Acceptability and effectiveness of NHS recommended e-therapies for depression, anxiety and stress: A meta-analysis
Simmonds-Buckley, M. orcid.org/0000-0003-3808-4134, Bennion, M.R. orcid.org/0000-0003-2318-1468, Kellett, S. et al. (3 more authors) (2020) Acceptability and effectiveness of NHS recommended e-therapies for depression, anxiety and stress: A meta-analysis. Journal of Medical Internet Research, 22 (10). e17049. ISSN 1438-8871
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
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.
© 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.
Published (online): 24 July 2020
The University of Sheffield > Faculty of Science (Sheffield) > Department of Psychology (Sheffield)
JMIR Publications Inc.
Filename: pdf.pdf