Efficacy of internet-based cognitive-behavioral therapy for depression in adolescents: A systematic review and meta-analysis

Digital interventions in mental health: An overview and future perspectives

As e-health offerings rapidly expand, they are transforming and challenging traditional mental health care systems globally, presenting both promising opportunities and significant risks. This article critically examines the potential and pitfalls of integrating digital technologies into mental health care, particularly in the realms of diagnosis, prevention, and treatment. It explores current advancements and evidence-based practices, and provides a vision for how future technologies can evolve responsibly to meet mental health needs. The article concludes with the TEQUILA framework, addressing essential elements and challenges for fostering a beneficial and ethical future. A responsible future for digital mental health requires building Trust by ensuring data privacy, security, and transparency in AI-driven decisions, along with Evidence-based and robust regulatory oversight to maintain Quality. Usability, design, usability tailored to diverse needs, and ethical alignment with users' Interests will all be essential, while Liability and Accreditation standards will safeguard accountability in this evolving landscape.

Randomized trial testing a self-guided digital mental health intervention teaching calming skills for Ukrainian children

Ukraine's war-exposed youth face a myriad of barriers to receiving mental health services, perhaps most notably a dearth of mental health professionals. Experts recommend evaluating digital mental health interventions (DMHIs), which require minimal clinician support. Based on the content of empirically supported treatments for war-exposed youth (e.g., Teaching Recovery Techniques), one strategy that might be useful is self-calming (e.g., paced breathing, progressive muscle relaxation). In this pre-registered randomized controlled trial (ClinicalTrials.gov Record: NCT06217705 ; first submitted January 12, 2024), we assessed the acceptability, utility, and clinical efficacy of one such DMHI (Project Calm) relative to a usual schoolwork control among a sample of Ukrainian students in grades 4-11. We analyzed outcomes for the full sample and subsamples with elevated symptoms at baseline. Although Calm was perceived favorably, there were no significant between-group differences in the full sample (N = 626); differences in subsample analyses demonstrated that while internalizing, externalizing, and trauma symptoms held steady for the Calm group, control participants' symptoms reduced. We generated potential explanations for these results (e.g., interference with youths' natural coping skills or fear extinction) through a focus group with school staff. Given that we found no evidence that calming skills taught via DMHI are effective for Ukrainian youth, we suggest that researchers test other strategies delivered by DMHI and that calming skills continue to be taught in provider-guided formats.

Comparative effectiveness and acceptability of internet-based psychological interventions on depression in young people: a systematic review and network meta-analysis

BACKGROUND

Depression represents a major global public health challenge, particularly among young individuals aged between 10 and 25. This age bracket is notably critical, as the onset of depression during these years tends to be more severe and consequential. In response to the growing demand for mental health services, internet-based psychological interventions have gained traction as a flexible and convenient alternative to traditional face-to-face treatment. This systematic review and network meta-analysis aims to rigorously assess the comparative efficacy and acceptability of internet-based psychological interventions in addressing depression within the young population over the past three decades.

METHODS

We conducted a comprehensive search of seven electronic databases for eligible randomized controlled trials published from January 1995 to July 2024. The literature screening process adhered to the principles of population, intervention, comparator, outcome, and study design. The quality of the included studies was assessed using the Cochrane Risk of Bias Assessment Tool. To evaluate the ranking probability of each intervention, we calculated the surface under the cumulative ranking curve values. Network meta-analysis (NMA) was conducted using RStudio and Stata software.

RESULTS

The NMA incorporated a total of 27 studies involving 3,451 participants. Among these studies, 18 assessed internet-based cognitive behavioral therapy (iCBT) interventions, whereas 12 employed a waitlist as a control group. At the end of the interventions, internet-based acceptance and commitment therapy (iACT), iCBT, internet-based dialectical behavior therapy (iDBT), and internet-based psychodynamic therapy (iPDT) all demonstrated statistically significant reductions in depression scores. Notably, no intervention measure was found to be statistically more acceptable than the others.

