Internet-based Cognitive Behavioral Therapy to reduce depression in China: Systematic review and meta-analysis of randomized controlled trials

1.Background.Internet-based cognitive behavioral treatments (iCBTs) have been used to reduce the symptoms of depression, but evidence from China is limited and not systematically integrated. Thus, this systematic review and meta-analysis was conducted to integrate evidence examining the effectiveness of iCBT programs to reduce depressive symptoms in the Chinese population. 2.Methods.A systematic literature search was conducted across multiple databases for randomized controlled trials (RCTs) published in English and Chinese including PsycINFO, Web of Science, PubMed, CNKI, and Wanfang, focusing on RCTs. The present review only included studies utilizing iCBT programs to reduce depressive symptoms on the Chinese population. Data were extracted independently by two reviewers (ZW and SW), and the risk of bias was assessed using the Cochrane Risk-of-Bias tool. Effect sizes (Cohen’s d) were pooled for individual outcomes using random-effects meta-analysis. Subgroup analyses, including one examining the impact of human provider involvement, were conducted to determine the overall effect size and explore potential moderators.3.ResultsEight randomized controlled trials were deemed eligible (N = 966). Results suggested that iCBT programs had a significant and sizeable effectiveness to reduce depression (d = -0.73, CI [-1.12, -0.34]). Furthermore, subgroup analyses indicated that the effectiveness of iCBT did not significantly differ between human-involved and non-human-delivered interventions. 4.ConclusioniCBT programs illustrate effectiveness in alleviating depressive symptoms in the context of Chinese population, despite the high heterogeneity between studies. Future studies are warranted to further validate this effectiveness with a scale-up approach.