Comparability of Patients in Trials of E-Health and Face-To-Face Psychotherapeutic Interventions for Depression: a Meta-Synthesis

Background: Depressive disorders are a public health problem. Face-to-face psychotherapeutic interventions are considered to be a first-line option for their treatment in adults. There is a growing interest in eHealth interventions to maximize accessibility for effective treatments. Thus, the number of randomized controlled trials (RCTs) of eHealth psychotherapeutic interventions has increased, and these interventions are often being offered to patients. However, it is unknown whether patients with depressive disorders differ in internet and face-to-face intervention trials. This information is essential to gain knowledge about the external validity of eHealth trials. Objective: To compare the baseline characteristics of patients with depressive disorder in eHealth and face-to-face psychotherapeutic intervention RCTs. Methods: Meta-epidemiological study. We searched five databases between 1990 and November 2017 (MEDLINE, EMBASE, PsycINFO, Google Scholar, Cuijpers’s database). We included RCTs of psychotherapeutic interventions with a cognitive component (such as cognitive therapy, cognitive–behavioral therapy, or interpersonal therapy) delivered face-to-face or via the internet to adults with a depressive disorder. Each included study had a matching study for predefined criteria to allow a valid comparison of baseline characteristics. Each study was classified as a face-to-face (CBT) or eHealth (iCBT) intervention trial. Two authors selected the studies, extracted data, and resolved disagreements by discussion. We tested whether predefined baseline characteristics differed in face-to-face and internet-based trials by using a mixed-effects model and testing for differences with a Z-test (statistical significance threshold set at 0.05). For continuous outcomes, we also estimated the difference in means between subgroups along with the 95% CI. Results: We included 58 RCTs (29 matching pairs) with 3,655 participants (71.5% females) with a mean age from 20 to 74 years. Caucasian participants were the most frequently reported. Other socioeconomic characteristics were poorly reported. The participants presented different depressive disorders measured with heterogeneous instruments. iCBT trials had a longer mean duration of depression at baseline (7.19 years higher; CI 95% 2.53 to 11.84; 10.0 versus 2.8 years, P=.002), but the proportion of patients with previous depression treatment was lower (24.8% versus 42.0%, P=.035). The subgroup analyses found no evidence of differences for the remaining baseline characteristics: age, gender, education, living area, depression severity, history of depression, actual antidepressant medication, actual physical comorbidity, actual mental comorbidity, study drop-out, quality of life, having children, family status and employment. We could not compare proficiency with computers due to the insufficient number of studies reporting this information. Conclusions: Our study found that the baseline characteristics of patients with depressive disorders included in RCTs of eHealth and face-to-face psychotherapeutic interventions are generally similar. However, patients in eHealth trials had a longer duration of depression, and a lower proportion had received previous depression treatment. This might indicate that eHealth trials attract patients who postpone earlier treatment attempts