Farrer Louise, Gulliver Amelia, Chan Jade K Y, Batterham Philip J, Reynolds Julia, Calear Alison, Tait Robert, Bennett Kylie, Griffiths Kathleen M
Centre for Mental Health Research, The Australian National University, Canberra ACT, Australia.
J Med Internet Res. 2013 May 27;15(5):e101. doi: 10.2196/jmir.2639.
Mental disorders are responsible for a high level of disability burden in students attending university. However, many universities have limited resources available to support student mental health. Technology-based interventions may be highly relevant to university populations. Previous reviews have targeted substance use and eating disorders in tertiary students. However, the effectiveness of technology-based interventions for other mental disorders and related issues has not been reviewed.
To systematically review published randomized trials of technology-based interventions evaluated in a university setting for disorders other than substance use and eating disorders.
The PubMed, PsycInfo, and Cochrane Central Register of Controlled Trials databases were searched using keywords, phrases, and MeSH terms. Retrieved abstracts (n=1618) were double screened and coded. Included studies met the following criteria: (1) the study was a randomized trial or a randomized controlled trial, (2) the sample was composed of students attending a tertiary institution, (3) the intervention was delivered by or accessed using a technological device or process, (4) the age range of the sample was between 18 and 25 years, and (5) the intervention was designed to improve, reduce, or change symptoms relating to a mental disorder.
A total of 27 studies met inclusion criteria for the present review. Most of the studies (24/27, 89%) employed interventions targeting anxiety symptoms or disorders or stress, although almost one-third (7/24, 29%) targeted both depression and anxiety. There were a total of 51 technology-based interventions employed across the 27 studies. Overall, approximately half (24/51, 47%) were associated with at least 1 significant positive outcome compared with the control at postintervention. However, 29% (15/51) failed to find a significant effect. Effect sizes were calculated for the 18 of 51 interventions that provided sufficient data. Median effect size was 0.54 (range -0.07 to 3.04) for 8 interventions targeting depression and anxiety symptoms and 0.84 (range -0.07 to 2.66) for 10 interventions targeting anxiety symptoms and disorders. Internet-based technology (typically involving cognitive behavioral therapy) was the most commonly employed medium, being employed in 16 of 27 studies and approximately half of the 51 technology-based interventions (25/51, 49%). Distal and universal preventive interventions were the most common type of intervention. Some methodological problems were evident in the studies, with randomization methods either inadequate or inadequately described, few studies specifying a primary outcome, and most of the studies failing to undertake or report appropriate intent-to-treat analyses.
The findings of this review indicate that although technological interventions targeting certain mental health and related problems offer promise for students in university settings, more high quality trials that fully report randomization methods, outcome data, and data analysis methods are needed.
精神障碍在大学生群体中造成了很高的残疾负担。然而，许多大学用于支持学生心理健康的资源有限。基于技术的干预措施可能与大学生群体高度相关。以往的综述主要针对大学生的物质使用和饮食失调问题。然而，基于技术的干预措施对其他精神障碍及相关问题的有效性尚未得到综述。
系统综述在大学环境中针对物质使用和饮食失调以外的精神障碍所开展的已发表的基于技术的干预措施的随机试验。
使用关键词、短语和医学主题词检索PubMed、PsycInfo和Cochrane对照试验中心注册库数据库。对检索到的1618篇摘要进行了双重筛选和编码。纳入的研究符合以下标准：（1）该研究为随机试验或随机对照试验；（2）样本由高等院校的学生组成；（3）干预措施通过技术设备或流程实施或获取；（4）样本年龄范围在18至25岁之间；（5）干预措施旨在改善、减轻或改变与精神障碍相关的症状。
共有27项研究符合本综述的纳入标准。大多数研究（24/27，89%）采用针对焦虑症状或障碍或压力的干预措施，尽管近三分之一（7/24，29%）的研究同时针对抑郁和焦虑。27项研究共采用了51种基于技术的干预措施。总体而言，与干预后对照组相比，约一半（24/51，47%）的干预措施至少有1项显著的积极结果。然而，29%（15/51）的干预措施未发现显著效果。对51项干预措施中的18项提供了充分数据的干预措施计算了效应量。针对抑郁和焦虑症状的8项干预措施的效应量中位数为0.54（范围为-0.07至3.04），针对焦虑症状和障碍的10项干预措施的效应量中位数为0.84（范围为-0.07至2.66）。基于互联网的技术（通常涉及认知行为疗法）是最常用的媒介，在27项研究中的16项以及51种基于技术的干预措施中的约一半（25/51，49%）中被采用。远程和普遍预防性干预是最常见的干预类型。研究中存在一些方法学问题，随机化方法要么不充分，要么描述不充分，很少有研究指定主要结局，并且大多数研究未进行或报告适当的意向性分析。
本综述的结果表明，尽管针对某些心理健康及相关问题的技术干预措施对大学环境中的学生有前景，但需要更多高质量的试验，全面报告随机化方法、结局数据和数据分析方法。
