Flow chart of included studies.

<p>Flow chart of included studies.</p

Meta-analysis of percentage of completed sessions, where the completed sessions (mean and sd) are divided by the total number of sessions.

<p>Meta-analysis of percentage of completed sessions, where the completed sessions (mean and sd) are divided by the total number of sessions.</p

Meta-analysis of percentage of completers of the entire intervention, where N completers is divided by the total N.

<p>Meta-analysis of percentage of completers of the entire intervention, where N completers is divided by the total N.</p

Meta-analyses of adherence to guided iCBT and individual face-to-face CBT.

a<p>As percentage of the total number of sessions.</p>b<p>As percentage of all participants who were allocated to the treatment.</p>c<p>Overall heterogeneity (<i>Q</i> value) was significant for all analyses.</p><p>Abbreviations: guided iCBT  =  guided internet-delivered cognitive behavioural therapy; FtF CBT  =  individual face-to-face cognitive behavioural therapy; C.I.  =  confidence interval.</p

Meta-analysis of the percentage of participants who completed 80% of the sessions, where N completers (80%) is divided by the total N.

<p>Meta-analysis of the percentage of participants who completed 80% of the sessions, where N completers (80%) is divided by the total N.</p

Table_1_Unveiling mechanisms of change in digital interventions for depression: Study protocol for a systematic review and individual participant data meta-analysis.DOCX

IntroductionThe efficacy and effectiveness of digital interventions for depression are both well-established. However, precise effect size estimates for mediators transmitting the effects of digital interventions are not available; and integrative insights on the specific mechanisms of change in internet- and mobile-based interventions (IMIs)—as related to key features like delivery type, accompanying support and theoretical foundation—are largely pending.ObjectiveWe will conduct a systematic review and individual participant data meta-analysis (IPD-MA) evaluating the mediators associated with therapeutic change in various IMIs for depression in adults.MethodsWe will use three electronic databases (i.e., Embase, Medline/PubMed, PsycINFO) as well as an already established database of IPD to identify relevant published and unpublished studies. We will include (1) randomized controlled trials that examine (2) mediators of (3) guided and unguided (4) IMIs with (5) various theoretical orientations for (6) adults with (7) clinically relevant symptoms of depression (8) compared to an active or passive control condition (9) with depression symptom severity as primary outcome. Study selection, data extraction, as well as quality and risk of bias (RoB) assessment will be done independently by two reviewers. Corresponding authors of eligible primary studies will be invited to share their IPD for this meta-analytic study. In a 1-stage IPD-MA, mediation analyses (e.g., on potential mediators like self-efficacy, emotion regulation or problem solving) will be performed using a multilevel structural equation modeling approach within a random-effects framework. Indirect effects will be estimated, with multiple imputation for missing data; the overall model fit will be evaluated and statistical heterogeneity will be assessed. Furthermore, we will investigate if indirect effects are moderated by different variables on participant- (e.g., age, sex/gender, symptom severity), study- (e.g., quality, studies evaluating the temporal ordering of changes in mediators and outcomes), and intervention-level (e.g., theoretical foundation, delivery type, guidance).DiscussionThis systematic review and IPD-MA will generate comprehensive information on the differential strength of mediators and associated therapeutic processes in digital interventions for depression. The findings might contribute to the empirically-informed advancement of psychotherapeutic interventions, leading to more effective interventions and improved treatment outcomes in digital mental health. Besides, with our novel approach to mediation analyses with IPD-MA, we might also add to a methodological progression of evidence-synthesis in psychotherapy process research.Study registration with Open Science Framework (OSF)https://osf.io/md7pq/.</p

Additional file 1: of Effectiveness of a transdiagnostic individually tailored Internet-based and mobile-supported intervention for the indicated prevention of depression and anxiety (ICare Prevent) in Dutch college students: study protocol for a randomised controlled trial

A populated SPIRIT checklist. (PDF 95 kb

Additional file 2: of Effectiveness of a transdiagnostic individually tailored Internet-based and mobile-supported intervention for the indicated prevention of depression and anxiety (ICare Prevent) in Dutch college students: study protocol for a randomised controlled trial

SPIRIT figure. (PDF 28 kb

Trajectories of psychosocial symptoms and wellbeing in asylum seekers and refugees exposed to traumatic events and resettled in Western Europe, Turkey, and Uganda

Background: Longitudinal studies examining mental health trajectories in refugees and asylum seekers are scarce. Objectives: To investigate trajectories of psychological symptoms and wellbeing in refugees and asylum seekers, and identify factors associated with these trajectories. Method: 912 asylum seekers and refugees from the control arm of three trials in Europe (n = 229), Turkey (n = 320), and Uganda (n = 363) were included. We described trajectories of psychological symptoms and wellbeing, and used trauma exposure, age, marital status, education, and individual trial as predictors. Then, we assessed the bidirectional interactions between wellbeing and psychological symptoms, and the effect of each predictor on each outcome controlling for baseline values. Results: Symptom improvement was identified in all trials, and for wellbeing in 64.7% of participants in Europe and Turkey, versus 31.5% in Uganda. In Europe and Turkey domestic violence predicted increased symptoms at post-intervention (ß = 1.36, 95% CI 0.17–2.56), whilst murder of family members at 6-month follow-up (ß = 1.23, 95% CI 0.27–2.19). Lower wellbeing was predicted by murder of family member (ß  = −1.69, 95% CI −3.06 to −0.32), having been kidnapped (ß  = −1.67, 95% CI −3.19 to −0.15), close to death (ß =  −1.38, 95% CI −2.70 to −0.06), and being in the host country ≥2 years (ß =  −1.60, 95% CI −3.05 to −0.14). In Uganda at post-intervention, having been kidnapped predicted increased symptoms (ß = 2.11, 95% CI 0.58–3.65), and lack of shelter (ß  = −2.51, 95% CI −4.44 to −0.58) and domestic violence predicted lower wellbeing (ß  = −1.36, 95% CI −2.67 to −0.05). Conclusion: Many participants adapt to adversity, but contextual factors play a critical role in determining mental health trajectories. Psychological symptoms improved in all participants and the trajectories went in similar directions. For wellbeing, the majority of participants in Western Europe and Turkey improved over time, while this proportion was smaller in Uganda.Asylum seekers and refugees have the capacity to adapt to traumatic events and ongoing adversity, but contextual factors play a critical role in determining mental health trajectories.Future interventions should focus on reinforcing wellbeing and ‘positive’ psychological outcomes, and targeting the social determinants of mental health. Psychological symptoms improved in all participants and the trajectories went in similar directions. For wellbeing, the majority of participants in Western Europe and Turkey improved over time, while this proportion was smaller in Uganda. Asylum seekers and refugees have the capacity to adapt to traumatic events and ongoing adversity, but contextual factors play a critical role in determining mental health trajectories. Future interventions should focus on reinforcing wellbeing and ‘positive’ psychological outcomes, and targeting the social determinants of mental health.</p