Abstract
BackgroundWeb-based interventions for depression have been widely tested for usability and functioning. However, the few studies that have addressed the therapeutic quality of these interventions have mainly focused on general aspects without consideration of specific quality factors related to particular treatment components. Clinicians and scientists are calling for standardized assessment criteria for web-based interventions to enable effective and trustworthy patient care. Therefore, an extensive evaluation of web-based interventions at the level of individual treatment components based on therapeutic guidelines and manuals is needed.ObjectiveThe objective of this study was to evaluate the quality of unguided web-based interventions for depression at the level of individual treatment components based on their adherence to current gold-standard treatment guidelines and manuals.MethodsA comprehensive online search of popular app stores and search engines in January 2018 revealed 11 desktop programs and 17 smartphone apps that met the inclusion criteria. Programs and apps were included if they were available for German users, interactive, unguided, and targeted toward depression. All programs and apps were tested by three independent researchers following a standardized procedure with a predefined symptom trajectory. During the testing, all web-based interventions were rated with a standardized list of criteria based on treatment guidelines and manuals for depression.ResultsOverall interrater reliability for all raters was substantial with an intraclass correlation coefficient of 0.73 and Gwet AC1 value of 0.80. The main features of web-based interventions included mood tracking (24/28, 86%), psychoeducation (21/28, 75%), cognitive restructuring (21/28, 75%), crisis management (20/28, 71%), behavioral activation (19/29, 68%), and relaxation training (18/28, 64%). Overall, therapeutic meaningfulness was rated higher for desktop programs (mean 4.13, SD 1.17) than for smartphone apps (mean 2.92, SD 1.46).ConclusionsAlthough many exercises from manuals are included in web-based interventions, the necessary therapeutic depth of the interventions is often not reached, and risk management is frequently lacking. There is a need for further research targeting general principles for the development and evaluation of therapeutically sound web-based interventions for depression.
Highlights
BackgroundMajor depression is the leading cause of disability and affects more than 300 million people worldwide [1], with a lifetime prevalence up to 20.6% for different populations [2,3,4]
The majority of web-based interventions implement cognitive behavioral therapy (CBT) as the therapeutic approach [48,49], we found only one study that examined the realization of a specific component of CBT in web-based interventions in detail [55]
We adapted inclusion criteria that can be found in previous scoping reviews on web-based interventions for depression in the scientific literature [48] to fit the purpose of this study, and added further criteria that we considered necessary to fulfill the particular objective of this study
Summary
BackgroundMajor depression is the leading cause of disability and affects more than 300 million people worldwide [1], with a lifetime prevalence up to 20.6% for different populations [2,3,4]. Web-based interventions are considered a promising model to address this treatment gap [13,14] They provide immediate support at any time and place, are cost-effective, and can be administered to a vast majority of people, reducing barriers and enabling high accessibility to treatment [20,21,22]. An extensive evaluation of web-based interventions at the level of individual treatment components based on therapeutic guidelines and manuals is needed. Objective: The objective of this study was to evaluate the quality of unguided web-based interventions for depression at the level of individual treatment components based on their adherence to current gold-standard treatment guidelines and manuals. All web-based interventions were rated with a standardized list of criteria based on treatment guidelines and manuals for depression. There is a need for further research targeting general principles for the development and evaluation of therapeutically sound web-based interventions for depression
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