Geramita Emily M, Herbeck Belnap Bea, Abebe Kaleab Z, Rothenberger Scott D, Rotondi Armando J, Rollman Bruce L
Division of General Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany.
J Med Internet Res. 2018 Jul 17;20(7):e10402. doi: 10.2196/10402.
We recently reported that depressed and anxious primary care patients randomized to a moderated internet support group (ISG) plus computerized cognitive behavioral therapy (cCBT) did not experience improvements in depression and anxiety over cCBT alone at 6-month follow-up.
The 1% rule posits that 1% of participants in online communities generate approximately 90% of new user-created content. The aims of this study were to apply the 1% rule to categorize patient engagement with the ISG and identify whether any patient subgroups benefitted from ISG use.
We categorized the 302 patients randomized to the ISG as: superusers (3/302, 1.0%), top contributors (30/302, 9.9%), contributors (108/302, 35.8%), observers (87/302, 28.8%) and those who never logged in (74/302, 24.5%). We then applied linear mixed models to examine associations between engagement and 6-month changes in health-related quality of life (HRQoL; Short Form Health Survey Mental Health Component, SF-12 MCS) and depression and anxiety symptoms (Patient-Reported Outcomes Measurement Information System, PROMIS).
At baseline, participant mean age was 42.6 years, 81.1% (245/302) were female, and mean Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder scale (GAD-7), and SF-12 MCS scores were 13.4, 12.6, and 31.7, respectively. Of the 75.5% (228/302) who logged in, 61.8 % (141/228) created ≥1 post (median 1, interquartile range, IQR 0-5); superusers created 42.3 % (630/1488) of posts (median 246, IQR 78-306), top contributors created 34.6% (515/1488; median 11, IQR 10-18), and contributors created 23.1 % (343/1488; median 3, IQR 1-5). Compared to participants who never logged in, the combined superuser + top contributor subgroup (n=33) reported 6-month improvements in anxiety (PROMIS: -11.6 vs -7.8; P=.04) and HRQoL (SF-12 MCS: 16.1 vs 10.1; P=.01) but not in depression. No other subgroup reported significant symptom improvements.
Patient engagement with the ISG was more broadly distributed than predicted by the 1% rule. The 11% of participants with the highest engagement levels reported significant improvements in anxiety and HRQoL.
ClinicalTrials.gov NCT01482806; https://clinicaltrials.gov/ct2/show/NCT01482806 (Archived by WebCite at http://www.webcitation.org/708Bjlge9).
我们最近报告称，在6个月的随访中，随机分配至适度互联网支持小组（ISG）加计算机化认知行为疗法（cCBT）的抑郁和焦虑初级保健患者，与仅接受cCBT的患者相比，抑郁和焦虑症状并未得到改善。
“1%规则”假定在线社区中1%的参与者产生了约90%的新用户创建内容。本研究的目的是应用“1%规则”对患者参与ISG的情况进行分类，并确定是否有任何患者亚组从使用ISG中受益。
我们将随机分配至ISG的302名患者分为：超级用户（3/302，1.0%）、顶级贡献者（30/302，9.9%）、贡献者（108/302，35.8%）、观察者（87/302，28.8%）和从未登录者（74/302，24.5%）。然后，我们应用线性混合模型来检验参与度与6个月健康相关生活质量（HRQoL；简短健康调查问卷心理健康分量表，SF-12 MCS）以及抑郁和焦虑症状（患者报告结局测量信息系统，PROMIS）变化之间的关联。
基线时，参与者的平均年龄为42.6岁，81.1%（245/302）为女性，患者健康问卷（PHQ-9）、广泛性焦虑障碍量表（GAD-7）和SF-12 MCS的平均得分分别为13.4、12.6和31.7。在登录的75.5%（228/302）患者中，61.8%（141/228）创建了≥1个帖子（中位数为1，四分位间距，IQR 0 - 5）；超级用户创建了42.3%（630/1488）的帖子（中位数为246，IQR 78 - 306），顶级贡献者创建了34.6%（515/1488；中位数为11，IQR 10 - 18），贡献者创建了23.1%（343/1488；中位数为3，IQR 1 - 5）。与从未登录的参与者相比，超级用户 + 顶级贡献者联合亚组（n = 33）报告在6个月时焦虑（PROMIS：-11.6对-7.8；P = 0.04）和HRQoL（SF-12 MCS：16.1对10.1；P = 0.01）有所改善，但抑郁症状未改善。没有其他亚组报告症状有显著改善。
患者对ISG的参与度分布比“1%规则”预测的更广泛。参与度最高的11%参与者报告焦虑和HRQoL有显著改善。
ClinicalTrials.gov NCT01482806；https://clinicaltrials.gov/ct2/show/NCT01482806（由WebCite存档于http://www.webcitation.org/708Bjlge9）。
