Department of Psychology, University of New Brunswick, PO Box 4400, Fredericton, NB, E3B 5A3, Canada.
Centre for Research in Family Health, IWK Health Centre, Halifax, NS.
J Anxiety Disord. 2016 Dec;44:9-26. doi: 10.1016/j.janxdis.2016.09.010. Epub 2016 Sep 22.
This systematic review and meta-analysis evaluated the efficacy of distance-delivered, guided approaches to treatment (e.g., delivered via telephone, Internet, mail, videoconferencing) for clinical and subclinical posttraumatic stress disorder (PTSD). A comprehensive search yielded 19 randomized controlled trials (1491 participants) to be included. Meta-analyses revealed that distance-delivered interventions led to significant within-group improvements in PTSD symptoms at post-treatment (g=0.81, 95% CI 0.65 to 0.97) and 3-6 month follow-up (g=0.78, 95% CI 0.59 to 0.97). Within-group depression and quality of life outcomes showed similar results, with medium post-treatment and follow-up effects. Compared to a waiting list, distance delivery (specifically, Internet treatments) led to superior PTSD outcomes (g=0.68, 95% CI 0.51 to 0.86). Compared to face-to-face interventions, distance delivery (specifically, videoconferencing treatments) did not result in significantly different PTSD outcomes at post-treatment (g=-0.05, 95% CI -0.31 to 0.20) but led to inferior outcomes at 3-6 month follow-up (g=-0.25, 95% CI -0.44 to -0.07). Distance delivery of PTSD treatment is promising, but research is needed to determine its optimal use.
本系统评价和荟萃分析评估了远程指导治疗方法（例如通过电话、互联网、邮件、视频会议提供）治疗临床和亚临床创伤后应激障碍（PTSD）的疗效。全面检索产生了 19 项随机对照试验（1491 名参与者）纳入分析。荟萃分析显示，远程干预在治疗后（g=0.81，95%CI 0.65 至 0.97）和 3 至 6 个月随访时（g=0.78，95%CI 0.59 至 0.97）显著改善了 PTSD 症状。抑郁和生活质量的组内结果也表现出相似的结果，具有中等治疗后和随访效果。与等待名单相比，远程提供（特别是互联网治疗）导致 PTSD 结果更好（g=0.68，95%CI 0.51 至 0.86）。与面对面干预相比，远程提供（特别是视频会议治疗）在治疗后并未导致 PTSD 结果显著不同（g=-0.05，95%CI -0.31 至 0.20），但在 3 至 6 个月随访时结果更差（g=-0.25，95%CI -0.44 至 -0.07）。远程 PTSD 治疗具有广阔前景，但需要进一步研究确定其最佳应用。
