The efficacy, acceptability and satisfaction of internet-based cognitive behavioral therapy with the absence of professional guidance for depression in adults: a systematic review and meta-analysis

Abstract

Abstract Background Depression is a high prevalence mental disorder and the global disease burden is substantial. Internet-based Cognitive Behavior Therapy (iCBT) is a means to compensate for the lack of accessibility of Cognitive Behavior Therapy (CBT) which is an effective therapeutic measure for depression. However, the characteristic of remote guidance combined with the absence of professional guidance of iCBT leads to an uncertain efficacy for depression. Methods We searched PubMed, Embase, The Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science from inception to May 2023. The Randomized Controlled Trials (RCTs) that iCBT with the absence of professional guidance for depression patients were selected. We assessed the risk of bias according to the Rob 2.0. Standardized mean difference (SMD), mean difference (MD) or risk ratio (RR) as well as their 95% confidence interval (CI) were calculated to evaluate the effect sizes by the software of R 5.4.1. The sources of heterogeneity were explored by subgroup analysis and meta regression. Results 30 studies involving 10,659 participants were included. Intervention group showed a statistically significant reduction compared with control group for the posttreatment depression symptom scores (SMD: -0.54; 95% CI: -0.64 to -0.44, P < 0.01) and for the depressive symptom scores after the follow-up period (SMD: -0.38; 95% CI: -0.53 to -0.23, P < 0.01). In addition, the depressive symptom scores continued to decrease statistically significantly after the follow-up period (SMD: 0.18; 95% CI: 0.09 to 0.26, P < 0.01) compared with the scores before the follow-up period in intervention group. The drop-out rate of intervention group is higher statistically significantly (Risk Ratio: 1.51; 95% CI: 1.26 to 1.80, P < 0.01) compared with control group. The subgroup and meta regression showed that the covariate of control condition was the main source of heterogeneity to primary outcome 1 and the covariate of support content to primary outcome 3. Conclusions ICBT with the absence of professional guidance can relieve symptoms of depression patients and also can maintain a long-term efficacy. In addition, depression patients have a high level of satisfaction with the intervention of iCBT with the absence of professional guidance. However, the drop-out rate of intervention group is higher than control group.