Imamura K, Kawakami N, Furukawa T A, Matsuyama Y, Shimazu A, Umanodan R, Kawakami S, Kasai K
Department of Mental Health,Graduate School of Medicine, The University of Tokyo,Tokyo,Japan.
Departments of Health Promotion and Human Behavior and of Clinical Epidemiology,Graduate School of Medicine/School of Public Health, Kyoto University,Kyoto,Japan.
Psychol Med. 2015 Jul;45(9):1907-17. doi: 10.1017/S0033291714003006. Epub 2015 Jan 7.
In this study we investigated whether an Internet-based computerized cognitive behavioral therapy (iCBT) program can decrease the risk of DSM-IV-TR major depressive episodes (MDE) during a 12-month follow-up of a randomized controlled trial of Japanese workers.
Participants were recruited from one company and three departments of another company. Those participants who did not experience MDE in the past month were randomly allocated to intervention or control groups (n = 381 for each). A 6-week, six-lesson iCBT program was provided to the intervention group. While the control group only received the usual preventive mental health service for the first 6 months, the control group was given a chance to undertake the iCBT program after a 6-month follow-up. The primary outcome was a new onset of DSM-IV-TR MDE during the 12-month follow-up, as assessed by means of the web version of the WHO Composite International Diagnostic Interview (CIDI), version 3.0 depression section.
The intervention group had a significantly lower incidence of MDE at the 12-month follow-up than the control group (Log-rank χ2 = 7.04, p < 0.01). The hazard ratio for the intervention group was 0.22 (95% confidence interval 0.06-0.75), when estimated by the Cox proportional hazard model.
The present study demonstrates that an iCBT program is effective in preventing MDE in the working population. However, it should be noted that MDE was measured by self-report, while the CIDI can measure the episodes more strictly following DSM-IV criteria.
在本研究中，我们调查了基于互联网的计算机化认知行为疗法（iCBT）项目在对日本员工进行的一项随机对照试验的12个月随访期间，是否能够降低DSM-IV-TR重度抑郁发作（MDE）的风险。
参与者从一家公司以及另一家公司的三个部门招募。过去一个月未经历过MDE的参与者被随机分配到干预组或对照组（每组n = 381）。为干预组提供了一个为期6周、共六节课的iCBT项目。对照组在前6个月仅接受常规的预防性心理健康服务，6个月随访后对照组有机会参加iCBT项目。主要结局是在12个月随访期间新发生的DSM-IV-TR MDE，通过WHO综合国际诊断访谈（CIDI）网络版3.0抑郁部分进行评估。
在12个月随访时，干预组MDE的发生率显著低于对照组（对数秩检验χ2 = 7.04，p < 0.01）。通过Cox比例风险模型估计，干预组的风险比为0.22（95%置信区间0.06 - 0.75）。
本研究表明，iCBT项目在预防在职人群的MDE方面是有效的。然而，应当注意的是，MDE是通过自我报告进行测量的，而CIDI能够更严格地按照DSM-IV标准测量发作情况。
