Prognostic Risk Factors in Randomized Clinical Trials of Face-to-Face and Internet-Based Psychotherapy for...

Area of Science:

• Psychiatry and Mental Health
• Clinical Psychology
• Health Services Research

Background:

• Adults with severe depressive symptoms, comorbidities, or socioeconomic disadvantages often have poorer prognoses.
• Excluding these patients from randomized controlled trials (RCTs) limits the generalizability of research findings.
• Understanding prognostic risk factors (PRFs) in different therapy modalities is crucial for evidence-based practice.

Purpose of the Study:

• To compare PRFs in patient samples of RCTs for face-to-face therapy (FTF) versus internet-based therapy (IBT) for depression.
• To assess the impact of PRFs on treatment effectiveness in different delivery formats.
• To inform future research and clinical guidelines for depression treatment.

Main Methods:

• Systematic review and meta-regression analysis of RCTs comparing FTF and IBT for depression (2000-2021).
• Searched PsycINFO, Cochrane CENTRAL, and meta-analysis reference lists.
• Utilized a prognostic risk index (PROG) to quantify PRFs in study samples.

Main Results:

• 105 RCTs with 18,363 patients were included; 48 examined FTF and 57 examined IBT.
• RCTs for FTF had significantly higher PROG scores (poorer prognosis) than RCTs for IBT (mean PROG FTF=3.55 vs IBT=2.27).
• No significant association was found between PROG and treatment effect size, though sensitivity analyses yielded mixed results.

Conclusions:

• Patient samples in FTF therapy RCTs exhibit poorer prognostic risk factors compared to those in IBT RCTs.
• This difference impacts the generalizability of current evidence on IBT for depression.
• Future research should prioritize clinically representative samples for IBT trials and improve PRF reporting.