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Table 2 Study characteristics

From: eHealth interventions for the prevention of depression and anxiety in the general population: a systematic review and meta-analysis

Study

Sample/eligibility

Conditions

Support

Intervention

Follow-up period (rate)

Outcome

Conclusions

Quality assessment

Buntrock et al. [41, 42]

N = 406; German general pop. (no MDD on SCID).

Aged 18+ years

(73.9% female)

i. iCBT

ii. Psychoed.

Automated SMS reminders, 2 h online trainer feedback

6 × 30 min sessions (3–6 weeks). Behavioural and problem-solving therapy.

6 weeks (90.1%)

6 months (80.0%)

12 months (82.3%)

Mean sessions: 5.84

Symptom reduction (CES-D). MDD incidence.

6-week BG ES: Cohen’s d = 0.69 (F1,403 = 54.104, p < .001).

6-month BG ES: Cohen’s d = 0.28 (F1,402 = 9.240, p = .003).

There was a significant difference in MDD incidence rates over 12 months favouring the intervention group (hazard ratio = 0.59, 95% CI: 0.42–0.82; p = .002).

23

Christensen et al. [43]

N = 558; Australian Internet users (No anxiety disorder on MINI).

Aged 18–30 years

(80.6% female)

i. iCBT + Psychoed. (A)

ii. A + telephone reminders

iii. A + email reminders

iv. Placebo website (B)

v. B + telephone reminders

Differing reminder conditions, 2-min/week. No therapeutic content.

10 × 10 weekly sessions. Mindfulness-focussed CBT for anxiety (e-couch).

10 weeks (64.5%)

6 months (54.3%)

12 months (47.3%)

Mean sessions: (i) 3.7; (ii) 7.3; (iii) 5.5; (iv) 3.7; (v) 8.3.

Symptom reduction (GAD-7).

GAD incidence.

Significant time effects for each of the three follow-ups. No significant group × time effects for any comparison. Overall, indicated prevention of GAD was deemed not effective

21

Clarke et al. [46]

Relevant subgroup: n = 63; US HMO member adults (CES-D < 20).

Aged 18+ years

(75.6% female)

i. iCBT + Psychoed.

ii. Usual care

No support.

7 chapters. CBT skills program (focusing on the cognitive restructuring techniques).

4 weeks (52.8%)

8 weeks (65.2%)

16 weeks (65.5%)

32 weeks (59.2%)

Mean logins: 2.6

Symptom reduction (CES-D).

Significant reduction in symptoms in intervention participants compared to control at the 16-week (BG ES: Cohen’s d = 0.17, p < .05) and 32-week (BG ES: Cohen’s d = 0.48, p < .01) follow-up.

16

Cukrowicz et al. [47]

N = 152; US undergrad. (BAI ≤ 18; BDI ≤ 19).

95% aged 18–21 years

(73.7% female)

i. Psychoed. + CBT

ii. Psychoed.

Facilitated session.

6 × 20 min segments (1 laboratory session).

Situational analysis-focussed CBT.

2 months (90.3%)

Symptom reduction (BAI & BDI).

BAI, BG ES: Cohen’s d = 0.24 (F1,145 = 7.84, p < .01).

BDI, BG ES: Cohen’s d = 0.27 (F1,145 = 9.64, p < .01.

Additional significant reductions on PANAS and STAI-S, and Reliable Change Index.

17

Imamura [44, 52]

N  =  762; Japanese workers (No past month MDD on WHO-CIDI).

Aged 18+ years

(16.1% female)

i. iCBT

ii. Stress reduction tips email

Email reminders. Homework feedback from clinical psychologist.

6 × 30 min sessions (6 weeks). CBT skills program (self-monitoring, cognitive restructuring, assertiveness, problem solving, and relaxation).

3 months (79.5%)

6 months (77.7%)

12 months (67.1%)

Mean sessions: 4.53

Symptom reduction (BDI-II). MDE incidence.

3-month BG ES: Cohen’s d = −0.14, 95% CI: −0.30 to 0.02 (t 621.35 =   − 1.99, p < .05).

6-month BG ES: Cohen’s d = −0.16, 95% CI: −0.32 to 0.00 (t 621.35 =   − 1.99, p < .05).

