互联网干预抑郁症的依从性与结果的关系。

The association between adherence and outcome in an Internet intervention for depression.

机构信息

Department of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Tübingen, Germany.

Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.

出版信息

J Affect Disord. 2018 Mar 15;229:443-449. doi: 10.1016/j.jad.2017.12.028. Epub 2017 Dec 27.

DOI:10.1016/j.jad.2017.12.028

PMID:29331706

Abstract

BACKGROUND

Adherence to Internet interventions is often reported to be rather low and this might adversely impact the effectiveness of these interventions. We investigated if patient characteristics are associated with adherence, and if adherence is associated with treatment outcome in a large RCT of an Internet intervention for depression, the EVIDENT trial.

METHODS

Patients were randomized to either care as usual (CAU) or CAU plus the Internet intervention Deprexis. A total of 509 participants with mild to moderate depressive symptoms were included in the intervention group and of interest for the present study. We assessed depression symptoms pre and post intervention (12 weeks). Patient characteristics, a self-rating screening for mental disorders, attitudes towards online interventions, and quality of life were assessed before randomization.

RESULTS

Adherence in this study was good with on average seven hours of usage time and eight number of sessions spent with the intervention. Some of the patient characteristics (age, sex, depressive symptoms, and confidence in the effectiveness of the program) predicted higher number of sessions in different models (explaining in total between 15 and 25% of variance). Older age (β = .16) and higher depressive symptoms (β = .15) were associated with higher usage duration. Higher adherence to the program predicted a greater symptom reduction in depressive symptoms over 12 weeks (number of sessions: β = .13, usage duration: β = .14), however, this prediction could mostly be explained by receiving guidance (β = .27 and .26).

LIMITATIONS

Receiving guidance and symptom severity at baseline were confounded since only participants with a moderate symptom severity at baseline received e-mail support. Therefore no firm conclusions can be drawn from the association we observed between baseline symptom severity and usage intensity.

CONCLUSIONS

We conclude that older age was associated with adherence and adherence was positively associated with outcome. The effects we have found were small however suggesting that adherence might also be influenced by further variables.

摘要

背景

互联网干预的依从性通常报告较低，这可能会对这些干预的效果产生不利影响。我们调查了患者特征是否与依从性相关，以及依从性是否与抑郁症的大型互联网干预试验 EVIDENT 中的治疗结果相关。

方法

患者被随机分配到常规护理（CAU）或 CAU 加互联网干预 Deprexis。共有 509 名轻度至中度抑郁症状的患者被纳入干预组，是本研究的兴趣所在。我们在干预前（12 周）和干预后评估抑郁症状。在随机分组前评估患者特征、精神障碍自评筛查、对在线干预的态度和生活质量。

结果

本研究的依从性良好，平均使用时间为 7 小时，干预次数为 8 次。一些患者特征（年龄、性别、抑郁症状和对计划有效性的信心）在不同模型中预测了更多的干预次数（共解释了 15%至 25%的方差）。年龄较大（β=0.16）和抑郁症状较高（β=0.15）与较高的使用时间相关。对方案的较高依从性预测在 12 周内抑郁症状有更大的减轻（干预次数：β=0.13，使用时间：β=0.14），然而，这一预测主要可以用接受指导来解释（β=0.27 和 0.26）。