%0 Journal Article
%@ 1438-8871
%I JMIR Publications
%V 22
%N 10
%P e17049
%T Acceptability and Effectiveness of NHS-Recommended e-Therapies for Depression, Anxiety, and Stress: Meta-Analysis
%A Simmonds-Buckley,Melanie
%A Bennion,Matthew Russell
%A Kellett,Stephen
%A Millings,Abigail
%A Hardy,Gillian E
%A Moore,Roger K
%+ Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, S1 2LT, Sheffield, S1 2LT, United Kingdom, 44 01142226630, m.simmonds-buckley@sheffield.ac.uk
%K e-therapy
%K anxiety
%K depression
%K treatment effectiveness
%K National Health Service
%K meta-analysis
%K mobile phone
%D 2020
%7 28.10.2020
%9 Review
%J J Med Internet Res
%G English
%X 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 
%M 33112238
%R 10.2196/17049
%U http://www.jmir.org/2020/10/e17049/
%U https://doi.org/10.2196/17049
%U http://www.ncbi.nlm.nih.gov/pubmed/33112238