van der Zanden Rianne, Kramer Jeannet, Gerrits Rob, Cuijpers Pim
Centre of Mental Health of Youth and Adolescents, Trimbos Institute, Utrecht, Netherlands.
J Med Internet Res. 2012 Jun 7;14(3):e86. doi: 10.2196/jmir.2033.
Depression is a serious mental health problem, whose first onset is usually in adolescence. Online treatment may offer a solution for the current undertreatment of depression in youth. For adults with depressive symptoms, the effectiveness of Internet-based cognitive behavioral therapy has been demonstrated. This study is one of the first randomized controlled trials to investigate the effectiveness online depression treatment for young people with depressive complaints and the first to focus on an online group course.
To evaluate and discuss the effectiveness of a guided Web-based group course called Grip op Je Dip (Master Your Mood [MYM]), designed for young people aged 16 to 25 years with depressive symptoms, in comparison with a wait-listed control group.
We randomly assigned 244 young people with depressive symptoms to the online MYM course or to a waiting-list control condition. The primary outcome measure was treatment outcome after 3 months on the Center for Epidemiologic Studies Depression Scale. Secondary outcomes were anxiety (measured by the Hospital Anxiety and Depression Scale) and mastery (Mastery Scale). We studied the maintenance of effects in the MYM group 6 months after baseline. Missing data were imputed.
The MYM group (n = 121) showed significantly greater improvement in depressive symptoms at 3 months than the control group (n = 123) (t(187 )= 6.62, P < .001), with a large between-group effect size of d = 0.94 (95% confidence interval [CI] 0.64-1.23). The MYM group also showed greater improvement in anxiety (t(187 )= 3.80, P < .001, d = 0.49, 95% CI 0.24-0.75) and mastery (t(187 )= 3.36, P = .001, d = 0.44, 95% CI 0.19-0.70). At 12 weeks, 56% (68/121) of the participants in the MYM group and 20% (24/123) in the control group showed reliable and clinically significant change. This between-group difference was significant (χ(2) (1 )= 35.0, P < .001) and yielded a number needed to treat of 2.7. Improvements in the MYM group were maintained at 6 months. A limitation is the infeasibility of comparing the 6-month outcomes of the MYM and control groups, as the controls had access to MYM after 3 months.
The online group course MYM was effective in reducing depressive symptoms and anxiety and in increasing mastery in young people. These effects persisted in the MYM group at 6 months.
抑郁症是一个严重的心理健康问题，其首次发病通常在青春期。在线治疗可能为当前青少年抑郁症治疗不足的问题提供解决方案。对于有抑郁症状的成年人，基于互联网的认知行为疗法的有效性已得到证实。本研究是首批调查针对有抑郁症状的年轻人进行在线抑郁症治疗有效性的随机对照试验之一，也是首个聚焦于在线团体课程的研究。
评估并讨论一种名为“掌控你的情绪（MYM）”的基于网络的引导式团体课程对16至25岁有抑郁症状的年轻人的有效性，并与等待名单对照组进行比较。
我们将244名有抑郁症状的年轻人随机分配到在线MYM课程组或等待名单对照组。主要结局指标是3个月后使用流行病学研究中心抑郁量表的治疗结果。次要结局指标是焦虑（用医院焦虑抑郁量表测量）和掌控感（掌控感量表）。我们研究了MYM组在基线后6个月的效果维持情况。对缺失数据进行了插补。
MYM组（n = 121）在3个月时抑郁症状的改善程度显著大于对照组（n = 123）（t(187 )= 6.62，P <.001），组间效应量d = 0.94较大（95%置信区间[CI] 0.64 - 1.23）。MYM组在焦虑（t(187 )= 3.80，P <.001，d = 0.49，95% CI 0.24 - 0.75）和掌控感（t(187 )= 3.36，P =.001，d = 0.44，95% CI 0.19 - 0.70）方面也有更大改善。在12周时，MYM组56%（68/121）的参与者和对照组20%（24/123）的参与者显示出可靠且具有临床意义的变化。这种组间差异具有显著性（χ(2) (1 )= 35.0，P <.001），需治疗人数为2.7。MYM组的改善在6个月时得以维持。一个局限性是无法比较MYM组和对照组6个月的结局，因为对照组在3个月后可以使用MYM。
在线团体课程MYM在减轻年轻人的抑郁症状和焦虑以及增强掌控感方面是有效的。这些效果在MYM组6个月时持续存在。
