Ebert D D, Nobis S, Lehr D, Baumeister H, Riper H, Auerbach R P, Snoek F, Cuijpers P, Berking M
Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
Division of Online Health Trainings, Innovation Incubator, Leuphana University, Lüneburg, Germany.
Diabet Med. 2017 Jan;34(1):99-107. doi: 10.1111/dme.13173. Epub 2016 Aug 4.
The aim of this research is to examine the 6-month effects of an Internet-based guided self-help intervention for comorbid depressive symptoms in people with diabetes.
Participants (n = 260) with Type 1 or 2 diabetes and elevated depressive symptoms [Center for Epidemiological Studies Depression Scale (CES-D) ≥ 23] were randomly assigned to a guided Internet-based self-help intervention or a control condition (treatment as usual + online psychoeducation about depression). The primary outcome was a change in depressive symptom severity (CES-D) from baseline to 6-month follow-up. The secondary outcomes included numbers of people achieving treatment response (reliable change of depressive symptoms) and remission (CES-D ≤ 16), as well as the effects on glycaemic control, diabetes-related emotional distress and diabetes acceptance. Repeated measures analysis of variance examined between-group differences using intent-to-treat principles.
Both conditions showed improvements in depression severity: intervention condition, d = 1.48 [95% confidence interval (95% CI): 1.21 to 1.76]; control condition d = 0.55 (95% CI: 0.30 to 0.80). Changes were significantly greater in the intervention condition with a large between-group effect size (d = 0.83, 95% CI: 0.57 to 1.08). Accordingly, effects on response [relative risk (RR) = 2.60 (95% CI: 2.01 to 3.36), P < 0.001] and remission [RR = 3.36 (95% CI: 2.98 to 5.44), P < 0.001] were in favour of the intervention group, as were differences in change in diabetes emotional distress (d = 0.50, 95% CI: 0.04 to 0.54), and physical and mental functioning [Short Form Health Survey (SF-12) Physical d = 0.27 (95% CI: 0.01 to 0.51) and SF-12 Mental d = 0.68 (95% CI: 0.11 to 0.40)]. The intervention group was not superior with regard to glycaemic control, diabetes self-management and diabetes acceptance.
The trial indicates that Internet-based guided self-help treatments for depression in people with diabetes can have sustained effects on depressive symptoms, well-being and emotional distress associated with diabetes.
本研究旨在探讨基于互联网的自助干预措施对糖尿病患者共病抑郁症状的6个月影响。
将1型或2型糖尿病且抑郁症状加重[流行病学研究中心抑郁量表（CES-D）≥23]的参与者（n = 260）随机分为基于互联网的自助引导干预组或对照组（常规治疗+关于抑郁症的在线心理教育）。主要结局是从基线到6个月随访期间抑郁症状严重程度（CES-D）的变化。次要结局包括达到治疗反应（抑郁症状可靠改变）和缓解（CES-D≤16）的人数，以及对血糖控制、糖尿病相关情绪困扰和糖尿病接受度的影响。重复测量方差分析采用意向性分析原则检验组间差异。
两组的抑郁严重程度均有所改善：干预组，d = 1.48 [95%置信区间（95%CI）：1.21至1.76]；对照组，d = 0.55（95%CI：0.30至0.80）。干预组的变化显著更大，组间效应量较大（d = 0.83，95%CI：0.57至1.08）。因此，对治疗反应[相对危险度（RR）= 2.60（95%CI：2.01至3.36），P < 0.001]和缓解[RR = 3.36（95%CI：2.98至5.44），P < 0.001]的影响有利于干预组，糖尿病情绪困扰的变化差异（d = 0.50，95%CI：0.04至0.54）以及身体和心理功能[简明健康调查量表（SF-12）身体维度d = 0.27（95%CI：0.01至0.51）和SF-12心理维度d = 0.68（95%CI：0.11至0.40）]也是如此。干预组在血糖控制、糖尿病自我管理和糖尿病接受度方面并不更优。
该试验表明，基于互联网的糖尿病患者抑郁自助引导治疗可对抑郁症状、幸福感以及与糖尿病相关的情绪困扰产生持续影响。
