E-health interventions have modest effect on primary care depression

  • J Affect Disord

  • curated by Jim Kling
  • Clinical Essentials
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Takeaway

  • A meta-analysis of guided or self-guided e-health interventions for depression among primary care patients shows a small but lasting effect on depressive symptoms.
  • The interventions had a moderate effect compared with waitlist controls.
  • There was insufficient evidence to determine efficacy for anxiety.

Why this matters

  • Previous meta-analyses of e-health interventions have focused on mixed populations of primary care, community self-referral, and specialist mental healthcare.

Study design

  • Meta-analysis of 14 randomized controlled trials that included 33 treatments (N=4183).

Key results

  • Compared with all control groups, e-health programs had a small effect size in the short term (standardized mean difference [SMD], −0.19; 95% CI, −0.31 to −0.06) and the long term (SMD, −0.22; 95% CI, −0.35 to −0.09).
  • E-health programs showed a small effect compared with usual care (SMD, −0.14; 95% CI, −0.26 to −0.02) and a moderate effect compared with waiting list control or no treatment (SMD, −0.45; 95% CI, −0.62 to −0.29).
  • Only 1 trial examined anxiety, and it showed a nonsignificant effect.

Limitations

  • Heterogeneity among e-health treatments.
  • Most interventions were guided.
  • Treatment adherence was difficult to interpret.

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