Computer-based psychological treatments for depression: A systematic review and meta-analysis

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Abstract

The aim of the paper was to systematically review the literature on computer-based psychological treatments for depression and conduct a meta-analysis of the RCT studies, including examining variables which may effect outcomes. Database and hand searches were made using specific search terms and inclusion criteria. The review included a total of 40 studies (45 published papers), and 19 RCTs (23 published papers) were included in a standard meta-analysis. The review describes the different computer-based treatments for depression, their design, communication types employed: synchronous, asynchronous, and face-to-face (F:F); alongside various types and frequency of support delivered. The evidence supports their effectiveness and highlights participant satisfaction. However, pertinent limitations are noted. Across 19 studies the meta-analysis revealed a moderate post-treatment pooled effect size d = .56 (95% confidence interval [CI] −. 71, −. 41), Z = 7.48, p < .001). Supported interventions yielded better outcomes, along with greater retention. The results reported statistically significant clinical improvement and recovery post-treatment. The review and meta-analysis support the efficacy and effectiveness of computer-based psychological treatments for depression, in diverse settings and with different populations. Further research is needed, in particular to investigate the influence of therapist factors in supported treatments, the reasons for dropout, and the maintenance of gains post-treatment.

Highlights

► Computer-based psychological interventions for depression are effective. ► A range of different interventions, communication types and support types exist. ► Improvements in depression are significant post-treatment with many recovering. ► Improvements are maintained at follow-up, but less pronounced. ► Supported interventions yield better outcomes and greater retention.

Section snippets

Literature search and selection of studies

The aim of the literature search was to find all references related to computer-based psychological treatments for depression. A search of three databases (EMBASE, PubMed, and PsychINFO including PsychARTICLES) was conducted for studies published in peer-reviewed journals in the last 10 years (March 2001–March 2011). While work has been carried out previous to March 2001 (e.g. Selmi, Klein, Greist, Sorrell, & Erdman, 1990), the authors decided that the years represented a meaningful timeframe in

Results of the review

Three databases, PubMed (n = 872), EMBASE (n = 1184), and PsychINFO including PsychARTICLES (n = 263), were searched. Identified papers (n = 2319) were screened against the established inclusion criteria, yielding 44 papers. A further one paper was identified through hand search (Wright et al., 2005). Fig. 1 shows the results of the systematic review. In total, 45 papers met the inclusion criteria and are reviewed below. These include 24 RCT studies (n = 28 papers) and 17 open trials (n = 17 papers).

Results from the meta-analysis

Using the search terms outlined in the method section, and the established eligibility criteria, 19 RCT studies (representing 23 papers) were included into the meta-analysis (Fig. 1).

Discussion

The aim of the paper was to systematically review the literature on computer-based psychological treatments for depression and conduct a meta-analysis on the available RCTs. Across 40 studies (45 published papers), eighteen different interventions were identified and described. While the majority were CBT-based programs, alternative content was described for some interventions. The majority were delivered online and four delivered through standalone CD-ROM, although one of these, Beating the

Conclusion

The review and meta-analysis support the efficacy and effectiveness of computer-based psychological treatments for depression, in community, primary, and secondary care, and with diverse populations. As well as reductions in self-reported symptoms, computer-based interventions can also produce clinically significant improvements and recovery in depression. Supported interventions yield better outcomes, along with greater retention. Further research is needed, in particular to investigate the

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