Forsell Erik, Bendix Marie, Holländare Fredrik, Szymanska von Schultz Barbara, Nasiell Josefine, Blomdahl-Wetterholm Margareta, Eriksson Caroline, Kvarned Sara, Lindau van der Linden Johanna, Söderberg Elin, Jokinen Jussi, Wide Katarina, Kaldo Viktor
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
Department of Clinical Sciences, Psychiatry, Umeå University, Sweden.
J Affect Disord. 2017 Oct 15;221:56-64. doi: 10.1016/j.jad.2017.06.013. Epub 2017 Jun 13.
Major depression occurs in 5-10% of pregnancies and is associated with many negative effects for mother and child, yet treatment options are scarce. To our knowledge, this is the first published randomised controlled trial on Internet delivered Cognitive Behavior Therapy (ICBT) for this group.
To test the efficacy of a pregnancy adapted version of an existing 10-week ICBT-program for depression as well as assessing acceptability and adherence DESIGN: Randomised controlled trial.
Online and telephone.
Self-referred pregnant women (gestational week 10-28 at intake) currently suffering from major depressive disorder.
42 pregnant women (gestational week 12-28) with major depression were randomised to either treatment as usual (TAU) provided at their antenatal clinic or to ICBT as an add-on to usual care.
The primary outcome was depressive symptoms measured with the Montgomery-Åsberg depression rating scale-self report (MADRS-S). The Edinburgh Postnatal Depression Scale and measures of anxiety and sleep were used. Credibility, satisfaction, adherence and utilization were also assessed.
The ICBT group had significantly lower levels of depressive symptoms post treatment (p < 0.001, Hedges g =1.21) and were more likely to be responders (i.e. achieve a statistically reliable improvement) (RR = 0.36; p = 0.004). Measures of treatment credibility, satisfaction, utilization, and adherence were comparable to implemented ICBT for depression.
Small sample size and no long-term evaluation.
Pregnancy adapted ICBT for antenatal depression is feasible, acceptable and efficacious. These results need to be replicated in larger trials to validate these promising findings.
重度抑郁症在5%-10%的孕期女性中出现，并且与母婴的许多负面影响相关，但治疗选择却很匮乏。据我们所知，这是首次发表的针对该群体的基于互联网的认知行为疗法（ICBT）的随机对照试验。
测试针对抑郁症的现有10周ICBT项目的孕期适配版本的疗效，并评估其可接受性和依从性。
随机对照试验。
在线和电话。
自我推荐的目前患有重度抑郁症的孕妇（入组时孕周为10-28周）。
42名患有重度抑郁症的孕妇（孕周为12-28周）被随机分为两组，一组接受产前诊所提供的常规治疗（TAU），另一组接受作为常规护理附加治疗的ICBT。
主要结局是用蒙哥马利-阿斯伯格抑郁评定量表自我报告版（MADRS-S）测量的抑郁症状。还使用了爱丁堡产后抑郁量表以及焦虑和睡眠测量指标。同时评估了可信度、满意度、依从性和利用率。
ICBT组治疗后抑郁症状水平显著更低（p<0.001，Hedges g=1.21），并且更有可能是反应者（即实现统计学上可靠的改善）（RR=0.36；p=0.004）。治疗可信度、满意度、利用率和依从性的测量结果与已实施的抑郁症ICBT相当。
样本量小且未进行长期评估。
针对产前抑郁症的孕期适配ICBT是可行、可接受且有效的。这些结果需要在更大规模的试验中重复验证，以证实这些有前景的发现。
