Online treatments for depressive symptoms are often not completed. Younger people, men, people with lower educational attainment and those in employment are more likely to drop out early, according to new research published in Nature Mental Health. People who complete more treatment modules have, on average, fewer depressive symptoms afterwards.
Lead researcher and clinical psychologist Lingyao Tong explains why the team wanted to investigate this: “Digital treatments are increasingly being used for depressive symptoms. Healthcare systems, including the UK’s National Health Service, for example, offer therapies online or through apps. But the effectiveness of such treatment also depends on whether people continue to use the programme.”
Tong therefore investigated which people are at greater risk of dropping out early. “We wanted to find out which groups are at greater risk of completing fewer treatment modules.” The researchers looked at factors including age, gender, educational attainment, employment status and relationship status. For the study, data from 8,082 adults across 71 previous randomised trials were combined and reanalysed.
How many people complete an online treatment for depression?
On average, participants completed 60.5% of the treatment modules. Only 37.3% completed all modules. Younger participants, men, people with lower educational attainment and those in employment completed fewer modules on average than other participants.
People who completed more treatment modules had, on average, less severe depressive symptoms after treatment. “There was a strong association between treatment adherence and treatment outcome. By this I mean that people who completed more modules had, on average, less severe depressive symptoms afterwards, even when the severity of their symptoms at the start of treatment was taken into account,” says Tong.
Tong adds an important caveat: “The study shows an association, but it does not prove that completing more modules is what caused people to feel better.”
Targeted support for people at risk of dropping out
According to Tong, the findings may help identify at an earlier stage who is more likely to struggle to stay engaged with an online treatment. Additional support may be particularly important for these groups. “Additional motivation, progress monitoring or other forms of targeted support may help people stay more engaged with digital treatments.”
Read the paper: An individual participant data meta-analysis of predictors of adherence to internet-based interventions for depression in Nature Mental Health.