Ningbo Medical Center Lihuili Hospital, Ningbo, China.
Ningbo College of Health Sciences, Ningbo, Zhejiang, China.
J Med Internet Res. 2024 Mar 1;26:e40187. doi: 10.2196/40187.
Subthreshold depression (sD) is prevalent in older populations in long-term care (LTC) settings, but psychological therapy in LTC settings in China is not readily available. Thus, internet-based cognitive behavioral therapy (ICBT) may be suitable for this population, but research on the efficacy of ICBT for older adults with sD, especially those living in LTC settings, is limited.
This study aimed to evaluate the efficacy and acceptability of ICBT treatment for sD among LTC residents in China. We also examined whether ICBT is as effective as group-based cognitive behavioral therapy (CBT) for treating sD in this population.
We conducted a pragmatic randomized controlled trial, which included 18 LTC institutions. A total of 354 participants were randomized to ICBT, group-based CBT, or a waiting list and were followed up for 12 months. The primary outcome was self-reported depressive symptoms on the Center for Epidemiological Studies Depression Scale (CES-D). Secondary outcomes were the scores of the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-Item (GAD-7), and Geriatric Depression Scale (GDS). A mixed-effects model was used to assess the efficacy of ICBT.
The ICBT group showed a significant improvement in self-reported depressive symptoms, which was maintained at the 12-month follow-up (all P<.001). The ICBT group exhibited a significantly larger reduction in the scores of the CES-D (Cohen d=0.07, 95% CI 0.04-0.09; P=.01), PHQ-9 (d=0.30, 95% CI 0.28-0.33; P<.001), GDS (d=0.10, 95% CI 0.08-0.13; P<.001), and GAD-7 (d=0.19, 95% CI 0.17-0.22; P<.001) compared with a waiting list at postintervention. ICBT had significantly stronger effects than CBT on the PHQ-9 and GAD-7 at postintervention (d=0.15, 95% CI 0.13-0.17; P<.001 and d=0.21, 95% CI 0.19-0.23; P<.001, respectively), 6-month follow-up (d=0.18, 95% CI 0.16-0.21; P<.001 and d=0.18, 95% CI 0.15-0.21; P<.001, respectively), and 12-month follow-up (d=0.15, 95% CI 0.11-0.19; P<.001 and d=0.18, 95% CI 0.14-0.21; P<.001, respectively).
ICBT is a relatively effective and acceptable intervention for reducing depressive symptoms among Chinese LTC residents with sD. These findings indicate the usefulness of ICBT application for sD in LTC settings.
Chinese Clinical Trial Registry ChiCTR2000030697; https://www.chictr.org.cn/showproj.aspx?proj=50781.
亚临床抑郁（sD）在长期护理（LTC）环境中的老年人群中较为普遍，但中国 LTC 环境中的心理治疗并不普及。因此，基于互联网的认知行为疗法（ICBT）可能适合这一人群，但针对老年 sD 患者，特别是居住在 LTC 环境中的患者，ICBT 疗效的研究有限。
本研究旨在评估针对中国 LTC 居民的 sD 的 ICBT 治疗的疗效和可接受性。我们还研究了 ICBT 是否与基于小组的认知行为疗法（CBT）一样有效，可用于治疗该人群的 sD。
我们开展了一项实用随机对照试验，共纳入了 18 家 LTC 机构。共有 354 名参与者被随机分配至 ICBT 组、基于小组的 CBT 组或等候名单组，并随访 12 个月。主要结局是采用流行病学研究中心抑郁量表（CES-D）自评的抑郁症状。次要结局是患者健康问卷-9（PHQ-9）、广泛性焦虑障碍 7 项（GAD-7）和老年抑郁量表（GDS）的评分。采用混合效应模型评估 ICBT 的疗效。
ICBT 组的自评抑郁症状显著改善，且在 12 个月的随访中保持稳定（均 P<.001）。ICBT 组的 CES-D 评分降低更为显著（Cohen d=0.07，95%CI 0.04-0.09；P=.01）、PHQ-9 评分降低更为显著（d=0.30，95%CI 0.28-0.33；P<.001）、GDS 评分降低更为显著（d=0.10，95%CI 0.08-0.13；P<.001）、GAD-7 评分降低更为显著（d=0.19，95%CI 0.17-0.22；P<.001），与干预后等候名单组相比。与 CBT 相比，ICBT 在干预后、6 个月随访和 12 个月随访时对 PHQ-9 和 GAD-7 的疗效更强（d=0.15，95%CI 0.13-0.17；P<.001 和 d=0.21，95%CI 0.19-0.23；P<.001，分别）、d=0.18，95%CI 0.16-0.21；P<.001 和 d=0.18，95%CI 0.15-0.21；P<.001，分别）、d=0.15，95%CI 0.11-0.19；P<.001 和 d=0.18，95%CI 0.14-0.21；P<.001，分别）。
ICBT 是一种针对中国 LTC 居民亚临床抑郁较为有效的、可接受的干预措施。这些发现表明，ICBT 在 LTC 环境中应用于亚临床抑郁是有效的。
中国临床试验注册中心 ChiCTR2000030697；https://www.chictr.org.cn/showproj.aspx?proj=50781.
