Kaiser Permanente, Kaiser Permanente Evidence-based Practice Center, Portland, Oregon.
Kaiser Permanente, Kaiser Permanente Evidence-based Practice Center, Portland, Oregon.
J Adolesc Health. 2022 Jul;71(1):14-29. doi: 10.1016/j.jadohealth.2022.01.220. Epub 2022 Mar 4.
We conducted a rapid evidence review to explore the benefits and harms of digital cognitive-behavioral therapy (dCBT) and the barriers to and facilitators of implementing dCBT for adolescents.
We searched MEDLINE, PsycINFO, CENTRAL through December 6, 2021, for controlled trials conducted in settings highly applicable to the United States. Additionally, we searched relevant systematic reviews for eligible studies. Results were summarized qualitatively.
We included 12 trials (n = 1,575) that examined the effects of nine dCBT programs. Overall, dCBT was slightly superior to comparators in improving depression symptoms immediately post-intervention, but not at a longer follow-up. The use of dCBT did not appear to result in an increased risk for suicidal attempts or ideation; however, the number of events was very small. Potential barriers to implementing/maintaining dCBT are challenges engaging/retaining patients, developing infrastructure, and training therapists to facilitate dCBT. Data on harms or unintended negative consequences were not reported in the included studies.
A limited body of evidence suggests that dCBT programs might outperform control interventions for reducing depressive symptoms immediately post-intervention, but not at a longer follow-up. The safety of dCBT programs for adolescents with depression is understudied.
我们进行了快速证据回顾,以探讨数字认知行为疗法(dCBT)的益处和危害,以及在青少年中实施 dCBT 的障碍和促进因素。
我们检索了 MEDLINE、PsycINFO 和 CENTRAL 数据库,截至 2021 年 12 月 6 日,以寻找高度适用于美国环境的对照试验。此外,我们还搜索了相关的系统评价,以寻找合格的研究。结果以定性方式进行总结。
我们纳入了 12 项试验(n=1575),这些试验考察了 9 种 dCBT 方案的效果。总体而言,dCBT 在干预后即刻改善抑郁症状方面略优于对照组,但在较长的随访中没有改善。使用 dCBT 似乎不会增加自杀企图或意念的风险;然而,事件数量非常少。实施/维持 dCBT 的潜在障碍包括患者参与/保留、基础设施开发和培训治疗师以促进 dCBT 的挑战。纳入的研究没有报告关于危害或意外负面后果的数据。
有限的证据表明,dCBT 方案可能在干预后即刻改善抑郁症状方面优于对照组,但在较长的随访中没有改善。针对患有抑郁症的青少年,dCBT 方案的安全性研究不足。