Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany.
J Med Internet Res. 2023 May 25;25:e41643. doi: 10.2196/41643.
Behavioral activation is an effective treatment for reducing depression. As depressive disorders affect many people worldwide, internet-based behavioral activation (iBA) could provide enhanced treatment access.
This study aimed to investigate whether iBA is effective in reducing depressive symptoms and to assess the impact on secondary outcomes.
We systematically searched MEDLINE, PsycINFO, PSYNDEX, and CENTRAL up to December 2021 for eligible randomized controlled trials. In addition, a reference search was conducted. Title and abstract screening, as well as a full-text screening, was conducted by 2 independent reviewers. Randomized controlled trials that investigated the effectiveness of iBA for depression as a treatment or main component were included. Randomized controlled trials had to report depressive symptoms, with a quantitative outcome measure and assess an adult population with depressive symptoms above cutoff. Two independent reviewers performed the data extraction and risk of bias assessment. Data were pooled in random-effects meta-analyses. The primary outcome was self-reported depressive symptoms posttreatment. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines.
A total of 12 randomized controlled trials, with 3274 participants (88% female, 43.61 years) were included. iBA was more effective in reducing depressive symptom severity posttreatment than inactive control groups (standardized mean difference -0.49; 95% CI -0.63 to -0.34; P<.001). The overall level of heterogeneity was moderate to substantial (I=53%). No significant effect of iBA on depressive symptoms could be found at 6-month follow-up. Participants assigned to iBA also experienced a significant reduction of anxiety and a significant increase in quality of life and activation compared to the inactive control groups. The results remained robust in multiple sensitivity analyses. The risk of bias assessment revealed at least some concerns for all studies, and there was evidence of slight publication bias.
This systematic review and meta-analysis implies that iBA is effective in reducing depressive symptoms. It represents a promising treatment option, providing treatment access where no treatment is available yet.
International Prospective Register of Systematic Reviews CRD42021236822; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=236822.
行为激活是一种有效的治疗方法，可减轻抑郁症状。由于抑郁障碍影响着全球众多人群，基于互联网的行为激活（iBA）可能提供了更好的治疗途径。
本研究旨在探讨 iBA 是否能有效减轻抑郁症状，并评估其对次要结局的影响。
我们系统检索了 MEDLINE、PsycINFO、PSYNDEX 和 CENTRAL 数据库，截至 2021 年 12 月，以获取合格的随机对照试验。此外，还进行了参考文献检索。由 2 名独立评审员进行标题和摘要筛选以及全文筛选。纳入的研究为以 iBA 作为治疗或主要组成部分的抑郁治疗的有效性研究。随机对照试验必须报告抑郁症状，并使用定量结局测量和评估抑郁症状高于临界值的成年人群。由 2 名独立评审员进行数据提取和偏倚风险评估。使用随机效应荟萃分析汇总数据。主要结局为治疗后自我报告的抑郁症状。本系统评价和荟萃分析遵循了系统评价和荟萃分析的首选报告项目（PRISMA）报告指南。
共纳入 12 项随机对照试验，共 3274 名参与者（88%为女性，平均年龄 43.61 岁）。与非活性对照组相比，iBA 更能有效减轻治疗后的抑郁症状严重程度（标准化均数差-0.49；95%CI-0.63 至-0.34；P<.001）。整体异质性水平为中度至高度（I=53%）。在 6 个月随访时，未发现 iBA 对抑郁症状有显著影响。与非活性对照组相比，接受 iBA 的参与者的焦虑症状也显著减轻，生活质量和活力显著提高。在多次敏感性分析中，结果仍然稳健。偏倚风险评估显示，所有研究至少存在一些关注，且存在轻微的发表偏倚证据。
本系统评价和荟萃分析表明，iBA 可有效减轻抑郁症状。它代表了一种有前途的治疗选择，为尚未提供治疗的地区提供了治疗途径。
国际前瞻性系统评价注册中心 CRD42021236822；https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=236822。
