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

Journal

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.

Authors with CRIS profile

Involved external institutions

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

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. Nature Mental Health. 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." Nature Mental Health (2026).

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