Wagner Birgit, Rosenberg Nicole, Hofmann Laura, Maass Ulrike
Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany.
Clinical Psychology and Psychotherapy, University of Potsdam, Potsdam, Germany.
Front Psychiatry. 2020 Jun 24;11:525. doi: 10.3389/fpsyt.2020.00525. eCollection 2020.
Web-based interventions have been introduced as novel and effective treatments for mental disorders and, in recent years, specifically for the bereaved. However, a systematic summary of the effectiveness of online interventions for people experiencing bereavement is still missing.
A systematic literature search was conducted by four reviewers who reviewed and meta-analytically summarized the evidence for web-based interventions for bereaved people.
Systematic searches (PubMed, Web of Science, PsycInfo, PsycArticles, Medline, and CINAHL) resulted in seven randomized controlled trials ( = 1,257) that addressed adults having experienced bereavement using internet-based interventions. We used random effects models to summarize treatment effects for between-group comparisons (treatment control at post) and stability over time (post follow-up).
All web-based interventions were based on cognitive behavioral therapy (CBT). In comparison with control groups, the interventions showed moderate ( = .54) to large effects ( = .86) for symptoms of grief and posttraumatic stress disorder (PTSD), respectively. The effect for depression was small ( = .44). All effects were stable over time. A higher number of treatment sessions achieved higher effects for grief symptoms and more individual feedback increased effects for depression. Other moderators ( dropout rate, time since loss, exposure) did not significantly reduce moderate degrees of heterogeneity between the studies.
The number of includable studies was low in this review resulting to lower power for moderator analyses in particular.
Overall, the results of web-based bereavement interventions are promising, and its low-threshold approach might reduce barriers to bereavement care. Nonetheless, future research should further examine potential moderators and specific treatment components ( exposure, feedback) and compare interventions with active controls.
基于网络的干预措施已被引入作为治疗精神障碍的新型有效方法，近年来，专门针对丧亲者。然而，对于丧亲者在线干预效果的系统总结仍然缺失。
由四位 reviewers 进行系统的文献检索，他们对丧亲者基于网络干预的证据进行了综述和荟萃分析总结。
系统检索（PubMed、科学网、PsycInfo、PsycArticles、Medline 和 CINAHL）产生了七项随机对照试验（ = 1257），这些试验使用基于互联网的干预措施来研究经历丧亲之痛的成年人。我们使用随机效应模型来总结组间比较（治疗后与对照组）的治疗效果以及随时间的稳定性（治疗后与随访）。
所有基于网络的干预措施均基于认知行为疗法（CBT）。与对照组相比，干预措施对悲伤症状和创伤后应激障碍（PTSD）症状分别显示出中等（ = 0.54）至较大效果（ = 0.86）。对抑郁症的效果较小（ = 0.44）。所有效果随时间稳定。更多的治疗疗程对悲伤症状产生更高的效果，更多的个人反馈对抑郁症产生更大的效果。其他调节因素（脱落率、丧亲时间、暴露）并未显著降低研究之间中等程度的异质性。
本综述中可纳入的研究数量较少，特别是导致调节因素分析的效能较低。
总体而言，基于网络的丧亲干预措施的结果很有前景，其低门槛方法可能会减少丧亲护理的障碍。尽管如此，未来的研究应进一步研究潜在的调节因素和特定的治疗成分（暴露、反馈），并将干预措施与积极对照进行比较。
