Dunedin Multidisciplinary Health & Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand.
Clinical Research Unit for Anxiety & Depression, St Vincent's Hospital, Darlinghurst, NSW, Australia.
Aust N Z J Psychiatry. 2024 Mar;58(3):238-249. doi: 10.1177/00048674231183641. Epub 2023 Jun 27.
Internet-based cognitive behavioural therapy (iCBT) is an efficacious, scalable intervention that could help meet the significant demand for psychological treatment. Yet, there is limited real-world evidence for its effectiveness. This study investigated the use and effectiveness of a free iCBT programme ('Just a Thought') in New Zealand.
We analysed 18 months of user data from the Just a Thought website to understand the characteristics of those who used the Depression and Generalised Anxiety Disorder courses, how many lessons they completed, how mental distress changed across each course and the factors associated with adherence and improvement in mental health.
The results for both courses followed very similar patterns. Course adherence was low overall. There were small differences in adherence by age, gender and ethnicity, and larger differences for those who were 'prescribed' Just a Thought by a healthcare worker. Mixed models showed significant reductions in mental distress, with some tapering of improvement across latter lessons. Those most likely to show clinically meaningful reductions in mental distress had completed more lessons, were older and had a higher baseline level of distress.
Alongside previous efficacy research, this real-world data indicate that iCBT is most likely to be effective at the population level and across different subgroups if users complete as much of the course as possible. Strategies to increase course adherence and maximise the public health benefits of iCBT include healthcare workers 'prescribing' iCBT and tailored solutions to meet the needs of young people, Māori and Pasifika.
基于互联网的认知行为疗法（iCBT）是一种有效的、可扩展的干预措施，可以帮助满足对心理治疗的巨大需求。然而，它在现实世界中的有效性的证据有限。本研究调查了在新西兰使用和实施免费 iCBT 项目（“Just a Thought”）的情况。
我们分析了 Just a Thought 网站 18 个月的用户数据，以了解使用抑郁和广泛性焦虑障碍课程的人群特征、完成的课程数量、每门课程的精神困扰变化以及与依从性和心理健康改善相关的因素。
两门课程的结果非常相似。总体而言，课程依从性较低。年龄、性别和种族的依从性存在微小差异，而医疗保健工作者“开处方”Just a Thought 的人之间的差异更大。混合模型显示精神困扰显著减少，后期课程的改善逐渐减弱。最有可能出现精神困扰显著降低的人群是完成了更多课程、年龄较大和基线困扰程度较高的人群。
除了之前的疗效研究外，这些真实世界的数据表明，如果用户尽可能完成课程，iCBT 最有可能在人群层面和不同亚组中有效。增加课程依从性并最大限度地发挥 iCBT 的公共卫生效益的策略包括医疗保健工作者“开处方”iCBT 和量身定制的解决方案，以满足年轻人、毛利人和太平洋岛民的需求。
