Acceptability and effectiveness of NHS recommended e-therapies for depression, anxiety and stress: A meta-analysis

Abstract

Background: There is a disconnect between the ability to swiftly develop e-therapies for the treatment of depression, anxiety, and stress, and the scrupulous evaluation of their clinical utility. This creates a risk that the e-therapies routinely provided within publicly funded psychological health care have evaded appropriate rigorous evaluation in their development.

Objective: This study aims to conduct a meta-analytic review of the gold standard evidence of the acceptability and clinical effectiveness of e-therapies recommended for use in the National Health Service (NHS) in the United Kingdom.

Methods: Systematic searches identified appropriate randomized controlled trials (RCTs). Depression, anxiety, and stress outcomes at the end of treatment and follow-up were synthesized using a random-effects meta-analysis. The grading of recommendations assessment, development, and evaluation approach was used to assess the quality of each meta-analytic comparison. Moderators of treatment effect were examined using subgroup and meta-regression analysis. Dropout rates for e-therapies (as a proxy for acceptability) were compared against controls.

Results: A total of 24 studies evaluating 7 of 48 NHS-recommended e-therapies were qualitatively and quantitatively synthesized. Depression, anxiety, and stress outcomes for e-therapies were superior to controls (depression: standardized mean difference [SMD] 0.38, 95% CI 0.24 to 0.52, N=7075; anxiety and stress: SMD 0.43, 95% CI 0.24 to 0.63, n=4863), and these small effects were maintained at follow-up. Average dropout rates for e-therapies (31%, SD 17.35) were significantly higher than those of controls (17%, SD 13.31). Limited moderators of the treatment effect were found.

Conclusions: Many NHS-recommended e-therapies have not been through an RCT-style evaluation. The e-therapies that have been appropriately evaluated generate small but significant, durable, beneficial treatment effects.

Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) registration CRD42019130184; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=130184

Metadata

Item Type:	Article
Authors/Creators:	Simmonds-Buckley, M. https://orcid.org/0000-0003-3808-4134 Bennion, M.R. https://orcid.org/0000-0003-2318-1468 Kellett, S. Millings, A. Hardy, G.E. Moore, R.K.
Copyright, Publisher and Additional Information:	© Melanie Simmonds-Buckley, Matthew Russell Bennion, Stephen Kellett, Abigail Millings, Gillian E Hardy, Roger K Moore. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 28.10.2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.
Dates:	Published: 28 October 2020 Published (online): 24 July 2020 Accepted: 24 July 2020
Institution:	The University of Sheffield
Academic Units:	The University of Sheffield > Faculty of Science (Sheffield) > Department of Psychology (Sheffield)
Depositing User:	Symplectic Sheffield
Date Deposited:	25 Aug 2020 09:53
Last Modified:	06 Nov 2020 16:33
Status:	Published
Publisher:	JMIR Publications Inc.
Refereed:	Yes
Identification Number:	10.2196/17049
Open Archives Initiative ID (OAI ID):	oai:eprints.whiterose.ac.uk:164210

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Acceptability and effectiveness of NHS recommended e-therapies for depression, anxiety and stress: A meta-analysis

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