title: Predictors of treatment dropout in self-guided web-based interventions for depression: an 'individual patient data' meta-analysis.
abstract: BACKGROUND
  It is well known that web-based interventions can be effective treatments for depression. However, dropout rates in web-based interventions are typically high, especially in self-guided web-based interventions. Rigorous empirical evidence regarding factors influencing dropout in self-guided web-based interventions is lacking due to small study sample sizes. In this paper we examined predictors of dropout in an individual patient data meta-analysis to gain a better understanding of who may benefit from these interventions.
  
  
  METHODS
  A comprehensive literature search for all randomized controlled trials (RCTs) of psychotherapy for adults with depression from 2006 to January 2013 was conducted. Next, we approached authors to collect the primary data of the selected studies. Predictors of dropout, such as socio-demographic, clinical, and intervention characteristics were examined.
  
  
  RESULTS
  Data from 2705 participants across ten RCTs of self-guided web-based interventions for depression were analysed. The multivariate analysis indicated that male gender [relative risk (RR) 1.08], lower educational level (primary education, RR 1.26) and co-morbid anxiety symptoms (RR 1.18) significantly increased the risk of dropping out, while for every additional 4 years of age, the risk of dropping out significantly decreased (RR 0.94).
  
  
  CONCLUSIONS
  Dropout can be predicted by several variables and is not randomly distributed. This knowledge may inform tailoring of online self-help interventions to prevent dropout in identified groups at risk.
authors.affiliation: Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Karyotaki
authors.affiliation: Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Kleiboer
authors.affiliation: Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Smit
authors.affiliation: Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands.
authors.forename: D T
authors.initials: DT
authors.lastname: Turner
authors.affiliation: Department of Psychology and Technology,Jaume University,Castellon,Spain.
authors.forename: A M
authors.initials: AM
authors.lastname: Pastor
authors.affiliation: Department of Behavioural Sciences and Learning,Sweden Institute for Disability Research,Linköping; University,Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Andersson
authors.affiliation: Department of Clinical Psychology and Psychotherapy,University of Bern,Bern,Switzerland.
authors.forename: T
authors.initials: T
authors.lastname: Berger
authors.affiliation: Department of Psychology and Technology,Jaume University,Castellon,Spain.
authors.forename: C
authors.initials: C
authors.lastname: Botella
authors.affiliation: Department of Psychology and Technology,Jaume University,Castellon,Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Breton
authors.affiliation: Department of Psychology,Stockholm University,Stockholm,Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Carlbring
authors.affiliation: Black Dog Institute and University of New South Wales,Prince of Wales Hospital,Sydney,Australia.
authors.forename: H
authors.initials: H
authors.lastname: Christensen
authors.affiliation: Department of Clinical Psychological Science,Faculty of Psychology,Maastricht University,The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: de Graaf
authors.affiliation: National Institute of Mental Health Research,The Australian National University,Sydney,Australia.
authors.forename: K
authors.initials: K
authors.lastname: Griffiths
authors.affiliation: Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Donker
authors.affiliation: National Institute of Mental Health Research,The Australian National University,Sydney,Australia.
authors.forename: L
authors.initials: L
authors.lastname: Farrer
authors.affiliation: Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands.
authors.forename: M J H
authors.initials: MJ
authors.lastname: Huibers
authors.affiliation: Department of Behavioural Sciences and Learning,Linkoping University,Linkoping,Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Lenndin
authors.affiliation: Centre for Youth Mental Health Research,University of Melbourne,Melbourne,Australia.
authors.forename: A
authors.initials: A
authors.lastname: Mackinnon
authors.affiliation: Research Department,Gaia AG,Hamburg,Germany.
authors.forename: B
authors.initials: B
authors.lastname: Meyer
authors.affiliation: Department of Psychiatry and Psychotherapy,University Medical Centre Hamburg-Eppendorf,Hamburg,Germany.
authors.forename: S
authors.initials: S
authors.lastname: Moritz
authors.affiliation: Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Riper
authors.affiliation: Avans Hogeschool,University of Tilburg,Tilburg,The Netherlands.
authors.forename: V
authors.initials: V
authors.lastname: Spek
authors.affiliation: Department of Behavioural Sciences and Learning,Linkoping University,Linkoping,Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Vernmark
authors.affiliation: Department of Clinical psychology,Vu University Amsterdam,Amsterdam,The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Cuijpers
mesh_terms: D001007:Anxiety / Q000628:therapy*; D003863:Depression / Q000628:therapy*; D006801:Humans; D020407:Internet; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D011379:Prognosis; D011613:Psychotherapy / Q000379:methods; D016032:Randomized Controlled Trials as Topic
keywords: Adherence; depression; eHealth; self-help; treatment; treatment dropout; web-based interventions