Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, People's Republic of China.
Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, People's Republic of China.
Psychol Med. 2023 Jul;53(9):3932-3942. doi: 10.1017/S0033291722000599. Epub 2022 Apr 7.
Subthreshold depression (sD) negatively impacts well-being and psychosocial function and is more prevalent compared with major depressive disorder (MDD). However, as adults with sD are less likely to seek face-to-face intervention, internet-based cognitive-behavioral therapy (ICBT) may overcome barriers of accessibility to psychotherapy. Although several trials explored the efficacy of ICBT for sD, the results remain inconsistent. This study evaluated whether ICBT is effective in reducing depressive symptoms among Chinese adults with sD.
A randomized controlled trial was performed. The participants were randomly assigned to 5 weeks of ICBT, group-based face-to-face cognitive-behavioral therapy (CBT), or a waiting list (WL). Assessments were conducted at baseline, post-intervention and at a 6-month follow-up. The primary outcome measured depressive symptoms using the Center for Epidemiological Studies Depression Scale (CES-D). Outcomes were analyzed using a mixed-effects model to assess the effects of ICBT.
ICBT participants reported greater reductions on all the outcomes compared to the WL group at post-intervention. The ICBT group showed larger improvement on the Patient Health Questionnaire-9 (PHQ-9) at post-intervention ( = 0.12) and at follow-up ( = 0.10), and with CES-D at post-intervention ( = 0.06), compared to the CBT group.
ICBT is effective in reducing depressive symptoms among Chinese adults with sD, and improvements in outcomes were sustained at a 6-month follow-up. Considering the low rates of face-to-face psychotherapy, our findings highlight the considerable potential and implications for the Chinese government to promote the use of ICBT for sD in China.
阈下抑郁（sD）会对幸福感和心理社会功能产生负面影响，其发病率高于重度抑郁症（MDD）。然而，由于患有 sD 的成年人不太可能寻求面对面的干预，基于互联网的认知行为疗法（ICBT）可能会克服获得心理治疗的障碍。尽管有几项试验探讨了 ICBT 治疗 sD 的疗效，但结果仍不一致。本研究评估了 ICBT 是否能有效减轻中国 sD 成年人的抑郁症状。
进行了一项随机对照试验。参与者被随机分配到 5 周的 ICBT、小组面对面认知行为疗法（CBT）或等待名单（WL）。在基线、干预后和 6 个月随访时进行评估。主要结局指标使用流行病学研究中心抑郁量表（CES-D）评估抑郁症状。使用混合效应模型分析结局，以评估 ICBT 的效果。
与 WL 组相比，ICBT 组在干预后所有结局的报告均有较大改善。ICBT 组在干预后（ = 0.12）和随访时（ = 0.10）的患者健康问卷-9（PHQ-9）和干预后（ = 0.06）的 CES-D 评分改善更大，而 CBT 组则没有。
ICBT 能有效减轻中国 sD 成年人的抑郁症状，且在 6 个月随访时改善仍持续。考虑到面对面心理治疗的低利用率，我们的发现突显了中国政府在促进中国使用 ICBT 治疗 sD 方面的巨大潜力和意义。
