@Article{info:doi/10.2196/17049,
author="Simmonds-Buckley, Melanie
and Bennion, Matthew Russell
and Kellett, Stephen
and Millings, Abigail
and Hardy, Gillian E
and Moore, Roger K",
title="Acceptability and Effectiveness of NHS-Recommended e-Therapies for Depression, Anxiety, and Stress: Meta-Analysis",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="28",
volume="22",
number="10",
pages="e17049",
keywords="e-therapy; anxiety; depression; treatment effectiveness; National Health Service; meta-analysis; mobile phone",
abstract="Background: There is a disconnect between the ability to swiftly develop e-therapies for the treatment of depression, anxiety, and stress, and the scrupulous evaluation of their clinical utility. This creates a risk that the e-therapies routinely provided within publicly funded psychological health care have evaded appropriate rigorous evaluation in their development. Objective: This study aims to conduct a meta-analytic review of the gold standard evidence of the acceptability and clinical effectiveness of e-therapies recommended for use in the National Health Service (NHS) in the United Kingdom. Methods: Systematic searches identified appropriate randomized controlled trials (RCTs). Depression, anxiety, and stress outcomes at the end of treatment and follow-up were synthesized using a random-effects meta-analysis. The grading of recommendations assessment, development, and evaluation approach was used to assess the quality of each meta-analytic comparison. Moderators of treatment effect were examined using subgroup and meta-regression analysis. Dropout rates for e-therapies (as a proxy for acceptability) were compared against controls. Results: A total of 24 studies evaluating 7 of 48 NHS-recommended e-therapies were qualitatively and quantitatively synthesized. Depression, anxiety, and stress outcomes for e-therapies were superior to controls (depression: standardized mean difference [SMD] 0.38, 95{\%} CI 0.24 to 0.52, N=7075; anxiety and stress: SMD 0.43, 95{\%} CI 0.24 to 0.63, n=4863), and these small effects were maintained at follow-up. Average dropout rates for e-therapies (31{\%}, SD 17.35) were significantly higher than those of controls (17{\%}, SD 13.31). Limited moderators of the treatment effect were found. Conclusions: Many NHS-recommended e-therapies have not been through an RCT-style evaluation. The e-therapies that have been appropriately evaluated generate small but significant, durable, beneficial treatment effects. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) registration CRD42019130184; https://www.crd.york.ac.uk/prospero/display{\_}record.php?RecordID=130184 ",
issn="1438-8871",
doi="10.2196/17049",
url="http://www.jmir.org/2020/10/e17049/",
url="https://doi.org/10.2196/17049",
url="http://www.ncbi.nlm.nih.gov/pubmed/33112238"
}