Lau Ying, Htun Tha Pyai, Wong Suei Nee, Tam Wai San Wilson, Klainin-Yobas Piyanee
Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Medical Resource Team, National University of Singapore Libraries, Singapore, Singapore.
J Med Internet Res. 2017 Apr 28;19(4):e138. doi: 10.2196/jmir.6712.
A growing number of meta-analyses have supported the application of therapist-supported Internet-based cognitive behavior therapy (iCBT) for psychological disorders across different populations, but relatively few meta-analyses have concentrated on postpartum women.
This meta-analysis evaluated the efficacy of therapist-supported iCBT in improving stress, anxiety, and depressive symptoms among postpartum women.
A total of 10 electronic databases were used to search for published and unpublished trials. Cochrane Collaboration tool for assessing risk of bias was utilized to measure methodological quality. Meta-analysis was performed using the RevMan software (Review Manager version 5.3 for Windows from the Nordic Cochrane Centre, the Cochrane Collaboration, 2014). Among the 789 studies identified, 8 randomized controlled trials were selected, involving 1523 participants across 6 countries.
More than half (65%) of the eligible studies had a low risk of bias with no heterogeneity. Results revealed that therapist-supported iCBT significantly improved stress (d=0.84, n=5), anxiety (d=0.36, n=6), and depressive symptoms (d=0.63, n=8) of the intervention group compared with those of the control group at post-intervention.
This review revealed that therapist-supported iCBT significantly improves stress, anxiety, and depressive symptoms among postpartum women with small to large effects. Future effectiveness studies should establish the essential components, format, and approach of iCBT with optimal levels of human support to maximize a long-term effect.
越来越多的荟萃分析支持在不同人群中应用治疗师辅助的基于互联网的认知行为疗法（iCBT）治疗心理障碍，但相对较少的荟萃分析关注产后女性。
本荟萃分析评估治疗师辅助的iCBT对改善产后女性压力、焦虑和抑郁症状的疗效。
共使用10个电子数据库检索已发表和未发表的试验。采用Cochrane协作网偏倚风险评估工具来衡量方法学质量。使用RevMan软件（北欧Cochrane中心的Review Manager 5.3 for Windows，Cochrane协作网，2014年）进行荟萃分析。在识别出的789项研究中，选择了8项随机对照试验，涉及6个国家的1523名参与者。
超过一半（65%）的合格研究偏倚风险低且无异质性。结果显示，与对照组相比，干预组在干预后，治疗师辅助的iCBT显著改善了压力（d=0.84，n=5）、焦虑（d=0.36，n=6）和抑郁症状（d=0.63，n=8）。
本综述表明，治疗师辅助的iCBT能显著改善产后女性的压力、焦虑和抑郁症状，效果从小到大都有。未来的有效性研究应确定iCBT的基本组成部分、形式和方法，并提供最佳水平的人力支持，以最大化长期效果。
