Abstract
Background: Anxiety and depressive disorders are prevalent in adolescents and young adults. However, the majority of youths with mental health problems do not receive treatment. Computerized cognitive behavior therapy (cCBT) may provide an accessible alternative to face-to-face treatment. However, the evidence base on cCBT in youths remains limited compared to
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research in adults. Objective: The objective of this study was to provide an up-to-date comprehensive systematic review and meta-analysis of the effectiveness of cCBT in treating anxiety and depression in adolescents and young adults compared to passive and active control groups. We aimed to examine both post-treatment and follow-up effects, and to explore moderators of treatment effects. Methods: We conducted systematic searches in six electronic databases: PubMed, EMBASE, PsycINFO, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials. Randomized controlled trials were included that compared cCBT with any control group in adolescents or young adults (with mean age between 12 and 25 years) with anxiety or depressive symptoms. The quality of included studies was assessed using the Cochrane risk-of-bias tool for randomized trials, version 2.0. The overall quality of the evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Post-treatment means and standard deviations were compared between the intervention and control groups, and pooled effect sizes (Hedges’ g) were calculated. A random-effects meta-analysis was conducted using Comprehensive Meta-Analysis software. Furthermore, we conducted subgroup analyses and meta-regression analyses to explore whether the study characteristics age, type of control group, level of guidance, recruitment setting, and treatment duration were associated with treatment outcome. Results: The database search resulted in 7670 papers. Twenty-four studies met all inclusion criteria and were included in the systematic review and meta-analysis. Most studies (22/24) had a high risk of bias due to the use of self-report measures and/or inappropriate handling of missing data. cCBT yielded small to medium post-treatment pooled effect sizes on anxiety symptoms (g=0.44; numbers-needed-to-treat [NNT]=4.10) and depressive symptoms (g=0.46; NNT=3.91). Subgroup analyses showed cCBT to yield a larger effect size compared to passive controls (g=0.54) than compared to active controls (g=0.02; P=0.008) on anxiety, but not depressive symptoms. No other moderators were identified. We found a small effect size for cCBT on depressive symptoms at long-term follow-up (g=0.27). No other significant follow-up effects were found; however, power to detect small differences was limited due to the small number of studies reporting follow-up data. Conclusions: cCBT appears beneficial for reducing anxiety and depressive symptoms at post-treatment in adolescents and young adults. However, more high-quality research in this population is needed: future studies should minimize risk of bias, and should include both active control conditions and long-term follow-up assessments.
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