Johansson Peter, Lundgren Johan, Andersson Gerhard, Svensson Erland, Mourad Ghassan
Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden.
Unit of Internal Medicine, Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping Univerisity, Norrköping, Sweden.
JMIR Cardio. 2022 Jun 3;6(1):e29926. doi: 10.2196/29926.
In patients with cardiovascular disease (CVD), knowledge about the associations among changes in depressive symptoms, self-efficacy, and self-care activities has been requested. This is because such knowledge can be helpful in the design of behavioral interventions aimed to improve self-efficacy, reduce depressive symptoms, and improve performance of self-care activities in CVD patients.
We aim to evaluate if internet-based cognitive behavioral therapy (iCBT) improves self-efficacy and explore the relationships among changes in depressive symptoms, self-efficacy, and physical activity, as well as the influence of iCBT on these relationships.
This study received funding in January 2015. Participant recruitment took place between January 2017 and February 2018, and the main findings were published in 2019. This study is a secondary analysis of data collected in a randomized controlled study evaluating the effects of a 9-week iCBT program compared to an online discussion forum (ODF) on depressive symptoms in patients with CVD (N=144). Data were collected at baseline and at the 9-week follow-up. Analysis of covariance was used to evaluate the differences in self-efficacy between the iCBT and ODF groups. Structural equation modeling explored the relationships among changes in depressive symptoms, self-efficacy, and physical activity, as well as the influence of iCBT on these relationships.
At follow-up, a significant difference in the increase in self-efficacy favoring iCBT was found (P=.04, Cohen d=0.27). We found an indirect association between changes in depressive symptoms and physical activity (β=-.24, P<.01), with the change in self-efficacy acting as a mediator. iCBT had a direct effect on the changes in depressive symptoms, which in turn influenced the changes in self-efficacy (β=.23, P<.001) and physical activity (β=.12, P<.001).
Self-efficacy was improved by iCBT. However, the influence of iCBT on self-efficacy and physical activity was mostly mediated by improvements in depressive symptoms.
ClinicalTrials.gov NCT02778074; https://clinicaltrials.gov/ct2/show/NCT02778074.
对于心血管疾病（CVD）患者，人们需要了解抑郁症状变化、自我效能感和自我护理活动之间的关联。这是因为此类知识有助于设计行为干预措施，旨在提高心血管疾病患者的自我效能感、减轻抑郁症状并改善自我护理活动表现。
我们旨在评估基于互联网的认知行为疗法（iCBT）是否能提高自我效能感，并探讨抑郁症状变化、自我效能感和身体活动之间的关系，以及iCBT对这些关系的影响。
本研究于2015年1月获得资助。参与者招募于2017年1月至2018年2月进行，主要研究结果于2019年发表。本研究是对一项随机对照研究中收集的数据进行的二次分析，该研究评估了为期9周的iCBT计划与在线讨论论坛（ODF）相比对心血管疾病患者（N = 144）抑郁症状的影响。在基线和9周随访时收集数据。采用协方差分析评估iCBT组和ODF组之间自我效能感的差异。结构方程模型探讨了抑郁症状变化、自我效能感和身体活动之间的关系，以及iCBT对这些关系的影响。
在随访时，发现自我效能感增加方面iCBT组有显著差异（P = 0.04，Cohen d = 0.27）。我们发现抑郁症状变化与身体活动之间存在间接关联（β = -0.24，P < 0.01），自我效能感变化起中介作用。iCBT对抑郁症状变化有直接影响，进而影响自我效能感变化（β = 0.23，P < 0.001）和身体活动变化（β = 0.12，P < 0.001）。
iCBT提高了自我效能感。然而，iCBT对自我效能感和身体活动的影响主要是通过抑郁症状的改善来介导的。
ClinicalTrials.gov NCT02778074；https://clinicaltrials.gov/ct2/show/NCT02778074。
