互联网治疗抑郁症：比较临床医生与技术人员辅助的随机对照试验。

Internet treatment for depression: a randomized controlled trial comparing clinician vs. technician assistance.

机构信息

Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Sydney, New South Wales, Australia.

出版信息

PLoS One. 2010 Jun 8;5(6):e10939. doi: 10.1371/journal.pone.0010939.

DOI:10.1371/journal.pone.0010939

PMID:20544030

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2882336/

Abstract

BACKGROUND

Internet-based cognitive behavioural therapy (iCBT) for depression is effective when guided by a clinician, less so if unguided.

QUESTION

Would guidance from a technician be as effective as guidance from a clinician?

METHOD

Randomized controlled non-inferiority trial comparing three groups: Clinician-assisted vs. technician-assisted vs. delayed treatment. Community-based volunteers applied to the VirtualClinic (www.virtualclinic.org.au) research program, and 141 participants with major depressive disorder were randomized. Participants in the clinician- and technician-assisted groups received access to an iCBT program for depression comprising 6 online lessons, weekly homework assignments, and weekly supportive contact over a treatment period of 8 weeks. Participants in the clinician-assisted group also received access to a moderated online discussion forum. The main outcome measures were the Beck Depression Inventory (BDI-II) and the Patient Health QUESTIONnaire-9 Item (PHQ-9). Completion rates were high, and at post-treatment, both treatment groups reduced scores on the BDI-II (p<0.001) and PHQ-9 (p<0.001) compared to the delayed treatment group but did not differ from each other. Within group effect sizes on the BDI-II were 1.27 and 1.20 for the clinician- and technician-assisted groups respectively, and on the PHQ-9, were 1.54 and 1.60 respectively. At 4-month follow-up participants in the technician group had made further improvements and had significantly lower scores on the PHQ-9 than those in the clinician group. A total of approximately 60 minutes of clinician or technician time was required per participant during the 8-week treatment program.

CONCLUSIONS

Both clinician- and technician-assisted treatment resulted in large effect sizes and clinically significant improvements comparable to those associated with face-to-face treatment, while a delayed treatment control group did not improve. These results provide support for large scale trials to determine the clinical effectiveness and acceptability of technician-assisted iCBT programs for depression. This form of treatment has potential to increase the capacity of existing mental health services.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12609000559213.

摘要

背景

基于互联网的认知行为疗法（iCBT）在有临床医生指导时有效，如果没有指导则效果较差。

问题

技术人员的指导是否与临床医生的指导一样有效？

方法

比较三组的随机对照非劣效性试验：临床医生辅助组、技术人员辅助组和延迟治疗组。社区志愿者申请参加 VirtualClinic（www.virtualclinic.org.au）研究计划，141 名患有重度抑郁症的参与者被随机分组。在临床医生和技术人员辅助组中，参与者可以使用包含 6 个在线课程、每周家庭作业和 8 周治疗期间每周支持性联系的抑郁 iCBT 计划。临床医生辅助组的参与者还可以访问一个经过Moderated（审核）的在线讨论论坛。主要结局指标是贝克抑郁量表（BDI-II）和患者健康问卷-9 项（PHQ-9）。完成率很高，在治疗后，两组的 BDI-II（p<0.001）和 PHQ-9（p<0.001）评分均低于延迟治疗组，但彼此之间没有差异。在 BDI-II 上的组内效应大小分别为临床医生辅助组的 1.27 和技术人员辅助组的 1.20，在 PHQ-9 上，分别为 1.54 和 1.60。在 4 个月的随访中，技术人员组的参与者进一步改善，PHQ-9 得分显著低于临床医生组。在 8 周的治疗计划中，每个参与者大约需要 60 分钟的临床医生或技术人员时间。