CONCLUSIONS

Our NMA indicated that iDBT appeared to be more effective, whereas internet-based mindfulness-based therapy (iMBT) may be more acceptable. These findings offered preliminary evidence regarding the comparative effectiveness and acceptability of internet-based psychological interventions in treating depression among young people. However, the limited number of eligible studies underscored the importance and necessity of further research to evaluate novel intervention measures.

TRIAL REGISTRATION

The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO), with the registration number CRD42024580958.

Treatment for Depression Among Adults: An Evidence and Gap Map of Systematic Reviews

OBJECTIVE

To identify and map systematic reviews on the effectiveness of treatment for depressive disorders among adults.

METHODS

We retrieved systematic reviews and meta-analyses of randomized controlled trials involving adults with depressive symptoms from twelve English and four Chinese databases (June 21, 2022). Using an interactive map, we visualized the effectiveness of evidence on depression based on an intervention-outcome framework. The interventions included psychotherapy, pharmacotherapy, complementary and alternative treatments, and others. The outcomes included the remission of depressive symptoms, symptoms of depressive disorder, life and social skills, and adverse events.

RESULTS

We included 994 systematic reviews and meta-analyses, including 32 that were review protocols, highlighting the distribution of psychotherapy, pharmacotherapy, and complementary and alternative treatments. However, the evidence and gap map (EGM) revealed significant gaps in evidence for specific interventions, populations, outcomes, and regions. While psychotherapy, pharmacotherapy, and complementary and alternative treatments dominate the landscape, the review highlighted a lack of research on interventions for specific types of depression, such as depression in people with bipolar disorder and treatment-resistant depression. It was a similar situation for underserved populations, including young and middle-aged adults, males, sexual minority individuals, and people with disabilities. The map also suggested the need for more research on the potential risks and side effects associated with both pharmacological and nonpharmacological treatments.

CONCLUSIONS

The contribution of this EGM was to present the available evidence on psychotherapy, pharmacotherapy, and complementary and alternative treatments for depression in adults, making available an evidence base that could inform future policy decisions and practice. It also identified evidence gaps in interventions, outcomes, population, regions, and evidence confidence. The need for further research on tailored treatments for specific populations was highlighted.

Comparative Efficacy of Different Cognitive Behavior Therapy Delivery Formats for Depression in Patients With Cancer: A Network Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Cognitive behavior therapy (CBT) has been shown to be effective in improving depression in patients with cancer. However, diversity exists in the CBT delivery formats, and the optimal delivery format remains unconfirmed.

OBJECTIVES

To compare the efficacy of different delivery formats of CBT interventions on depression in patients with cancer.

DESIGN

Network meta-analysis of randomized controlled trials.

DATA SOURCE

Six databases, including PubMed, Web of Science, Embase, CINAHL, the Cochrane Central Register of Controlled Trials and PsycINFO, were searched from inception to May 30, 2024.

METHODS

Two reviewers independently conducted study inclusion, data extraction, and risk of bias assessment. A pairwise meta-analysis and a network meta-analysis were performed sequentially to determine the efficacy of CBT delivery formats for improving depression in patients with cancer.

RESULTS

A total of 34 randomized controlled trials involving six delivery formats of CBT were included. Face-to-face group CBT (SMD = -0.88, 95% CI [-1.33, -0.44]), internet-based individual CBT (SMD = -0.49, 95% CI [-0.92, -0.06]), app-based individual CBT (SMD = -0.81, 95% CI [-1.45, -0.18]), and combined delivery formats of CBT for individual (SMD = -0.35, 95% CI [-0.62, -0.09]) were significantly more effective than the inactive control. The ranking probabilities revealed that face-to-face group CBT (P-score = 0.86), app-based individual CBT (P-score = 0.74) and internet-based individual CBT (P-score = 0.57) were the three most effective delivery formats of CBT.

