Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany.
Westphalian University of Applied Sciences, Gelsenkirchen, Germany.
J Med Internet Res. 2020 Jul 13;22(7):e16136. doi: 10.2196/16136.
Web-based interventions for depression have been widely tested for usability and functioning. However, the few studies that have addressed the therapeutic quality of these interventions have mainly focused on general aspects without consideration of specific quality factors related to particular treatment components. Clinicians and scientists are calling for standardized assessment criteria for web-based interventions to enable effective and trustworthy patient care. Therefore, an extensive evaluation of web-based interventions at the level of individual treatment components based on therapeutic guidelines and manuals is needed.
The objective of this study was to evaluate the quality of unguided web-based interventions for depression at the level of individual treatment components based on their adherence to current gold-standard treatment guidelines and manuals.
A comprehensive online search of popular app stores and search engines in January 2018 revealed 11 desktop programs and 17 smartphone apps that met the inclusion criteria. Programs and apps were included if they were available for German users, interactive, unguided, and targeted toward depression. All programs and apps were tested by three independent researchers following a standardized procedure with a predefined symptom trajectory. During the testing, all web-based interventions were rated with a standardized list of criteria based on treatment guidelines and manuals for depression.
Overall interrater reliability for all raters was substantial with an intraclass correlation coefficient of 0.73 and Gwet AC1 value of 0.80. The main features of web-based interventions included mood tracking (24/28, 86%), psychoeducation (21/28, 75%), cognitive restructuring (21/28, 75%), crisis management (20/28, 71%), behavioral activation (19/29, 68%), and relaxation training (18/28, 64%). Overall, therapeutic meaningfulness was rated higher for desktop programs (mean 4.13, SD 1.17) than for smartphone apps (mean 2.92, SD 1.46).
Although many exercises from manuals are included in web-based interventions, the necessary therapeutic depth of the interventions is often not reached, and risk management is frequently lacking. There is a need for further research targeting general principles for the development and evaluation of therapeutically sound web-based interventions for depression.
基于网络的抑郁干预措施在可用性和功能方面已经得到了广泛的测试。然而，少数关注这些干预措施治疗质量的研究主要集中在一般方面，而没有考虑到与特定治疗成分相关的特定质量因素。临床医生和科学家呼吁为基于网络的干预措施制定标准化评估标准，以实现有效的、值得信赖的患者护理。因此，需要基于治疗指南和手册，对基于网络的干预措施的个别治疗成分进行广泛的评估。
本研究的目的是基于当前黄金标准治疗指南和手册，评估基于网络的抑郁干预措施在个别治疗成分方面的质量。
我们于 2018 年 1 月在热门应用商店和搜索引擎中进行了全面的在线搜索，共发现了 11 个桌面程序和 17 个智能手机应用程序，这些程序和应用程序符合纳入标准。符合纳入标准的程序和应用程序为：可供德国用户使用、具有交互性、无指导、针对抑郁。所有程序和应用程序均由三名独立研究人员按照标准化程序进行测试，程序和应用程序的测试过程遵循预定义的症状轨迹。在测试过程中，所有基于网络的干预措施均根据抑郁治疗指南和手册，使用标准化的标准清单进行评分。
所有评分者的总体组内一致性较高，组内相关系数为 0.73，Gwet AC1 值为 0.80。基于网络的干预措施的主要特征包括情绪跟踪（24/28，86%）、心理教育（21/28，75%）、认知重构（21/28，75%）、危机管理（20/28，71%）、行为激活（19/29，68%）和放松训练（18/28，64%）。总体而言，桌面程序的治疗意义评分较高（平均 4.13，标准差 1.17），智能手机应用程序的评分较低（平均 2.92，标准差 1.46）。
虽然基于网络的干预措施中包含了许多手册中的练习，但干预措施的必要治疗深度往往达不到，并且风险管理也经常缺失。需要进一步研究开发和评估针对抑郁症的具有治疗意义的基于网络的干预措施的一般原则。
