Effectiveness of internet-based interventions for children, youth, and young adults with anxiety and/or depression: a systematic review and meta-analysis
1 Centre for Healthcare Innovation Evaluation Platform, Winnipeg Regional Health Authority, 200-1155 Concordia Avenue, Winnipeg, Manitoba R2K 2M9, Canada
2 Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
3 Concordia Hospital Library, University of Manitoba, 1095 Concordia Avenue, Winnipeg, Manitoba R2N 3S8, Canada
4 Addictions Foundation of Manitoba, 1031 Portage Avenue, Winnipeg, Manitoba R3G 0R8, Canada
5 Manitoba Adolescent Treatment Centre, 120 Tecumseh St, Winnipeg, Manitoba R3E 2A9, Canada
6 Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON N6G 1H1, Canada
7 Mental Health Crisis Response Centre, Winnipeg Regional Health Authority, 817 Bannatyne Avenue, Winnipeg MB R3E 0W4, Canada
BMC Health Services Research 2014, 14:313 doi:10.1186/1472-6963-14-313Published: 18 July 2014
The majority of internet-based anxiety and depression intervention studies have targeted adults. An increasing number of studies of children, youth, and young adults have been conducted, but the evidence on effectiveness has not been synthesized. The objective of this research is to systematically review the most recent findings in this area and calculate overall (pooled) effect estimates of internet-based anxiety and/or depression interventions.
We searched five literature databases (PubMed, EMBASE, CINAHL, PsychInfo, and Google Scholar) for studies published between January 1990 and December 2012. We included studies evaluating the effectiveness of internet-based interventions for children, youth, and young adults (age <25 years) with anxiety and/or depression and their parents. Two reviewers independently assessed the risk of bias regarding selection bias, allocation bias, confounding bias, blinding, data collection, and withdrawals/dropouts. We included studies rated as high or moderate quality according to the risk of bias assessment. We conducted meta-analyses using the random effects model. We calculated standardized mean difference and its 95% confidence interval (95% CI) for anxiety and depression symptom severity scores by comparing internet-based intervention vs. waitlist control and internet-based intervention vs. face-to-face intervention. We also calculated pooled remission rate ratio and 95% CI.
We included seven studies involving 569 participants aged between 7 and 25 years. Meta-analysis suggested that, compared to waitlist control, internet-based interventions were able to reduce anxiety symptom severity (standardized mean difference and 95% CI = −0.52 [−0.90, −0.14]) and increase remission rate (pooled remission rate ratio and 95% CI =3.63 [1.59, 8.27]). The effect in reducing depression symptom severity was not statistically significant (standardized mean difference and 95% CI = −0.16 [−0.44, 0.12]). We found no statistical difference in anxiety or depression symptoms between internet-based intervention and face-to-face intervention (or usual care).
The present analysis indicated that internet-based interventions were effective in reducing anxiety symptoms and increasing remission rate, but not effective in reducing depression symptom severity. Due to the small number of higher quality studies, more attention to this area of research is encouraged.
PROSPERO registration: CRD42012002100