Köhnen Moritz, Dreier Mareike, Seeralan Tharanya, Kriston Levente, Härter Martin, Baumeister Harald, Liebherz Sarah
Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department for Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany.
JMIR Ment Health. 2021 Feb 10;8(2):e21700. doi: 10.2196/21700.
Evidence on technology-based psychological interventions (TBIs) for the treatment of depression is rapidly growing and covers a broad scope of research. Despite extensive research in this field, guideline recommendations are still limited to the general effectiveness of TBIs.
This study aims to structure evidence on TBIs by considering different application areas (eg, TBIs for acute treatment and their implementation in health care, such as stand-alone interventions) and treatment characteristics (eg, therapeutic rationale of TBIs) to provide a comprehensive evidence base and to identify research gaps in TBIs for diagnosed depression. Moreover, the reporting of negative events in the included studies is investigated in this review to enable subsequent safety assessment of the TBIs.
Randomized controlled trials on adults diagnosed with unipolar depression receiving any kind of psychotherapeutic treatment, which was at least partly delivered by a technical medium, were eligible for inclusion in our preregistered systematic review. We searched for trials in CENTRAL (Cochrane Central Register of Controlled Trials; until August 2020), MEDLINE, PsycINFO, PSYNDEX, CINAHL; until the end of January 2018), clinical trial registers, and sources of gray literature (until the end of January 2019). Study selection and data extraction were conducted by 2 review authors independently.
Database searches resulted in 15,546 records, of which 241 publications were included, representing 83 completed studies and 60 studies awaiting classification (ie, preregistered studies, study protocols). Almost all completed studies (78/83, 94%) addressed the acute treatment phase, being largely either implemented as stand-alone interventions (66/83, 80%) or blended treatment approaches (12/83, 14%). Studies on TBIs for aftercare (4/83, 5%) and for bridging waiting periods (1/83, 1%) were scarce. Most TBI study arms (n=107) were guided (59/107, 55.1%), delivered via the internet (80/107, 74.8%), and based on cognitive behavioral treatment approaches (88/107, 79.4%). Almost all studies (77/83, 93%) reported information on negative events, considering dropouts from treatment as a negative event. However, reports on negative events were heterogeneous and largely unsystematic.
Research has given little attention to studies evaluating TBIs for aftercare and for bridging waiting periods in people with depression, even though TBIs are seen as highly promising in these application areas; thus, high quality studies are urgently needed. In addition, the variety of therapeutic rationales on TBIs has barely been represented by identified studies hindering the consideration of patient preferences when planning treatment. Finally, future studies should use specific guidelines to systematically assess and report negative events.
International Prospective Register of Systematic Reviews (PROSPERO) CRD42016050413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016050413.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2018-028042.
关于基于技术的心理干预（TBI）治疗抑郁症的证据正在迅速增加，涵盖了广泛的研究范围。尽管该领域进行了广泛研究，但指南建议仍仅限于TBI的总体有效性。
本研究旨在通过考虑不同的应用领域（例如，用于急性治疗的TBI及其在医疗保健中的实施，如独立干预）和治疗特征（例如，TBI的治疗原理）来构建TBI的证据，以提供全面的证据基础，并确定已确诊抑郁症患者TBI研究中的差距。此外，本综述还对纳入研究中不良事件的报告进行了调查，以便对TBI进行后续安全性评估。
对被诊断为单相抑郁症的成年人接受任何至少部分通过技术媒介提供的心理治疗的随机对照试验，有资格纳入我们预先注册的系统评价。我们在CENTRAL（Cochrane对照试验中心注册库；截至2020年8月）、MEDLINE、PsycINFO、PSYNDEX、CINAHL（截至2018年1月底）、临床试验注册库和灰色文献来源（截至2019年1月底）中检索试验。研究选择和数据提取由两名综述作者独立进行。
数据库检索得到15546条记录，其中纳入241篇出版物，代表83项完成的研究和60项等待分类的研究（即预先注册的研究、研究方案）。几乎所有完成的研究（78/83，94%）都涉及急性治疗阶段，主要以独立干预（66/83，80%）或混合治疗方法（12/83，14%）的形式实施。关于TBI用于后续护理（4/83，5%）和缩短等待期（1/83，1%）的研究很少。大多数TBI研究组（n = 107）有指导（59/107，55.1%），通过互联网提供（（80/107，74.8%），并基于认知行为治疗方法（88/107，79.4%）。几乎所有研究（77/83，93%）都报告了不良事件的信息，将治疗退出视为不良事件。然而，关于不良事件的报告各不相同，而且很大程度上不系统。
尽管TBI在这些应用领域被视为非常有前景，但研究很少关注评估TBI用于抑郁症患者后续护理和缩短等待期的研究；因此，迫切需要高质量的研究。此外，已确定的研究几乎没有体现出TBI治疗原理的多样性，这阻碍了在规划治疗时考虑患者偏好。最后，未来的研究应使用特定指南来系统地评估和报告不良事件。
国际前瞻性系统评价注册库（PROSPERO）CRD42016
