title: Effectiveness of internet-based interventions for children, youth, and young adults with anxiety and/or depression: a systematic review and meta-analysis.
abstract: BACKGROUND
  The majority of internet-based anxiety and depression intervention studies have targeted adults. An increasing number of studies of children, youth, and young adults have been conducted, but the evidence on effectiveness has not been synthesized. The objective of this research is to systematically review the most recent findings in this area and calculate overall (pooled) effect estimates of internet-based anxiety and/or depression interventions.
  
  
  METHODS
  We searched five literature databases (PubMed, EMBASE, CINAHL, PsychInfo, and Google Scholar) for studies published between January 1990 and December 2012. We included studies evaluating the effectiveness of internet-based interventions for children, youth, and young adults (age <25 years) with anxiety and/or depression and their parents. Two reviewers independently assessed the risk of bias regarding selection bias, allocation bias, confounding bias, blinding, data collection, and withdrawals/dropouts. We included studies rated as high or moderate quality according to the risk of bias assessment. We conducted meta-analyses using the random effects model. We calculated standardized mean difference and its 95% confidence interval (95% CI) for anxiety and depression symptom severity scores by comparing internet-based intervention vs. waitlist control and internet-based intervention vs. face-to-face intervention. We also calculated pooled remission rate ratio and 95% CI.
  
  
  RESULTS
  We included seven studies involving 569 participants aged between 7 and 25 years. Meta-analysis suggested that, compared to waitlist control, internet-based interventions were able to reduce anxiety symptom severity (standardized mean difference and 95% CI = -0.52 [-0.90, -0.14]) and increase remission rate (pooled remission rate ratio and 95% CI =3.63 [1.59, 8.27]). The effect in reducing depression symptom severity was not statistically significant (standardized mean difference and 95% CI = -0.16 [-0.44, 0.12]). We found no statistical difference in anxiety or depression symptoms between internet-based intervention and face-to-face intervention (or usual care).
  
  
  CONCLUSIONS
  The present analysis indicated that internet-based interventions were effective in reducing anxiety symptoms and increasing remission rate, but not effective in reducing depression symptom severity. Due to the small number of higher quality studies, more attention to this area of research is encouraged.
  
  
  BACKGROUND
  PROSPERO registration: CRD42012002100.
authors.affiliation: Centre for Healthcare Innovation Evaluation Platform, Winnipeg Regional Health Authority, 200-1155 Concordia Avenue, Winnipeg, Manitoba R2K 2M9, Canada. xibiao.ye@gmail.com.
authors.forename: Xibiao
authors.initials: X
authors.lastname: Ye
authors.forename: Sunita Bayyavarapu
authors.initials: SB
authors.lastname: Bapuji
authors.forename: Shannon Elizabeth
authors.initials: SE
authors.lastname: Winters
authors.forename: Ashley
authors.initials: A
authors.lastname: Struthers
authors.forename: Melissa
authors.initials: M
authors.lastname: Raynard
authors.forename: Colleen
authors.initials: C
authors.lastname: Metge
authors.forename: Sara Adi
authors.initials: SA
authors.lastname: Kreindler
authors.forename: Catherine Joan
authors.initials: CJ
authors.lastname: Charette
authors.forename: Jacqueline Angela
authors.initials: JA
authors.lastname: Lemaire
authors.forename: Margaret
authors.initials: M
authors.lastname: Synyshyn
authors.forename: Karen
authors.initials: K
authors.lastname: Sutherland
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000628:therapy*; D002648:Child; D003866:Depressive Disorder / Q000628:therapy*; D006297:Health Services Accessibility; D006801:Humans; D020407:Internet; D011613:Psychotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D055815:Young Adult