Internet-delivered cognitive behavioral therapy (iCBT) for common mental disorders and subsequent sickness absence: a systematic review and meta-analysis

Lina Udd-granat, Jouni Lahti, Michael Donnelly, Charlene Treanor, Sami P. Pirkola, Tea Lallukka, Anne Kouvonen*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

4 Citations (Scopus)
47 Downloads (Pure)


Aim: The study aimed to critically review and synthesize the best available evidence about the effectiveness of therapist-guided internet-delivered cognitive behavioral therapy (iCBT) in terms of reducing sickness absence (SA).

Methods: We searched Medline (PubMed), Embase, PsycInfo, CINAHL, and Cochrane Central (up to November 2020) for English language peer-reviewed papers that described randomized controlled trials of therapist-guided iCBT compared with usual treatment for SA in adults with common mental disorders. Eligible studies were assessed with the Cochrane Risk of Bias 1 tool, meta-analysis was conducted using a random-effects model, and standardized mean differences (SMD) with 95% confidence intervals (CI) were reported. A subgroup analysis investigated potential moderating variables (diagnosis, SA at baseline, and estimated accuracy of self-report). 

Results: We identified 2788 references, of which 68 remained after the completion of the systematic screening process. A hand search of reference lists yielded no additional studies. The full texts of these 68 studies were appraised critically, and 11 were deemed to be suitable for a meta-analysis. SA was similar for iCBT and usual treatment groups (SMD: 0.02, 95% CI, –0.08 to 0.11), and remained similar even after the removal of two studies in which the recall time was over 3 months (SMD: 0.00, –0.11 to 0.12). Similar SA levels in intervention and control groups at 6-month and 12-month follow-up were observed in studies of participants with depression symptoms. 

Conclusions: iCBT did not appear to be effective in terms of reducing (largely self-assessed) SA in adults with common mental disorders. There is a need to improve the method and consistency of assessing SA.

Original languageEnglish
JournalScandanavian Journal of Public Health
Early online date04 Feb 2022
Publication statusEarly online date - 04 Feb 2022

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by the Academy of Finland (grant 315343) and the Strategic Research Council at the Academy of Finland (grants 327145 and 327148 for the DigiIn Project). LUG was partially funded by Occupational Health Helsinki. The authors also wish to acknowledge the contributions of additional data and comments by Claudia Buntrock, Martin Kraepelien, Dominique Hange, Elin Lindsäter, of authors sharing full-text versions of manuscripts as mentioned in the PRISMA Checklist, and for comments to the data analysis by Christopher Cardwell. The funders had no role in the planning, performing or reporting on this review.

Publisher Copyright:
© Author(s) 2022.


  • absenteeism
  • cognitive behavioral therapy
  • Mental health
  • sick leave
  • telemedicine

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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