Tong L., Panagiotopoulou OM., Miguel C., Harrer M., Amarnath A., Ciharova M., Gemmill AW., Salamanca-Sanabria A., Williams A., Fonseca A., Zarski AC., Geraedts A., van Straten A., Raevuori A., Arntz A., Ghosh A., Meyer B., Allenhof C., Lukas CA., Knaevelsrud C., Williams C., Lu C., Bockting C., Ebert DD., Richards D., Feil EG., Addington EL., Forsell E., Cao F., Vázquez FL., Boele FW., Kay-Lambkin F., Holländare F., Andersson G., Baumeister H., Hadjistavropoulos HD., Riper H., Choi I., Klein JP., Milgrom J., Lambert J., Dahne J., Stewart JC., Smith J., Montero-Marin J., Newby J., Abi Ramia J., Reins JA., Lundgren J., Moskowitz JT., Jackson KL., Lillevoll K., Vernmark K., Sander LB., Braun L., Warmerdam L., Littlewood L., Heinrich M., Gili M., Deady M., Kraepelien M., Berking M., Schaub MP., Buhrman M., Forand NR., Titov N., Pugh N., Lindefors N., Gupta N., Zagorscak P., Carlbring P., Johansson P., El Chammay R., Arjadi R., van der Zanden R., Araya R., Krämer R., Johansson R., Kenter RMF., Boeschoten R., Gupta SK., Schlicker S., Perini S., Gilbody S., Köhler S., Nobis S., Berger T., Hegerl U., Blanco V., Kaldo V., Pop V., Spek V., Pots W., Sun Y., Forsell Y., Cuijpers P., Karyotaki E.

Internet-based psychological interventions can effectively reduce depressive symptoms in adults, but adherence remains challenging. In this preregistered individual participant data meta-analysis, we examined predictors of treatment adherence. We searched PubMed, Embase and PsycINFO on 6 February 2024 for randomized trials of internet-based interventions among adults with elevated depressive symptoms. We conducted a one-stage logit-link multilevel beta regression, with adherence defined as the proportion of completed modules post-intervention. This study included 71 trials (85 treatment arms, 8,082 participants). Lower adherence was associated with younger age (β = 0.005, standard error (SE) 0.002, P = 0.028), male gender (β = −0.163, SE 0.053, P = 0.002), lower education (β = −0.133, SE 0.05, P = 0.008) and employment (β = −0.113, SE 0.054, P = 0.037). No significant interactions were found between individual predictors and intervention format (guided versus self-guided). Higher adherence was associated with lower post-intervention depression severity, adjusting for baseline severity (β = −0.30, SE 0.04, P < 0.001). Identifying subgroups at risk of low adherence may inform targeted strategies to improve engagement and clinical effectiveness.

An individual participant data meta-analysis of predictors of adherence to internet-based interventions for depression

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