CONCLUSIONS

This study revealed the efficacy ranking of different CBT delivery formats in improving depression in patients with cancer. These findings are expected to provide evidence-based support for future research and clinical decision making for improving depression in patients with cancer.

TRIAL REGISTRATION

PROSPERO (CRD42024553977).

The Acceptability and Effects of Internet-Based Cognitive Behavioral Therapy on Depressive Symptoms and Remission in 13- to 17-Year-Old Adolescents: A Systematic Review and Meta-Analysis

OBJECTIVE

This study aimed to evaluate the acceptability and effects of internet-based cognitive behavioral therapy (iCBT) or CBT-oriented interventions compared with control groups on depressive symptoms, remission of depression, and quality of life (QOL) in adolescents.

METHODS

We searched English and Chinese databases for randomized controlled trials up to October 10, 2024 that investigated the effects of iCBT compared with controls in adolescents exhibiting elevated depressive symptoms or diagnosed with depression. Standardized mean differences (SMDs), relative risks (RRs), and 95% confidence intervals were applied to evaluate the pooled effects of outcomes.

RESULTS

A total of 19 RCTs involving 3574 cases were included in this study. We found small effects on depressive symptoms severity at different time points (posttest: SMD = -0.49 [-0.66, -0.33]; 3-month follow-up [FU3]: SMD = -0.21 [-0.30, -0.11]; FU6: SMD = -0.18 [-0.35, -0.02]; FU12: SMD = -0.38 [-0.56, -0.20]). We also found a significant effect in depression remission rate at the posttest (RR = 1.74 [1.36, 2.21]) and a significant effect in QOL at the posttest (SMD = 0.30 [0.07, 0.54]). However, the result regarding acceptability was nonsignificant (RR = 1.22 [0.76, 1.97]). No significant publication bias was found in these results.

CONCLUSION

iCBT or internet-based CBT-oriented interventions can effectively reduce depressive symptom severity and improve depression remission rate and QOL in depressed adolescents. These results are preliminary and require further validation through future systematic reviews.

Effectiveness of internet-based self-help interventions for depression in adolescents and young adults: a systematic review and meta-analysis

OBJECTIVE

To assess the effectiveness of Internet-based self-help interventions in treating depression in adolescents and young adults.

METHODS

A systematic search was conducted across six databases, including PubMed, to identify randomized controlled trials (RCTs) that satisfied the specified inclusion and exclusion criteria. The intervention measure consisted of Internet-based self-help interventions.

RESULTS

A total of 23 randomized controlled trials (RCTs) were included in this analysis. Meta-analysis indicated that Internet-based self-help therapies significantly reduced depression scores in adolescents and young adults. (OR = -0.68, 95%CI [-0.88, -0.47], P < 0.001). We examined the effects of patient recruitment from various regions, medication usage, therapist involvement, weekly intervention time, and intervention duration. Patients selected from school, primary healthcare centers, clinics and local communities had better results. Intervention lasting 30 to 60 min and 60 to180 minutes per week were effective in the short term.

CONCLUSION

The internet-based self-help intervention can be effective in treating depression in adolescents and young adults. However, factors such as patient recruitment locations, medication usage, Therapists' involvement, weekly intervention time, and intervention duration interacted with the outcome. Subgroup analysis on potential adverse effects and gender was impossible due to insufficient data from the included studies.

[Digital Beacons of Hope? The Challenges and Potentials of Digital Health Applications for Children and Adolescents with Mental Disorders in Germany]

