Department of Medical Social Sciences, Osher Center for Integrative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Medical Social Sciences, Osher Center for Integrative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Affect Disord. 2019 Oct 1;257:352-364. doi: 10.1016/j.jad.2019.07.049. Epub 2019 Jul 5.
This manuscript describes the first two phases of pilot testing MARIGOLD, an online self-guided positive emotion skills intervention for adults with elevated depressive symptoms, along with enhancements to overcome retention and adherence problems reported in previous research.
Adults with elevated depressive symptoms were recruited online and assessed at baseline, post-intervention, 1- and 3-month follow-up. Phase 1 participants (n = 58) were randomized to MARIGOLD, daily emotion reporting, or waitlist. Phase 2 participants (n = 79) were randomized to MARIGOLD plus one enhancement: online discussion board (ODB), virtual badges (VB), or facilitator contact (FC). Post-intervention interviews assessed acceptability. Intention-to-treat analyses examined retention, adherence, and preliminary efficacy.
In both phases, retention and adherence did not differ between groups. MARIGOLD skills were highly acceptable, but qualitative results indicate web-based features (e.g., log-in, ODB, VB) require refinement prior to larger testing. Neither phase demonstrated between-group differences in preliminary efficacy. In Phase 1 within-group analyses, MARIGOLD and emotion reporting control demonstrated a similar pattern of findings (stable depressive symptoms, increased positive emotion, decreased negative emotion and stress), whereas the waitlist group significantly increased in depressive mood. Most Phase 2 within-group analyses demonstrated the expected pattern of results (i.e., decreases in PHQ-8 and negative emotion, increases in positive emotion). However, CES-D scores were stable in FC; perceived stress was stable in FC and ODB.
This pilot study is not powered to evaluate efficacy.
Positive emotion skills, plus enhancements for web-based, self-guided delivery, warrant additional study in people with elevated depressive symptoms.
本手稿描述了 MARIGOLD 的前两个试验阶段，这是一种针对抑郁症状升高的成年人的在线自我引导积极情绪技能干预措施，同时还增强了克服先前研究中报告的保留和坚持问题的措施。
在网上招募抑郁症状升高的成年人，并在基线、干预后、1 个月和 3 个月随访时进行评估。第一阶段的参与者（n=58）随机分配到 MARIGOLD、每日情绪报告或候补名单。第二阶段的参与者（n=79）随机分配到 MARIGOLD 加一项增强措施：在线讨论板（ODB）、虚拟徽章（VB）或协调员联系（FC）。干预后访谈评估可接受性。意向治疗分析检查了保留率、依从性和初步疗效。
在两个阶段中，组间的保留率和依从率没有差异。MARIGOLD 技能非常受欢迎，但定性结果表明，需要在更大规模的测试之前改进基于网络的功能（例如，登录、ODB、VB）。两个阶段均未显示出初步疗效的组间差异。在第一阶段的组内分析中，MARIGOLD 和情绪报告对照组表现出相似的发现模式（抑郁症状稳定、积极情绪增加、消极情绪和压力减少），而候补组的抑郁情绪显著增加。第二阶段的大多数组内分析都表现出预期的结果模式（即 PHQ-8 和消极情绪减少，积极情绪增加）。然而，FC 组的 CES-D 分数保持稳定；FC 和 ODB 组的感知压力保持稳定。
这项初步研究没有足够的能力评估疗效。
积极情绪技能，加上针对基于网络的自我引导交付的增强措施，值得在抑郁症状升高的人群中进一步研究。
