Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB, Canada.
Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
J Med Internet Res. 2022 Jan 11;24(1):e27939. doi: 10.2196/27939.
The COVID-19 pandemic has had adverse impacts on mental health and substance use worldwide. Systematic reviews suggest eHealth interventions can be effective at addressing these problems. However, strong positive eHealth outcomes are often tied to the intensity of web-based therapist guidance, which has time and cost implications that can make the population scale-up of more effective interventions difficult. A way to offset cost while maintaining the intensity of therapist guidance is to offer eHealth programs to groups rather than more standard one-on-one formats.
This systematic review aims to assess experimental evidence for the effectiveness of live health professional-led group eHealth interventions on mental health, substance use, or bereavement among community-dwelling adults. Within the articles selected for our primary aim, we also seek to examine the impact of interventions that encourage physical activity compared with those that do not.
Overall, 4 databases (MEDLINE, CINAHL, PsycINFO, and the Cochrane Library) were searched in July 2020. Eligible studies were randomized controlled trials (RCTs) of eHealth interventions led by health professionals and delivered entirely to adult groups by videoconference, teleconference, or webchat. Eligible studies reported mental health, substance use, or bereavement as primary outcomes. The results were examined by outcome, eHealth platform, and intervention length. Postintervention data were used to calculate effect size by study. The findings were summarized using the Synthesis Without Meta-Analysis guidelines. Risk of bias was assessed using the Cochrane Collaboration Tool.
Of the 4099 identified studies, 21 (0.51%) RCTs representing 20 interventions met the inclusion criteria. These studies examined mental health outcomes among 2438 participants (sample size range: 47-361 participants per study) across 7 countries. When effect sizes were pooled, live health professional-led group eHealth interventions had a medium effect on reducing anxiety compared with inactive (Cohen d=0.57) or active control (Cohen d=0.48), a medium to small effect on reducing depression compared with inactive (Cohen d=0.61) or active control (Cohen d=0.21), and mixed effects on mental distress and coping. Interventions led by videoconference, and those that provided 8-12 hours of live health professional-led group contact had more robust effects on adult mental health. Risk of bias was high in 91% (19/21) of the studies. Heterogeneity across interventions was significant, resulting in low to very low quality of evidence. No eligible RCT was found that examined substance use, bereavement, or physical activity.
Live eHealth group interventions led by health professionals can foster moderate improvements in anxiety and moderate to small improvements in depression among community-based adults, particularly those delivered by videoconference and those providing 8-12 hours of synchronous engagement.
PROSPERO CRD42020187551; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=187551.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13643-020-01479-3.
新冠疫情对全球的心理健康和物质使用产生了负面影响。系统评价表明，电子健康干预措施在解决这些问题方面可能是有效的。然而，强烈的积极电子健康结果通常与基于网络的治疗师指导的强度有关，这涉及到时间和成本方面的问题，这使得更有效的干预措施难以在人群中推广。一种可以在保持治疗师指导强度的同时降低成本的方法是为群体提供电子健康项目，而不是更标准的一对一模式。
本系统评价旨在评估由健康专业人员主导的现场群组式电子健康干预措施对社区居住成年人的心理健康、物质使用或丧亲问题的有效性。在我们的主要目标所选择的文章中，我们还试图研究鼓励身体活动的干预措施与不鼓励身体活动的干预措施的影响。
总共对 4 个数据库（MEDLINE、CINAHL、PsycINFO 和 Cochrane 图书馆）进行了 2020 年 7 月的搜索。符合条件的研究是由健康专业人员领导的电子健康干预措施的随机对照试验（RCTs），这些干预措施完全通过视频会议、电话会议或网络聊天为成人小组提供服务。符合条件的研究将心理健康、物质使用或丧亲作为主要结果进行报告。结果根据结果、电子健康平台和干预时间进行了检查。使用研究的后干预数据计算效应大小。使用无荟萃分析指南总结研究结果。使用 Cochrane 合作工具评估偏倚风险。
在 4099 项确定的研究中，21 项（0.51%）RCT 代表 20 项干预措施符合纳入标准。这些研究在 7 个国家的 2438 名参与者中检查了心理健康结果（每个研究的样本量范围：47-361 名参与者）。当合并效应大小时，与非活动（Cohen d=0.57）或活动对照（Cohen d=0.48）相比，由现场健康专业人员领导的群组式电子健康干预措施对减轻焦虑有中等影响，与非活动（Cohen d=0.61）或活动对照（Cohen d=0.21）相比，对减轻抑郁有中等到较小的影响，对心理困扰和应对方式的影响混合。由视频会议主导的干预措施，以及提供 8-12 小时现场健康专业人员主导的群组接触的干预措施，对成年人的心理健康有更强的效果。91%（19/21）的研究存在高偏倚风险。干预措施之间存在显著的异质性，导致证据质量低至非常低。没有找到符合条件的 RCT 来检查物质使用、丧亲或身体活动。
由健康专业人员领导的现场电子健康群组干预措施可以促进社区成年人的焦虑适度改善和抑郁适度至较小改善，尤其是通过视频会议提供的、提供 8-12 小时同步参与的干预措施。
