Linardon Jake, Cuijpers Pim, Carlbring Per, Messer Mariel, Fuller-Tyszkiewicz Matthew
School of Psychology, Deakin University, Geelong, Victoria, Australia.
Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
World Psychiatry. 2019 Oct;18(3):325-336. doi: 10.1002/wps.20673.
Although impressive progress has been made toward developing empirically-supported psychological treatments, the reality remains that a significant proportion of people with mental health problems do not receive these treatments. Finding ways to reduce this treatment gap is crucial. Since app-supported smartphone interventions are touted as a possible solution, access to up-to-date guidance around the evidence base and clinical utility of these interventions is needed. We conducted a meta-analysis of 66 randomized controlled trials of app-supported smartphone interventions for mental health problems. Smartphone interventions significantly outperformed control conditions in improving depressive (g=0.28, n=54) and generalized anxiety (g=0.30, n=39) symptoms, stress levels (g=0.35, n=27), quality of life (g=0.35, n=43), general psychiatric distress (g=0.40, n=12), social anxiety symptoms (g=0.58, n=6), and positive affect (g=0.44, n=6), with most effects being robust even after adjusting for various possible biasing factors (type of control condition, risk of bias rating). Smartphone interventions conferred no significant benefit over control conditions on panic symptoms (g=-0.05, n=3), post-traumatic stress symptoms (g=0.18, n=4), and negative affect (g=-0.08, n=5). Studies that delivered a cognitive behavior therapy (CBT)-based app and offered professional guidance and reminders to engage produced larger effects on multiple outcomes. Smartphone interventions did not differ significantly from active interventions (face-to-face, computerized treatment), although the number of studies was low (n≤13). The efficacy of app-supported smartphone interventions for common mental health problems was thus confirmed. Although mental health apps are not intended to replace professional clinical services, the present findings highlight the potential of apps to serve as a cost-effective, easily accessible, and low intensity intervention for those who cannot receive standard psychological treatment.
尽管在开发基于实证的心理治疗方法方面已经取得了令人瞩目的进展，但现实情况仍然是，相当一部分有心理健康问题的人没有接受这些治疗。找到缩小这一治疗差距的方法至关重要。由于应用程序支持的智能手机干预措施被吹捧为一种可能的解决方案，因此需要获得有关这些干预措施的证据基础和临床效用的最新指导。我们对66项针对心理健康问题的应用程序支持的智能手机干预措施的随机对照试验进行了荟萃分析。智能手机干预措施在改善抑郁症状（g = 0.28，n = 54）、广泛性焦虑症状（g = 0.30，n = 39）、压力水平（g = 0.35，n = 27）、生活质量（g = 0.35，n = 43）、一般精神痛苦（g = 0.40，n = 12）、社交焦虑症状（g = 0.58，n = 6）和积极情绪（g = 0.44，n = 6）方面明显优于对照条件，即使在调整了各种可能的偏倚因素（对照条件类型、偏倚风险评分）后，大多数效果仍然稳健。智能手机干预措施在恐慌症状（g = -0.05，n = 3）、创伤后应激症状（g = 0.18，n = 4）和消极情绪（g = -0.08，n = 5）方面与对照条件相比没有显著益处。提供基于认知行为疗法（CBT）的应用程序并提供专业指导和参与提醒的研究在多个结果上产生了更大的效果。智能手机干预措施与积极干预措施（面对面、计算机化治疗）没有显著差异，尽管研究数量较少（n≤13）。因此，应用程序支持的智能手机干预措施对常见心理健康问题的疗效得到了证实。尽管心理健康应用程序并非旨在取代专业临床服务，但目前的研究结果凸显了应用程序作为一种经济高效、易于获取且低强度的干预措施，为那些无法接受标准心理治疗的人的潜力。
