Efficacy of Internet-based Interventions for Children, Youth, and Young Adults

with Anxiety and/or Depression: A Systematic Review and Meta-Analysis

Xibiao YeCHI Evaluation Platform, Winnipeg Regional

Health Authority, Manitoba Department of Community Health Sciences, Faculty of Medicine, University of Manitoba

Why this knowledge synthesis?

Low access to mental health treatment services

CIHR Access to Mental Health Services for Children and Youth knowledge synthesis priorities

The Availability, Efficacy/Effectiveness, Cost-effectiveness, Acceptability, and Equity of E-Mental Health Services for Children, Youth, and Young Adults (CIHR GRANT NO. KA1-119794)

Did the internet-based intervention work?

NOTE: Weights are from random effects analysis

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Anxiety symptomsKeller 2010March 2009Reid 2011Sethi 2010Spence 2011Storch 2011Subtotal (I-squared = 63.9%, p = 0.017)

Depression symptomsKeller 2010March 2009O'Kearney 2009Reid 2011Sethi 2010Spence 2011Storch 2011Subtotal (I-squared = 54.7%, p = 0.039)

IDStudy

-0.95 (-1.64, -0.26)-0.55 (-1.02, -0.08)-0.06 (-0.50, 0.37)-1.32 (-2.32, -0.31)-0.82 (-1.26, -0.39)0.18 (-0.52, 0.89)-0.53 (-0.93, -0.14)

-1.33 (-2.06, -0.60)-0.08 (-0.54, 0.38)-0.18 (-0.50, 0.14)0.09 (-0.34, 0.52)0.07 (-0.83, 0.97)-0.18 (-0.60, 0.24)0.30 (-0.41, 1.01)-0.16 (-0.45, 0.12)

difference (95% CI)standardized mean

Favours Internet-based Favours Control 0-4 -2 0 2 4

Overall (I-squared = 0.0%, p = 0.875)

Study

Storch 2011

ID

March 2009

Spence 2011

3.63 (1.59, 8.27)

Relative

4.22 (1.08, 16.45)

Risk (95% CI)

2.90 (0.87, 9.66)

4.91 (0.65, 37.11)

Favours Internet-based Favours Control 1.05 .2 1 5 20

Anxiety remission rate

How did the internet-based intervention compare to usual care (face-to-face)?

NOTE: Weights are from random effects analysis

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Anxiety symptoms

Sethi 2010

Spence 2011

Subtotal (I-squared = 0.0%, p = 0.555)

Depression symptoms

Sethi 2010

Spence 2006

Subtotal (I-squared = 84.3%, p = 0.012)

ID

Study

0.16 (-0.74, 1.07)

-0.14 (-0.62, 0.34)

-0.08 (-0.50, 0.35)

2.32 (1.13, 3.51)

0.61 (0.02, 1.20)

1.39 (-0.29, 3.06)

difference (95% CI)

standardized mean

Favours Internet-based Favours Control 0-4 -2 0 2 4

How long the effect was maintained?

• Most studies have examined short-term effect (<12 weeks)

• No studies compared the intervention and control groups >6 months after the intervention

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Conclusion

• Pooled effect estimates are limited by the small number of studies.

• Internet-based interventions are effective in reducing anxiety symptoms, and may be as effective as face-to-face interventions.

• The interventions may not work for depression.

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