Lindqvist Karin, Mechler Jakob, Carlbring Per, Lilliengren Peter, Falkenström Fredrik, Andersson Gerhard, Johansson Robert, Edbrooke-Childs Julian, Dahl Hanne-Sofie J, Lindert Bergsten Katja, Midgley Nick, Sandell Rolf, Thorén Agneta, Topooco Naira, Ulberg Randi, Philips Björn
Department of Psychology, Stockholm University, Stockholm, Sweden.
Ersta Sköndal Bräcke University College, Stockholm, Sweden.
J Med Internet Res. 2020 Mar 30;22(3):e18047. doi: 10.2196/18047.
Adolescent depression is one of the largest health issues in the world and there is a pressing need for effective and accessible treatments.
This trial examines whether affect-focused internet-based psychodynamic therapy (IPDT) with therapist support is more effective than an internet-based supportive control condition on reducing depression in adolescents.
The trial included 76 adolescents (61/76, 80% female; mean age 16.6 years), self-referred via an open access website and fulfilling criteria for major depressive disorder. Adolescents were randomized to 8 weeks of IPDT (38/76, 50%) or supportive control (38/76, 50%). The primary outcome was self-reported depressive symptoms, measured with the Quick Inventory of Depressive Symptomatology for Adolescents (QIDS-A17-SR). Secondary outcomes were anxiety severity, emotion regulation, self-compassion, and an additional depression measure. Assessments were made at baseline, postassessment, and at 6 months follow-up, in addition to weekly assessments of the primary outcome measure as well as emotion regulation during treatment.
IPDT was significantly more effective than the control condition in reducing depression (d=0.82, P=.01), the result of which was corroborated by the second depression measure (d=0.80, P<.001). IPDT was also significantly more effective in reducing anxiety (d=0.78, P<.001) and increasing emotion regulation (d=0.97, P<.001) and self-compassion (d=0.65, P=.003). Significantly more patients in the IPDT group compared to the control group met criteria for response (56% vs 21%, respectively) and remission (35% vs 8%, respectively). Results on depression and anxiety symptoms were stable at 6 months follow-up. On average, participants completed 5.8 (SD 2.4) of the 8 modules.
IPDT may be an effective intervention to reduce adolescent depression. Further research is needed, including comparisons with other treatments.
International Standard Randomised Controlled Trial Number (ISRCTN) 16206254; http://www.isrctn.com/ISRCTN16206254.
青少年抑郁症是全球最大的健康问题之一，迫切需要有效且可及的治疗方法。
本试验旨在研究在治疗师支持下，以情感为导向的基于互联网的心理动力疗法（IPDT）在减轻青少年抑郁症方面是否比基于互联网的支持性对照干预更有效。
该试验纳入了76名青少年（61/76，80%为女性；平均年龄16.6岁），这些青少年通过一个开放访问网站自荐，并符合重度抑郁症的标准。青少年被随机分为接受8周的IPDT治疗组（38/76，50%）或支持性对照组（38/76，50%）。主要结局是自我报告的抑郁症状，采用青少年抑郁症状快速量表（QIDS - A17 - SR）进行测量。次要结局包括焦虑严重程度、情绪调节、自我同情以及另一项抑郁测量指标。除了在基线、治疗后及6个月随访时进行评估外，还在治疗期间每周对主要结局指标以及情绪调节进行评估。
在减轻抑郁方面，IPDT比对照组显著更有效（d = 0.82，P = 0.01），第二项抑郁测量指标也证实了这一结果（d = 0.80，P < 0.001）。IPDT在减轻焦虑（d = 0.78，P < 0.001）、增强情绪调节（d = 0.97，P < 0.001）和自我同情（d = 0.65，P = 0.003）方面也显著更有效。与对照组相比，IPDT组达到缓解标准（分别为56%对21%）和痊愈标准（分别为35%对8%）的患者显著更多。抑郁和焦虑症状的结果在6个月随访时保持稳定。平均而言，参与者完成了8个模块中的5.8个（标准差2.4）。
IPDT可能是减轻青少年抑郁症的一种有效干预措施。需要进一步研究，包括与其他治疗方法进行比较。
国际标准随机对照试验编号（ISRCTN）16206254；http://www.isrctn.com/ISRCTN16206254 。
