title: Technology-adaptable interventions for treating depression in adults with cognitive impairments: protocol for a systematic review.
abstract: BACKGROUND
  Depression is a common comorbidity in individuals with cognitive impairment. Those with cognitive impairments face unique challenges in receiving the benefits of many conventional therapies for depression, and may have poorer outcomes in areas such as recovery and quality of life. However, the stigmatization of mental health disorders, cost barriers and physical disabilities may prevent these individuals from seeking mental health care. An online, self-help intervention specifically developed for adults with cognitive deficits and depression may be particularly beneficial to this population. We aim to inform the design of such an intervention through a systematic review by answering the following research question: among adults with cognitive impairment (including those with acquired brain injuries or neurodegenerative diseases), which technology-amenable interventions have been shown to effectively decrease symptoms of depression? Specifically, psychotherapeutic and/or behavioural interventions that could be delivered in a self-guided, online system will be included.
  
  
  METHODS
  Comprehensive electronic searches will be conducted in MEDLINE, EMBASE, PsycINFO and CINAHL. Additional studies will be obtained through manually searching the references of relevant systematic reviews, contacting primary authors of select articles and tracking conference proceedings and trial registries. Article titles and abstracts will be screened using predefined eligibility criteria, and then judged for their amenability to the proposed self-help, technology-based intervention. The full text of those articles with selected interventions will then be screened to determine final eligibility for inclusion. Included articles will be categorized by intervention type and assessed for risk of bias using the Cochrane Effective Practice and Organization of Care Risk of Bias tool for non-randomized trials, controlled before-after studies and interrupted time series. The primary outcome will be a change in score on a validated depression scale, and adverse events will be documented as a secondary outcome. After data extraction from selected articles, pooling of data and meta-analysis will be conducted if a sufficient pool of studies with comparable methodology and quality are identified. Alternatively, plain language summaries will be developed. The quality of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.
  
  
  BACKGROUND
  PROSPERO CRD42014014417.
authors: St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. topolovec-vranicj@smh.ca.|University of Toronto, 563 Spadina Crescent, Toronto, Ontario, M5S 2J7, Canada. topolovec-vranicj@smh.ca.
authors: Jane
authors: J
authors: Topolovec-Vranic
authors: McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4L8, Canada. mansooys@mcmaster.ca.
authors: Yasmeen
authors: Y
authors: Mansoor
authors: St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. naomi.ennis@psych.ryerson.ca.|Ryerson University, 350 Victoria Street, Toronto, Ontario, M5B 2K3, Canada. naomi.ennis@psych.ryerson.ca.
authors: Naomi
authors: N
authors: Ennis
authors: St. Michael's Hospital, 30 Bond St, Toronto, Ontario, M5B 1W8, Canada. lightfootd@smh.ca.
authors: David
authors: D
authors: Lightfoot
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D003072:Cognition Disorders / Q000150:complications*; D003863:Depression / Q000150:complications / Q000628:therapy*; D003866:Depressive Disorder / Q000150:complications / Q000628:therapy*; D006801:Humans; D020407:Internet; D011613:Psychotherapy / Q000379:methods*; D011788:Quality of Life; D012107:Research Design; D012648:Self Care; D000078202:Systematic Reviews as Topic