Leykin Yan, Muñoz Ricardo F, Contreras Omar, Latham Melissa D
University of California, San Francisco.
University of California, San Francisco ; Palo Alto University.
Internet Interv. 2014 Oct 1;1(4):175-181. doi: 10.1016/j.invent.2014.09.002.
Internet interventions provide an option for those who either cannot or choose not to engage with traditional treatments. Most research on internet interventions involves guided or supported interventions. However, unsupported interventions offer considerably more scalability and cost-effectiveness, which makes them attractive for large-scale implementation. In this study, 309 participants recruited via Google AdWords entered an unsupported cognitive-behavioral internet intervention for depressive symptoms. To maximize the ecological validity of the study, participants received no incentives or live contact with study personnel. Furthermore, the study was open to individuals at any level of depressive symptoms, and all participants received the active intervention. The main outcome measures were depressive symptom level and self-efficacy in managing depressive symptoms. At follow-up, depression scores were significantly lower than baseline scores at each follow-up point (1, 2, 4, and 7 months), with pre-post effect sizes ranging from medium to large. Follow-up depression self-efficacy scores were significantly higher than baseline scores at each follow-up point, with pre-post effect sizes in the medium range. The results remained significant when analyzing only participants with depression scores indicative of a presence of a major depressive episode; results likewise remained significant when employing the conservative last observation carried forward convention, even in the presence of high attrition observed in this study. The results illustrate the potential of unsupported internet intervention to address the health needs of the global community.
互联网干预为那些无法或选择不接受传统治疗的人提供了一种选择。大多数关于互联网干预的研究都涉及有指导或有支持的干预措施。然而，无支持的干预措施具有更高的可扩展性和成本效益，这使得它们对于大规模实施具有吸引力。在本研究中，通过谷歌广告关键词招募的309名参与者进入了一项针对抑郁症状的无支持认知行为互联网干预项目。为了使研究的生态效度最大化，参与者没有获得任何激励，也没有与研究人员进行现场接触。此外，该研究对任何抑郁症状水平的个体开放，所有参与者都接受了积极干预。主要结局指标是抑郁症状水平和管理抑郁症状的自我效能感。在随访时，各随访点（1、2、4和7个月）的抑郁评分均显著低于基线评分，前后效应量从中等到大。随访时的抑郁自我效能感评分在各随访点均显著高于基线评分，前后效应量处于中等范围。仅分析抑郁评分表明存在重度抑郁发作的参与者时，结果仍然显著；即使在本研究中观察到高失访率的情况下，采用保守的末次观察结转法时结果同样显著。这些结果说明了无支持互联网干预在满足全球社区健康需求方面的潜力。
