Central Institute of Mental Health, Department of Public Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, Health Service and Population Research Department, King's College London, London, United Kingdom.
JAMA Psychiatry. 2024 Mar 1;81(3):227-239. doi: 10.1001/jamapsychiatry.2023.4590.
Targeting low self-esteem in youth exposed to childhood adversity is a promising strategy for preventing adult mental disorders. Ecological momentary interventions (EMIs) allow for the delivery of youth-friendly, adaptive interventions for improving self-esteem, but robust trial-based evidence is pending.
To examine the efficacy of SELFIE, a novel transdiagnostic, blended EMI for improving self-esteem plus care as usual (CAU) compared with CAU only.
DESIGN, SETTING, AND PARTICIPANTS: This was a 2-arm, parallel-group, assessor-blinded, randomized clinical trial conducted from December 2018 to December 2022. The study took place at Dutch secondary mental health services and within the general population and included youth (aged 12-26 years) with low self-esteem (Rosenberg Self-Esteem Scale [RSES] <26) exposed to childhood adversity.
A novel blended EMI (3 face-to-face sessions, email contacts, app-based, adaptive EMI) plus CAU or CAU only.
The primary outcome was RSES self-esteem at postintervention and 6-month follow-up. Secondary outcomes included positive and negative self-esteem, schematic self-beliefs, momentary self-esteem and affect, general psychopathology, quality of life, observer-rated symptoms, and functioning.
A total of 174 participants (mean [SD] age, 20.7 [3.1] years; 154 female [89%]) were included in the intention-to-treat sample, who were primarily exposed to childhood emotional abuse or neglect, verbal or indirect bullying, and/or parental conflict. At postintervention, 153 participants (87.9%) and, at follow-up, 140 participants (80.5%), provided primary outcome data. RSES self-esteem was, on average, higher in the experimental condition (blended EMI + CAU) than in the control condition (CAU) across both postintervention and follow-up as a primary outcome (B = 2.32; 95% CI, 1.14-3.50; P < .001; Cohen d-type effect size [hereafter, Cohen d] = 0.54). Small to moderate effect sizes were observed suggestive of beneficial effects on positive (B = 3.85; 95% CI, 1.83-5.88; P < .001; Cohen d = 0.53) and negative (B = -3.78; 95% CI, -6.59 to -0.98; P = .008; Cohen d = -0.38) self-esteem, positive (B = 1.58; 95% CI, 0.41-2.75; P = .008; Cohen d = 0.38) and negative (B = -1.71; 95% CI, -2.93 to -0.48; P = .006; Cohen d = -0.39) schematic self-beliefs, momentary self-esteem (B = 0.29; 95% CI, 0.01-0.57; P = .04; Cohen d = 0.24), momentary positive affect (B = 0.23; 95% CI, 0.01-0.45; P = .04; Cohen d = 0.20), momentary negative affect (B = -0.33; 95% CI, -0.59 to -0.03, P = .01, Cohen d = -0.27), general psychopathology (B = -17.62; 95% CI, -33.03 to -2.21; P = .03; Cohen d = -0.34), and quality of life (B = 1.16; 95% CI, 0.18-2.13; P = .02; Cohen d = 0.33) across postintervention and follow-up. No beneficial effects on symptoms and functioning were observed.
A transdiagnostic, blended EMI demonstrated efficacy on the primary outcome of self-esteem and signaled beneficial effects on several secondary outcomes. Further work should focus on implementing this novel EMI in routine public mental health provision.
Dutch Trial Register Identifier:NL7129(NTR7475).
针对儿童期逆境中自尊心较低的青少年进行治疗，是预防成年精神障碍的一种很有前途的策略。生态瞬时干预（EMI）允许提供适合年轻人的适应性干预措施，以提高自尊心，但仍需要基于强有力的试验证据。
研究SELFIE，一种新型的、混合式的、针对自尊心的 EMI，与常规护理（CAU）相比，加上常规护理（CAU）是否能改善自尊心。
设计、地点和参与者：这是一项 2 臂、平行组、评估者盲法、随机临床试验，于 2018 年 12 月至 2022 年 12 月进行。该研究在荷兰二级精神卫生服务机构和一般人群中进行，包括自尊心较低（罗森伯格自尊量表[RSES]＜26）且暴露于儿童期逆境的青少年（年龄 12-26 岁）。
一种新型混合 EMI（3 次面对面、电子邮件、基于应用程序的自适应 EMI）加上 CAU 或仅 CAU。
主要结果是干预后和 6 个月随访时的 RSES 自尊。次要结果包括积极和消极的自尊、图式自我信念、瞬间自尊和情感、一般精神病理学、生活质量、观察者评定的症状和功能。
共有 174 名参与者（平均年龄[标准差]，20.7[3.1]岁；154 名女性[89%]）被纳入意向治疗样本，他们主要暴露于儿童期情感虐待或忽视、言语或间接欺凌以及/或父母冲突。在干预后，有 153 名参与者（87.9%）和，在随访时，有 140 名参与者（80.5%）提供了主要结局数据。RSES 自尊在实验组（混合 EMI + CAU）的平均值高于对照组（CAU），无论是在干预后还是随访时，这都是主要结果（B=2.32；95%CI，1.14-3.50；P<0.001；Cohen d 型效应大小[以下简称 Cohen d] =0.54）。中等至较小的效应大小表明对积极（B=3.85；95%CI，1.83-5.88；P<0.001；Cohen d=0.53）和消极（B=-3.78；95%CI，-6.59 至-0.98；P=0.008；Cohen d=-0.38）自尊、积极（B=1.58；95%CI，0.41-2.75；P=0.008；Cohen d=0.38）和消极（B=-1.71；95%CI，-2.93 至-0.48；P=0.006；Cohen d=-0.39）图式自我信念、瞬间自尊（B=0.29；95%CI，0.01-0.57；P=0.04；Cohen d=0.24）、瞬间积极情绪（B=0.23；95%CI，0.01-0.45；P=0.04；Cohen d=0.20）、瞬间消极情绪（B=-0.33；95%CI，-0.59 至-0.03；P=0.01；Cohen d=-0.27）、一般精神病理学（B=-17.62；95%CI，-33.03 至-2.21；P=0.03；Cohen d=-0.34）和生活质量（B=1.16；95%CI，0.18-2.13；P=0.02；Cohen d=0.33）均有显著改善，无论是在干预后还是随访时。对症状和功能没有观察到有益的影响。
一种针对自尊心的、混合式的 EMI 显示出了对主要结果的有效性，并显示出对几个次要结果的有益影响。进一步的工作应集中在常规公共精神卫生服务中实施这种新型 EMI。
荷兰试验注册标识符：NL7129（NTR7475）。