12-month BG ES: Cohen’s d = −0.08, 95% CI: −0.26 to 0.09 (t 610.33 =   − 1.42, p = .16).

Significant reduction in MDE incidence in intervention compared to control at 12-month (Log-rank χ 2 = 7.04, p < .01) but not 6-month (Log-rank χ 2 = 3.26, p = .07).

24

Levin et al. [48]

Relevant subgroup: n  =  43; US undergrad. (DASS in normal range).

Aged 18–21 years (53.9% female)

i. ACT

ii. Waitlist

Email reminders.

2 sessions. Youth-focussed ACT program.

3 weeks (79.5%)

6 weeks (77.7%)a

92% completed program

Symptom reduction (DASS).

No significant between group differences were observed on depression, anxiety of stress among the non-distressed subgroup (p > .10).

19

Lintvedt et al. [49]

Relevant subgroup: n  =  52; Norwegian undergrad. (subclinical: CES-D).

Aged 18+ years (53.9% female)

i. Psychoed. + iCBT

ii. Waitlist

Weekly automated assignments.

5 weekly modules. CBT, interpersonal therapy, relaxation self-help program (Moodgym) & psychoed. Program (Bluepages)

8 weeks (68.0%)

Mean modules: 2–3

Symptom reduction (CES-D).

There was a significant increase in depressive symptoms for the subclinical control group compared to the intervention group (F 1,24 = 6.86, p < .05; Hedges g = 0.61).

22

Morgan et al. [50]

N = 1326; English speaking gen. Pop. (subclinical: PHQ-9)

Aged 18–79 years (77.6% female)

i. Self-help emails

ii. Psychoed. emails

No support.

2 emails/week (6 weeks). Persuasive framing, tailoring, goal setting, limiting cognitive load.

3 weeks (54.8%)

6 weeks (42.9%)

95.6% received the emails

Symptom reduction (PHQ-9).

There was a small significant difference in depression symptoms in intervention group compared to control (d = 0.17, 95% CI: 0.01 to 0.34). There was a lower, although non-significant, risk of major depression in the active group.

20

Musiat et al. [51]

Relevant subgroup: n  =  859; UK tertiary students (low risk on the SURPS).

Aged 18–57 years (70.5% female)

i. iCBT

ii. Student life program

No support.

5 × 30 min modules Personality trait-driven CBT program (PLUS)

6 weeks (49.7%)a

12 weeks (38.3%)

47% completed a module

Symptom reduction (PHQ-9; GAD-7).

Significant intervention effects were found in the high risk group but for those at low risk no significant change was detected in PHQ-9 (p > .999) or GAD-7 (p = .415)

21

Spek et al. [40, 45]

N = 301; Dutch older general pop. (no MDD on WHO-CIDI).

Aged 50–75 years (63.5% female)

i. iCBT

ii. group CBT

iii waitlist

No support.

8 sessions (8 weeks) Psychoed. and CBT (Coping with depression)

10 weeks (60.1%)

12 months (63.1%)

Mean modules: 5.5

Symptom reduction (BDI-II).

Significant intervention effects were found in both intervention groups compared to control. No differences were found between interventions (Internet vs control: post-treatment BG ES: Cohen’s d = 0.55; 12-month BG ES: Cohen’s d = 0.53).

24

  1. MDD major depressive disorder, MDE major depressive episode, Psychoed. psychoeducation, iCBT Internet Cognitive Behavioural Therapy, SCID Structured Clinical Interview for DSM, TAU treatment as usual, MINI Mini-International Neuropsychiatric Interview, HMO Health Maintenance Organization, BDI-II Beck Depression Inventory, BAI Beck Anxiety Inventory, WHO-CIDI World Health Organisation Composite International Diagnostic Interview, PHQ-9 Patient Health Questionnaire, GAD-7 Generalized Anxiety Disorder–7-item scale, BG ES between-group effect size, ACT Acceptance and Commitment Therapy, CES-D Center for Epidemiological Studies-Depression, DASS Depression Anxiety Stress Scale; undergrad. Undergraduate, PANAS Positive and Negative Affect Schedule, STAI-S State-Trait Anxiety Inventory
  2. aResults not reported at this follow-up point