captured via data linkage to relevant administrative datasets in Australia.SignificanceThe results of this trial will provide important data concerning the relative outcomes of these different models of care and will inform the integration of digital psychological interventions translation into healthcare services.Ethics and DisseminationThe Human Research Ethics Committee of Macquarie University approved the proposed study (Reference No: 520231325151475). The results will be disseminated through peer‐reviewed publication(s).ANZCTR Trial Registration NumberACTRN12623001327673.Plain Language SummaryThis study seeks to find out if a 10‐week online psychological treatment can improve the mental health and well‐being of Australian adults with epilepsy. Around 375 participants will be randomly assigned to different groups: one will receive treatment with guidance from mental health clinician (guided group), one without guidance (unguided group), and one starting later (waiting control group). All participants will fill out the same outcome measures online. The main goal of this research is to compare these groups and assess how well the treatment works in improving mental health outcomes.

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The effectiveness of self-guided interventions in adults with depressive symptoms: a systematic review and meta-analysis

Tong,

Panagiotopoulou,

Cuijpers

et al. 2024

eBioMedicine

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Human contact in internet-based interventions for depression: A pre-registered replication and meta-analysis of randomized trials

Cited by 13 publications

References 24 publications

Uptake of a self‐guided digital treatment for depression and anxiety: A qualitative study exploring patient perspectives and decision‐making

Uptake of a self‐guided digital treatment for depression and anxiety: A qualitative study exploring patient perspectives and decision‐making

Comparative effectiveness of digital mental healthcare models for adults with epilepsy: A study protocol of a randomized controlled trial

The effectiveness of self-guided interventions in adults with depressive symptoms: a systematic review and meta-analysis

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