Skaczkowski Gemma, van der Kruk Shannen, Loxton Sophie, Hughes-Barton Donna, Howell Cate, Turnbull Deborah, Jensen Neil, Smout Matthew, Gunn Kate
Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia.
Australian Medical Placements Health Education and Training, Adelaide, Australia.
JMIR Ment Health. 2022 Feb 8;9(2):e31018. doi: 10.2196/31018.
A large number of Australians experience mental health challenges at some point in their lives. However, in many parts of Australia, the wait times to see general practitioners and mental health professionals can be lengthy. With increasing internet use across Australia, web-based interventions may help increase access to timely mental health care. As a result, this is an area of increasing research interest, and the number of publicly available web-based interventions is growing. However, it can be confusing for clinicians and consumers to know the resources that are evidence-based and best meet their needs.
This study aims to scope out the range of web-based mental health interventions that address depression, anxiety, suicidal ideation, or general mental well-being and are freely available to Australian adults, along with their impact, acceptability, therapeutic approach, and key features.
The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews (PRISMA-ScR [PRISMA extension for Scoping Reviews]) guided the review process. Keywords for the search were depression, anxiety, suicide, and well-being. The search was conducted using Google as well as the key intervention databases Beacon, Head to Health, and e-Mental Health in Practice. Interventions were deemed eligible if they targeted depression, anxiety, suicidal ideation, or general mental well-being (eg, resilience) in adults; and were web-based, written in English, interactive, free, and publicly available. They also had to be guided by an evidence-based therapeutic approach.
Overall, 52 eligible programs were identified, of which 9 (17%) addressed depression, 15 (29%) addressed anxiety, 13 (25%) addressed general mental well-being, and 13 (25%) addressed multiple issues. Only 4% (2/52) addressed distress in the form of suicidal ideation. The most common therapeutic approach was cognitive behavioral therapy. Half of the programs guided users through exercises in a set sequence, and most programs enabled users to log in and complete the activities on their own without professional support. Just over half of the programs had been evaluated for their effectiveness in reducing symptoms, and 11% (6/52) were being evaluated at the time of writing. Program evaluation scores ranged from 44% to 100%, with a total average score of 85%.
There are numerous web-based programs for depression, anxiety, suicidal ideation, and general well-being, which are freely and publicly available in Australia. However, identified gaps include a lack of available web-based interventions for culturally and linguistically diverse populations and programs that use newer therapeutic approaches such as acceptance and commitment therapy and dialectical behavior therapy. Despite most programs included in this review being of good quality, clinicians and consumers should pay careful attention when selecting which program to recommend and use, as variations in the levels of acceptability and impact of publicly available programs do exist.
大量澳大利亚人在人生的某个阶段会经历心理健康挑战。然而，在澳大利亚的许多地区，看全科医生和心理健康专业人员的等待时间可能很长。随着澳大利亚互联网使用的增加，基于网络的干预措施可能有助于增加及时获得心理健康护理的机会。因此，这是一个研究兴趣日益增加的领域，公开可用的基于网络的干预措施的数量也在不断增长。然而，临床医生和消费者可能会感到困惑，难以确定哪些资源是基于证据的，最能满足他们的需求。
本研究旨在梳理出针对抑郁症、焦虑症、自杀意念或总体心理健康状况且可供澳大利亚成年人免费使用的基于网络的心理健康干预措施的范围，以及它们的影响、可接受性、治疗方法和关键特征。
循证综述的PRISMA（系统评价和Meta分析的首选报告项目）指南（PRISMA-ScR [循证综述的PRISMA扩展版]）指导了综述过程。搜索关键词为抑郁症、焦虑症、自杀和幸福感。搜索使用了谷歌以及关键干预数据库Beacon、Head to Health和e-Mental Health in Practice。如果干预措施针对成年人的抑郁症、焦虑症、自杀意念或总体心理健康状况（如心理韧性）；基于网络、用英语编写、具有互动性、免费且公开可用；并且以循证治疗方法为指导，则被视为符合条件。
总体而言，共识别出52个符合条件的项目，其中9个（17%）针对抑郁症，15个（29%）针对焦虑症，13个（25%）针对总体心理健康状况，13个（25%）针对多个问题。只有4%（2/52）的项目以自杀意念的形式解决痛苦问题。最常见的治疗方法是认知行为疗法。一半的项目按设定顺序指导用户进行练习，大多数项目允许用户自行登录并完成活动，无需专业支持。略多于一半的项目已对其减轻症状的有效性进行了评估，11%（6/52）在撰写本文时正在进行评估。项目评估得分从44%到100%不等，总平均分为85%。
在澳大利亚有众多针对抑郁症、焦虑症、自杀意念和总体幸福感的基于网络的项目，这些项目免费且公开可用。然而，发现的差距包括缺乏针对文化和语言背景多样人群的基于网络的干预措施，以及使用诸如接纳与承诺疗法和辩证行为疗法等较新治疗方法的项目。尽管本综述中纳入的大多数项目质量良好，但临床医生和消费者在选择推荐和使用哪个项目时应谨慎关注，因为公开可用项目的可接受性和影响水平确实存在差异。
