Effectiveness of information technology-based cognitive behavioral therapy on depression and anxiety symptoms among older adults: Systematic review and meta-analysis

Background

Depression and anxiety are prevalent among older adults. However, most older adults have poor access to age-specific mental health services. While Information technology-based Cognitive Behavioral Therapy (ICBT) has shown promise as an accessible alternative to face-to-face interventions, its effectiveness specifically within the older adults warrants further investigation.

Objective

To evaluate the effectiveness of ICBT on depression and anxiety symptoms among older adults.

Methods

Research articles retrieved from PubMed, EMBASE, the Cochrane Library, Web of Science, PsycINFO, and MEDLINE from inception to April 10, 2024, were reviewed. The search was designed to identify Randomized Controlled Trials (RCTs) that examined the efficacy of ICBT in reducing self-reported depression or anxiety symptoms in older adults. The quality of included studies was assessed using the Cochrane risk-of-bias tool for randomized trials, version 2.0. Posttreatment means and standard deviations (SDs) were compared between intervention and control groups, and pooled effect sizes (Hedges' g) were calculated.

Results

A total of 11 RCTs were eligible for inclusion in this review. Compared to control groups, ICBT yielded small to medium post-treatment pooled effect sizes regarding depressive symptoms (Hedges' g = −0.65, 95 % CI −0.95 to −0.35; P < 0.001) and anxiety symptoms (Hedges' g = −0.47, 95 % CI −0.74 to −0.19; P < 0.001). Subgroup analyses showed that: (1) interventions lasting ≥8 weeks (Hedges' g = −0.88, 95 % CI −1.37 to −0.39; P < 0.001) were more effective than <8 weeks for depressive symptoms; however, <8 weeks (Hedges' g = −0.52, 95 % CI −0.93 to −0.10; P = 0.014) was more effective for anxiety symptoms; (2) ICBT delivered through slideshows was more effective than through other digital platforms for both depressive (Hedges' g = −1.36, 95 % CI −2.40 to −0.31; P = 0.011) and anxiety symptoms (Hedges' g = −1.00, 95 % CI −1.30 to −0.70; P < 0.001); and (3) non-tailored ICBT was more effective than tailored versions for both depressive (Hedges' g = −1.06, 95 % CI −2.03 to −0.09; P = 0.032) and anxiety symptoms (Hedges' g = −0.70, 95 % CI −1.14 to −0.27; P = 0.001).

Conclusions

This meta-analysis reinforces the effectiveness of ICBT in relieving depression and anxiety symptoms among older adults. Future research should identify the most effective components of ICBT to optimize their development.