Digital interventions for generalised anxiety disorder (GAD): systematic review and network meta-analysis (Preprint)

UNSTRUCTURED Generalised anxiety disorder (GAD) is the most common mental health condition based on weekly prevalence. Digital interventions (DIs) have been used as alternatives or as add-ons to conventional therapies to improve access, patient choice and clinical outcomes. Little is known about their comparative effectiveness for GAD. To address this, we conducted a systematic review and network meta-analysis (NMA) of randomised controlled trials (RCTs) comparing DIs with medication, non-digital interventions, non-therapeutic controls and no intervention. We included 21 RCTs with a total of 2,350 participants from GAD populations. Pooled outcomes using analysis of Covariance and rankograms based on the surface under the cumulative ranking curves (SUCRA) indicated that antidepressant medication and group therapy had a higher probability than DIs of being the ‘best’ intervention. Supported DIs were not necessarily “better” than unsupported (pure self-help) ones. Due to very wide confidence intervals, NMA results were inconclusive as to whether DIs are better than no intervention and non-therapeutic active controls, or whether they confer an additional benefit to standard therapy. Future research needs to compare DIs with one-to-one therapy and with manualised non-digital self-help and to include antidepressant medication as a treatment comparator and effect modifier.