Spek Viola, Nyklícek Ivan, Smits Niels, Cuijpers Pim, Riper Heleen, Keyzer Jules, Pop Victor
Department of Psychology and Health, Tilburg University, The Netherlands.
Psychol Med. 2007 Dec;37(12):1797-806. doi: 10.1017/S0033291707000542. Epub 2007 Apr 30.
Subthreshold depression is a highly prevalent condition and a risk factor for developing a major depressive episode. Internet-based cognitive behaviour therapy may be a promising approach for the treatment of subthreshold depression. The current study had two aims: (1) to determine whether an internet-based cognitive behaviour therapy intervention and a group cognitive behaviour therapy intervention are more effective than a waiting-list control group; and (2) to determine whether the effect of the internet-based cognitive behaviour therapy differs from the group cognitive behaviour therapy intervention.
A total of 191 women and 110 men with subthreshold depression were randomized into internet-based treatment, group cognitive behaviour therapy (Lewinsohn's Coping With Depression course), or a waiting-list control condition. The main outcome measure was treatment response after 10 weeks, defined as the difference in pre- and post-treatment scores on the Beck Depression Inventory (BDI). Missing data, a major limitation of this study, were imputed using the Multiple Imputation (MI) procedure Data Augmentation.
In the waiting-list control group, we found a pre- to post-improvement effect size of 0.45, which was 0.65 in the group cognitive behaviour therapy condition and 1.00 within the internet-based treatment condition. Helmert contrasts showed a significant difference between the waiting-list condition and the two treatment conditions (p=0.04) and no significant difference between both treatment conditions (p=0.62).
An internet-based intervention may be at least as effective as a commonly used group cognitive behaviour therapy intervention for subthreshold depression in people over 50 years of age.
阈下抑郁是一种高度普遍的状况，也是发生重度抑郁发作的一个风险因素。基于互联网的认知行为疗法可能是治疗阈下抑郁的一种有前景的方法。本研究有两个目的：（1）确定基于互联网的认知行为疗法干预和团体认知行为疗法干预是否比等待名单对照组更有效；（2）确定基于互联网的认知行为疗法的效果是否与团体认知行为疗法干预不同。
总共191名患有阈下抑郁的女性和110名男性被随机分配到基于互联网的治疗组、团体认知行为疗法组（Lewinsohn的《应对抑郁课程》）或等待名单对照条件组。主要结局指标是10周后的治疗反应，定义为贝克抑郁量表（BDI）治疗前后得分的差异。缺失数据是本研究的一个主要局限，采用多重填补（MI）程序数据扩充法进行填补。
在等待名单对照组中，我们发现治疗前到治疗后的效应量为0.45，在团体认知行为疗法组为0.65，在基于互联网的治疗组为1.00。赫尔默特对比显示等待名单组与两个治疗组之间存在显著差异（p = 0.04），而两个治疗组之间无显著差异（p = 0.62）。
对于50岁以上人群的阈下抑郁，基于互联网的干预可能至少与常用的团体认知行为疗法干预一样有效。
