Department of Clinical Psychology, Amsterdam Public Health research institute, VU, Amsterdam, the Netherlands.
Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
Clin Psychol Rev. 2018 Jul;63:80-92. doi: 10.1016/j.cpr.2018.06.007. Epub 2018 Jun 19.
Little is known about clinically relevant changes in guided Internet-based interventions for depression. Moreover, methodological and power limitations preclude the identification of patients' groups that may benefit more from these interventions. This study aimed to investigate response rates, remission rates, and their moderators in randomized controlled trials (RCTs) comparing the effect of guided Internet-based interventions for adult depression to control groups using an individual patient data meta-analysis approach. Literature searches in PubMed, Embase, PsycINFO and Cochrane Library resulted in 13,384 abstracts from database inception to January 1, 2016. Twenty-four RCTs (4889 participants) comparing a guided Internet-based intervention with a control group contributed data to the analysis. Missing data were multiply imputed. To examine treatment outcome on response and remission, mixed-effects models with participants nested within studies were used. Response and remission rates were calculated using the Reliable Change Index. The intervention group obtained significantly higher response rates (OR = 2.49, 95% CI 2.17-2.85) and remission rates compared to controls (OR = 2.41, 95% CI 2.07-2.79). The moderator analysis indicated that older participants (OR = 1.01) and native-born participants (1.66) were more likely to respond to treatment compared to younger participants and ethnic minorities respectively. Age (OR = 1.01) and ethnicity (1.73) also moderated the effects of treatment on remission.Moreover, adults with more severe depressive symptoms at baseline were more likely to remit after receiving internet-based treatment (OR = 1.19). Guided Internet-based interventions lead to substantial positive treatment effects on treatment response and remission at post-treatment. Thus, such interventions may complement existing services for depression and potentially reduce the gap between the need and provision of evidence-based treatments.
关于基于指导的互联网干预对抑郁症的临床相关变化，人们知之甚少。此外，方法学和能力限制使得无法确定可能从这些干预中获益更多的患者群体。本研究旨在通过个体患者数据荟萃分析方法，调查比较成人抑郁症的基于指导的互联网干预与对照组的随机对照试验（RCT）的反应率、缓解率及其调节剂。从数据库建立到 2016 年 1 月 1 日，在 PubMed、Embase、PsycINFO 和 Cochrane Library 中进行了文献检索，共检索到 13384 篇摘要。24 项 RCT（4889 名参与者）将基于指导的互联网干预与对照组进行比较，为分析提供了数据。缺失数据采用多重插补法处理。为了检查反应和缓解的治疗效果，使用参与者嵌套在研究中的混合效应模型。使用可靠变化指数计算反应和缓解率。与对照组相比，干预组的反应率（OR=2.49，95%CI 2.17-2.85）和缓解率（OR=2.41，95%CI 2.07-2.79）显著更高。 调节分析表明，与年轻参与者和少数民族相比，年龄较大的参与者（OR=1.01）和本土出生的参与者（1.66）更有可能对治疗产生反应。年龄（OR=1.01）和种族（1.73）也调节了治疗对缓解的影响。此外，基线时抑郁症状更严重的成年人在接受基于互联网的治疗后更有可能缓解（OR=1.19）。基于指导的互联网干预在治疗反应和缓解方面产生了显著的积极治疗效果。因此，此类干预措施可能会补充现有的抑郁症服务，并可能缩小基于证据的治疗需求与提供之间的差距。
