Pearson Rahel, Carl Emily, Creech Suzannah K
Veterans Health Administration Veterans Integrated Service Network 17, Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Affairs Healthcare System, Waco, TX, United States.
Department of Psychology, University of Texas, Austin, TX, United States.
J Med Internet Res. 2022 Jun 3;24(6):e30065. doi: 10.2196/30065.
Computerized psychological interventions can overcome logistical and psychosocial barriers to the use of mental health care in the Veterans Affairs and Department of Defense settings.
In this systematic review, we aim to outline the existing literature, with the goal of describing: the scope and quality of the available literature, intervention characteristics, study methods, study efficacy, and study limitations and potential directions for future research.
Systematic searches of two databases (PsycINFO and PubMed) using PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines were conducted from inception until November 15, 2020. The following inclusion criteria were used: the study was published in an English language peer-reviewed journal, participants were randomly allocated to a computerized psychological intervention or a control group (non-computerized psychological intervention active treatment or nonactive control group), an intervention in at least one treatment arm was primarily delivered through the computer or internet with or without additional support, participants were veterans or service members, and the study used validated measures to examine the effect of treatment on psychological outcomes.
This review included 23 studies that met the predefined inclusion criteria. Most studies were at a high risk of bias. Targeted outcomes, participant characteristics, type of support delivered, adherence, and participant satisfaction were described. Most of the examined interventions (19/24, 79%) yielded positive results. Study limitations included participant characteristics limiting study inference, high rates of attrition, and an overreliance on self-reported outcomes.
Relatively few high-quality studies were identified, and more rigorous investigations are needed. Several recommendations for future research are discussed, including the adoption of methods that minimize attrition, optimize use, and allow for personalization of treatment.
计算机化心理干预可以克服退伍军人事务部和国防部环境中使用心理健康护理的后勤和社会心理障碍。
在本系统评价中，我们旨在概述现有文献，目的是描述：现有文献的范围和质量、干预特征、研究方法、研究疗效以及研究局限性和未来研究的潜在方向。
按照PRISMA（系统评价和Meta分析的首选报告项目）指南，对两个数据库（PsycINFO和PubMed）进行了从建库至2020年11月15日的系统检索。采用以下纳入标准：研究发表在英文同行评审期刊上，参与者被随机分配到计算机化心理干预组或对照组（非计算机化心理干预主动治疗组或非主动对照组），至少一个治疗组的干预主要通过计算机或互联网进行，有或没有额外支持，参与者为退伍军人或现役军人，且研究使用经过验证的测量方法来检验治疗对心理结果的影响。
本评价纳入了23项符合预定义纳入标准的研究。大多数研究存在高偏倚风险。描述了目标结局、参与者特征、提供的支持类型、依从性和参与者满意度。大多数所检验的干预措施（19/24，79%）产生了阳性结果。研究局限性包括限制研究推断的参与者特征、高失访率以及对自我报告结局的过度依赖。
确定的高质量研究相对较少，需要更严格的调查。讨论了未来研究的若干建议，包括采用尽量减少失访、优化使用并允许治疗个性化的方法。
