The MacDonald Franklin OSI Research Centre, Parkwood Institute Research, Lawson Health Research Institute, Mental Health Building, 550 Wellington Road, RM F4-367, London, ON, N6C 0A7, Canada.
Schulich School of Medicine, University of Western Ontario, London, ON, Canada.
BMC Psychiatry. 2023 Apr 3;23(1):223. doi: 10.1186/s12888-023-04668-1.
Military and veteran populations are unique in their trauma exposures, rates of mental illness and comorbidities, and response to treatments. While reviews have suggested that internet-based Cognitive Behavioral Therapy (iCBT) can be useful for treating mental health conditions, the extent to which they may be appropriate for military and veteran populations remain unclear. The goals of the current meta-analysis are to: (1) substantiate the effects of iCBT for military and veteran populations, (2) evaluate its effectiveness compared to control conditions, and (3) examine potential factors that may influence their effectiveness.
This review was completed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting and Cochrane review guidelines. The literature search was conducted using PsycInfo, Medline, Embase, and Proquest Dissertation & Theses on June 4, 2021 with no date restriction. Inclusion criteria included studies that: (1) were restricted to adult military or veteran populations, (2) incorporated iCBT as the primary treatment, and (3) evaluated mental health outcomes. Exclusion criteria included: (1) literature reviews, (2) qualitative studies, (3) study protocols, (4) studies that did not include a clinical/analogue population, and (5) studies with no measure of change on outcome variables. Two independent screeners reviewed studies for eligibility. Data was pooled and analyzed using random-effects and mixed-effects models. Study data information were extracted as the main outcomes, including study condition, sample size, and pre- and post-treatment means, standard deviations for all assessed outcomes, and target outcome. Predictor information were also extracted, and included demographics information, the types of outcomes measured, concurrent treatment, dropout rate, format, length, and delivery of intervention.
A total of 20 studies and 91 samples of data were included in the meta-analysis. The pooled effect size showed a small but meaningful effect for iCBT, g = 0.54, SE = 0.04, 95% CI (0.45, 0.62), Z = 12.32, p < .001. These effects were heterogenous across samples, (I = 87.96), Q(90) = 747.62, p < .001. Predictor analyses found length of intervention and concurrent treatment to influence study variance within sampled studies, p < .05. Evaluation of iCBT on primary outcomes indicated a small but meaningful effect for PTSD and depression, while effects of iCBT on secondary outcomes found similar results with depression, p < .001.
Findings from the meta-analysis lend support for the use of iCBT with military and veteran populations. Conditions under which iCBT may be optimized are discussed.
军人和退伍军人在创伤暴露、精神疾病和合并症的发生率以及对治疗的反应方面具有独特性。虽然有评论表明，基于互联网的认知行为疗法（iCBT）可用于治疗精神健康状况，但它们是否适用于军人和退伍军人仍不清楚。本研究的目的是：（1）证实 iCBT 对军人和退伍军人的疗效，（2）评估其与对照条件相比的效果，（3）检查可能影响其疗效的潜在因素。
本综述遵循系统评价和荟萃分析的首选报告项目（PRISMA）报告和 Cochrane 综述指南进行。文献检索于 2021 年 6 月 4 日在 PsycInfo、Medline、Embase 和 Proquest Dissertation & Theses 上进行，无日期限制。纳入标准包括：（1）仅限于成年军人或退伍军人人群，（2）采用 iCBT 作为主要治疗方法，（3）评估精神健康结果。排除标准包括：（1）文献综述，（2）定性研究，（3）研究方案，（4）不包括临床/模拟人群的研究，（5）无结局变量变化测量的研究。两名独立的筛查员对研究进行了资格审查。使用随机效应和混合效应模型对数据进行汇总和分析。研究数据信息作为主要结果提取，包括研究条件、样本量以及所有评估结果的治疗前和治疗后的平均值、标准差，以及目标结果。还提取了预测信息，包括人口统计学信息、测量的结果类型、同期治疗、辍学率、干预的形式、长度和交付方式。
荟萃分析共纳入 20 项研究和 91 个数据样本。汇总的效应大小表明，iCBT 对军人和退伍军人具有小但有意义的效果，g=0.54，SE=0.04，95%置信区间（0.45，0.62），Z=12.32，p<0.001。这些效果在样本中存在异质性，I=87.96，Q（90）=747.62，p<0.001。预测分析发现，干预的长度和同期治疗会影响样本研究中的变异，p<0.05。对 iCBT 主要结局的评估表明，创伤后应激障碍和抑郁的效果较小但有意义，而 iCBT 对次要结局的效果发现，抑郁的结果类似，p<0.001。
荟萃分析的结果支持将 iCBT 用于军人和退伍军人。讨论了可能优化 iCBT 的条件。