Digital Beacons of Hope? The Challenges and Potentials of Digital Health Applications for Children and Adolescents with Mental Disorders in Germany Abstract: With the Digital Healthcare Act, Germany has taken a decisive step toward promoting high-quality, evidence-based digital health applications (DiHAs). Presently, there is a significant gap in the provision of mental health services throughout Germany, particularly regarding children and adolescents and especially in the aftermath of the COVID-19 pandemic. DiHAs as low-threshold, location- and time-independent additional mental health services - may offer a way to address this situation. Particularly in the emerging generation of digital natives, there is a high demand for digital mental health services. However, despite the rapidly growing supply of DiHAs for adults, there is a lack of approved DiHAs for children and adolescents with mental disorders. Rather, the demand for care is left to the unregulated market of diverse internet- and mobile-based interventions; early studies have questioned the evidence base, safety, and quality. This discrepancy arises from various specific challenges and risks that reduce incentives to develop DiHAs for this particularly vulnerable target group, including (1) limited evidence, (2) high complexity in study execution, (3) high complexity in the development of applications, (4) poorly researched specific risks, and (5) high regulatory requirements. This article discusses these challenges and risks and outlines the perspectives for a high-quality, safe, and evidence-based digital mental healthcare for children and adolescents.

Feasibility of a trauma-focused internet- and mobile-based intervention for youth with posttraumatic stress symptoms

Background: Many youth with posttraumatic stress symptoms (PTSS) do not receive evidence-based care. Internet- and Mobile-Based Interventions (IMIs) comprising evidence-based trauma-focused components can address this gap, but research is scarce. Thus, we investigated the feasibility of a trauma-focused IMI for youth with PTSS.Methods: In a one-arm non-randomized prospective proof-of-concept study, 32 youths aged 15-21 years with clinically relevant PTSS (CATS ≥ 21) received access to a trauma-focused IMI with therapist guidance, comprising nine sessions on an eHealth platform accessible via web-browser. We used a feasibility framework assessing recruitment capability, sample characteristics, data collection, satisfaction, acceptability, study management abilities, safety aspects, and efficacy of the IMI in PTSS severity and related outcomes. Self-rated assessments took place pre-, mid-, post-intervention and at 3-month follow-up and clinician-rated assessments at baseline and post-intervention.Results: The sample mainly consisted of young adult females with interpersonal trauma and high PTSS levels (CATS, M = 31.63, SD = 7.64). The IMI sessions were found useful and comprehensible, whereas feasibility of trauma processing was perceived as difficult. Around one-third of participants (31%) completed the IMI's eight core sessions. The study completer analysis showed a significant reduction with large effects in self-rated PTSS at post-treatment [t(21) = 4.27; p < .001; d = 0.88] and follow-up [t(18) = 3.83; p = .001; d = 0.84], and clinician-rated PTSD severity at post-treatment [t(21) = 4.52; p < .001; d = 0.93]. The intention-to-treat analysis indicated significant reductions for PTSS at post-treatment and follow-up with large effect sizes (d = -0.97- -1.02). All participants experienced at least one negative effect, with the most common being the resurfacing of unpleasant memories (n = 17/22, 77%).Conclusion: The study reached highly burdened young adults. The IMI was accepted in terms of usefulness and comprehensibility but many youths did not complete all sessions. Exploration of strategies to improve adherence in trauma-focused IMIs for youth is warranted, alongside the evaluation of the IMI's efficacy in a subsequent randomized controlled trial.

Effects of acupuncture and moxibustion on ulcerative colitis: An overview of systematic reviews

Ulcerative colitis (UC) is a gastrointestinal disease with an unknown etiology that severely affects patients' quality of life. Acupuncture and moxibustion therapies are effective in the treatment of UC, but existing systematic reviews (SRs) and meta-analyses (MAs) on this subject have variable methodological and outcome quality. Therefore, this study aimed to summarize and evaluate the evidence of existing SRs and MAs to provide more reliable evidence for clinical practice. Data were extracted from seven databases through systematic search and evaluated in terms of the methodological quality, reporting quality, risk of bias, and quality of evidence using the AMSTAR-2, PRISMA, ROBIS, and GRADE systems, respectively. Ten studies were finally included, and all of them showed many problems with the overall design and quality of outcomes. Because of the lack of high-quality evidence to support the findings from the existing studies, we should take this conclusion with caution and strictly implement the registration, design, and implementation of trials based on evidence to provide high-quality results in future studies.