计算机化认知行为疗法治疗青少年抑郁和焦虑的系统评价和荟萃分析。
Computerized Cognitive Behavioral Therapy for Treatment of Depression and Anxiety in Adolescents: Systematic Review and Meta-analysis.
机构信息
Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
出版信息
J Med Internet Res. 2022 Apr 11;24(4):e29842. doi: 10.2196/29842.
BACKGROUND
Depression and anxiety are major public health concerns among adolescents. Computerized cognitive behavioral therapy (cCBT) has emerged as a potential intervention, but its efficacy in adolescents remains unestablished.
OBJECTIVE
This review aimed to systematically review and meta-analyze findings on the efficacy of cCBT for the treatment of adolescent depression and anxiety.
METHODS
Embase, PsycINFO, and Ovid MEDLINE were systematically searched for randomized controlled trials in English, which investigated the efficacy of cCBT for reducing self-reported depression or anxiety in adolescents aged 11 to 19 years. Titles, abstracts, and full texts were screened for eligibility by 2 independent researchers (TB and LC). A random-effects meta-analysis was conducted to pool the effects of cCBT on depression and anxiety symptom scores compared with the control groups. Study quality was assessed using the Cochrane Collaboration Risk of Bias tool.
RESULTS
A total of 16 randomized controlled trials were eligible for inclusion in this review, of which 13 (81%) were included in the meta-analysis. The quality of the studies was mixed, with 5 (31%) studies rated as good overall, 2 (13%) rated as fair, and 9 (56%) rated as poor. Small but statistically significant effects of cCBT were detected, with cCBT conditions showing lower symptom scores at follow-up compared with control conditions for both anxiety (standardized mean difference -0.21, 95% CI -0.33 to -0.09; I=36.2%) and depression (standardized mean difference -0.23, 95% CI -0.39 to -0.07; I=59.5%). Secondary analyses suggested that cCBT may be comparable with alternative, active interventions (such as face-to-face therapy or treatment as usual).
CONCLUSIONS
This meta-analysis reinforces the efficacy of cCBT for the treatment of anxiety and depression and is the first to examine this exclusively in adolescents. Future research could aim to identify the active components of these interventions toward optimizing their development and increasing the feasibility and acceptability of cCBT in this age group.
TRIAL REGISTRATION
PROSPERO CRD42019141941; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=141941.
背景
抑郁和焦虑是青少年面临的主要公共卫生问题。计算机化认知行为疗法（cCBT）已经成为一种潜在的干预手段，但它在青少年中的疗效尚未确定。
目的
本综述旨在系统地回顾和荟萃分析 cCBT 治疗青少年抑郁和焦虑的疗效。
方法
系统检索了英文的 Embase、PsycINFO 和 Ovid MEDLINE，以查找关于 cCBT 降低 11 至 19 岁青少年自我报告抑郁或焦虑的随机对照试验。由 2 名独立研究人员（TB 和 LC）筛选标题、摘要和全文的纳入资格。采用随机效应荟萃分析比较 cCBT 与对照组对抑郁和焦虑症状评分的影响。使用 Cochrane 协作风险偏倚工具评估研究质量。
结果
共有 16 项随机对照试验符合纳入本综述的条件，其中 13 项（81%）纳入荟萃分析。研究质量参差不齐，5 项（31%）总体质量良好，2 项（13%）质量中等，9 项（56%）质量较差。cCBT 显示出较小但具有统计学意义的效果，cCBT 组在随访时的焦虑症状评分（标准化均数差-0.21，95%CI -0.33 至 -0.09；I²=36.2%）和抑郁症状评分（标准化均数差-0.23，95%CI -0.39 至 -0.07；I²=59.5%）均低于对照组。二次分析表明，cCBT 可能与替代的有效干预措施（如面对面治疗或常规治疗）相当。
结论
本荟萃分析强化了 cCBT 治疗焦虑和抑郁的疗效，也是首次专门在青少年中对此进行的研究。未来的研究可以旨在确定这些干预措施的有效成分，以优化其发展，并提高 cCBT 在该年龄段的可行性和可接受性。
试验注册
PROSPERO CRD42019141941；https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=141941。
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