An individual participant data meta-analysis of predictors of adherence to internet-based interventions for depression

Tong L, Panagiotopoulou OM, Miguel C, Harrer M, Amarnath A, Ciharova M, Gemmill AW, Salamanca-Sanabria A, Williams A, Fonseca A, Zarski AC, Geraedts A, van Straten A, Raevuori A, Arntz A, Ghosh A, Meyer B, Allenhof C, Lukas CA, Knaevelsrud C, Williams C, Lu C, Bockting C, Ebert DD, Richards D, Feil EG, Addington EL, Forsell E, Cao F, Vázquez FL, Boele FW, Kay-Lambkin F, Holländare F, Andersson G, Baumeister H, Hadjistavropoulos HD, Riper H, Choi I, Klein JP, Milgrom J, Lambert J, Dahne J, Stewart JC, Smith J, Montero-Marin J, Newby J, Abi Ramia J, Reins JA, Lundgren J, Moskowitz JT, Jackson KL, Lillevoll K, Vernmark K, Sander LB, Braun L, Warmerdam L, Littlewood L, Heinrich M, Gili M, Deady M, Kraepelien M, Berking M, Schaub MP, Buhrman M, Forand NR, Titov N, Pugh N, Lindefors N, Gupta N, Zagorscak P, Carlbring P, Johansson P, El Chammay R, Arjadi R, van der Zanden R, Araya R, Krämer R, Johansson R, Kenter RMF, Boeschoten R, Gupta SK, Schlicker S, Perini S, Gilbody S, Köhler S, Nobis S, Berger T, Hegerl U, Blanco V, Kaldo V, Pop V, Spek V, Pots W, Sun Y, Forsell Y, Cuijpers P, Karyotaki E (2026)

Publication Type: Journal article

Publication year: 2026

DOI: 10.1038/s44220-026-00707-4

Abstract

Internet-based psychological interventions can effectively reduce depressive symptoms in adults, but adherence remains challenging. In this preregistered individual participant data meta-analysis, we examined predictors of treatment adherence. We searched PubMed, Embase and PsycINFO on 6 February 2024 for randomized trials of internet-based interventions among adults with elevated depressive symptoms. We conducted a one-stage logit-link multilevel beta regression, with adherence defined as the proportion of completed modules post-intervention. This study included 71 trials (85 treatment arms, 8,082 participants). Lower adherence was associated with younger age (β = 0.005, standard error (SE) 0.002, P = 0.028), male gender (β = −0.163, SE 0.053, P = 0.002), lower education (β = −0.133, SE 0.05, P = 0.008) and employment (β = −0.113, SE 0.054, P = 0.037). No significant interactions were found between individual predictors and intervention format (guided versus self-guided). Higher adherence was associated with lower post-intervention depression severity, adjusting for baseline severity (β = −0.30, SE 0.04, P < 0.001). Identifying subgroups at risk of low adherence may inform targeted strategies to improve engagement and clinical effectiveness.

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Involved external institutions

Hospital Universitari Son Espases / Hospital Universitario Son Espases Spain (ES) University of New South Wales (UNSW) Australia (AU) Karolinska Institute Sweden (SE) University of Zurich / Universität Zürich (UZH) Switzerland (CH) Uppsala University Sweden (SE) Hofstra University United States (USA) (US) Macquarie University Australia (AU) Austin Health Australia (AU) A*STAR Institute for Human Development and Potential Singapore (SG) College of Health and Care Professionals of British Columbia Canada (CA) Universidade do Porto Portugal (PT) Philipps-Universität Marburg Germany (DE) Arbo Unie Netherlands (NL) Vrije Universiteit Amsterdam (VU) / University Amsterdam Netherlands (NL) Helsinki University Central Hospital (HUCH) / Helsingin seudun yliopistollinen keskussairaala (HYKS) Finland (FI) Indian Institute of Technology Kanpur (IITK) India (IN) Freie Universität Berlin Germany (DE) Stockholm University / Stockholms universitet Sweden (SE) Linköpings universitet / Linköping University Sweden (SE) The Ministry of Public Health Lebanon (LB) Universitas Katolik Indonesia Atma Jaya Indonesia (ID) Erasmus University Rotterdam (EUR) / Erasmus Universiteit Rotterdam Netherlands (NL) Albert-Ludwigs-Universität Freiburg Germany (DE) Universitätsklinikum Ulm Germany (DE) National Health Care Institute Netherlands (NL) University of York United Kingdom (GB) University of Amsterdam Netherlands (NL) University of California San Francisco (UCSF) United States (USA) (US) Gaia AG Germany (DE) University of Leeds United Kingdom (GB) University of Indianapolis United States (USA) (US) Imperial College London / The Imperial College of Science, Technology and Medicine United Kingdom (GB) Parc Sanitari Sant Joan de Déu Spain (ES) Technische Hochschule Lübeck (THL) / Technical University of Applied Sciences Lübeck Germany (DE) Northwestern University United States (USA) (US) Universitetet i Tromsø / The Arctic University of Norway (UiT) Norway (NO) Indiana University – Purdue University Indianapolis United States (USA) (US) Charité - Universitätsmedizin Berlin Germany (DE) Klinikum Osnabrück Germany (DE) Universität Bern Switzerland (CH) Goethe-Universität Frankfurt am Main Germany (DE) University of Santiago de Compostela / Universidad de Santiago de Compostela (USC) Spain (ES) Tilburg University Netherlands (NL) Fontys University of Applied Sciences Netherlands (NL) Stiftung Deutsche Depressionshilfe Germany (DE) mentalis GmbH Germany (DE) University of Glasgow United Kingdom (GB) Sun Yat-Sen University China (CN) Technische Universität München (TUM) Germany (DE) RED Digital Health Consulting Ireland (IE) Oregon Research Institute United States (USA) (US) Cheeloo College of Medicine (CCOM) China (CN) Universität Ulm Germany (DE) University of Regina Canada (CA) University of Sydney (USYD) Australia (AU) Universität zu Lübeck Germany (DE) University of Bath United Kingdom (GB) Haukeland University Hospital / Haukeland universitetssykehus Norway (NO) Arjuna Labs United States (USA) (US) Peking University Sixth Hospital China (CN)

How to cite

APA:

Tong, L., Panagiotopoulou, O.M., Miguel, C., Harrer, M., Amarnath, A., Ciharova, M.,... Karyotaki, E. (2026). An individual participant data meta-analysis of predictors of adherence to internet-based interventions for depression. . https://doi.org/10.1038/s44220-026-00707-4

MLA:

Tong, Lingyao, et al. "An individual participant data meta-analysis of predictors of adherence to internet-based interventions for depression." (2026).

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