Eilert Nora, Wogan Rebecca, Leen Aisling, Richards Derek
e-Mental Health Group, School of Psychology, University of Dublin Trinity College, Dublin, Ireland.
SilverCloud Science, SilverCloud Health, Dublin, Ireland.
JMIR Pediatr Parent. 2022 May 12;5(2):e33551. doi: 10.2196/33551.
Mental health difficulties in children and adolescents are highly prevalent; however, only a minority receive adequate mental health care. Internet-delivered interventions offer a promising opportunity to increase access to mental health treatment. Research has demonstrated their effectiveness as a treatment for depression and anxiety in adults. This work provides an up-to-date examination of the available intervention options and their effectiveness for children and young people (CYP).
In this systematic review and meta-analysis, we aimed to determine the evidence available for the effectiveness of internet-delivered interventions for treating anxiety and depression in CYP.
Systematic literature searches were conducted throughout November 2020 using PubMed, PsycINFO, and EBSCO academic search complete electronic databases to find outcome trials of internet-delivered interventions treating symptoms of anxiety and/or depression in CYP by being either directly delivered to the CYP or delivered via their parents. Studies were eligible for meta-analysis if they were randomized controlled trials. Risk of bias and publication biases were evaluated, and Hedges g between group effect sizes evaluating intervention effects after treatment were calculated. Meta-analyses used random-effects models as per protocol.
A total of 23 studies met the eligibility criteria for the systematic review, of which 16 were included in the meta-analyses, including 977 participants in internet-delivered treatment conditions and 1008 participants in control conditions across 21 comparisons. Random-effects models detected a significant small effect for anxiety symptoms (across 20 comparisons; Hedges g=-0.25, 95% CI -0.38 to -0.12; P<.001) and a small but not significant effect for depression (across 13 comparisons; Hedges g=-0.27, 95% CI -0.55 to 0.01; P=.06) in favor of internet-delivered interventions compared with control groups. Regarding secondary outcomes, there was a small effect of treatment across 9 comparisons for impaired functioning (Hedges g=0.52, 95% CI 0.24-0.80; P<.001), and 5 comparisons of quality of life showed no effect (Hedges g=-0.01, 95% CI -0.23 to 0.21; P=.94).
The results show that the potential of internet-delivered interventions for young people with symptoms of anxiety or depression has not been tapped into to date. This review highlights an opportunity for the development of population-specific interventions and their research to expand our current knowledge and build an empirical base for digital interventions for CYP.
PROSPERO CRD42020220171; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=220171.
儿童和青少年的心理健康问题非常普遍；然而，只有少数人能得到充分的心理健康护理。互联网提供的干预措施为增加获得心理健康治疗的机会提供了一个有前景的途径。研究已证明其作为成人抑郁症和焦虑症治疗方法的有效性。这项工作对现有的干预选项及其对儿童和年轻人（CYP）的有效性进行了最新审查。
在这项系统评价和荟萃分析中，我们旨在确定互联网提供的干预措施治疗CYP焦虑症和抑郁症有效性的现有证据。
2020年11月，使用PubMed、PsycINFO和EBSCO学术搜索完整电子数据库进行了系统文献检索，以查找互联网提供的干预措施治疗CYP焦虑和/或抑郁症状的结局试验，这些干预措施要么直接提供给CYP，要么通过其父母提供。如果研究是随机对照试验，则有资格进行荟萃分析。评估了偏倚风险和发表偏倚，并计算了治疗后评估干预效果的组间效应量之间的Hedges g。荟萃分析按照方案使用随机效应模型。
共有23项研究符合系统评价的纳入标准，其中16项纳入荟萃分析，包括21项比较中977名接受互联网提供治疗的参与者和1008名对照条件下的参与者。随机效应模型在焦虑症状方面检测到显著的小效应（20项比较；Hedges g = -0.25，95％CI -0.38至-0.12；P <.001），抑郁方面有小但不显著的效应（13项比较；Hedges g = -0.27，95％CI -0.55至0.01；P =.06），表明与对照组相比，互联网提供的干预措施更具优势。关于次要结局，9项功能受损比较中有治疗的小效应（Hedges g = 0.52，95％CI 0.24 - 0.80；P <.001），5项生活质量比较无效应（Hedges g = -0.01，95％CI -0.23至0.21；P =.94）。
结果表明迄今尚未充分挖掘互联网提供的干预措施对有焦虑或抑郁症状年轻人的潜力。本综述突出了开发针对特定人群的干预措施及其研究的机会，以扩展我们目前的知识并为CYP的数字干预建立实证基础。
PROSPERO CRD42020220171；https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=22,0171 。
