Dülsen Patrick, Baumeister Harald
Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Straße 16, 89081, Ulm, Germany.
Eur Child Adolesc Psychiatry. 2025 Jan;34(1):101-121. doi: 10.1007/s00787-024-02404-y. Epub 2024 Mar 2.
Mental disorders, most commonly anxiety disorders and fourth most common depression, are prevalent in children and adolescents. Internet- and mobile-based interventions might represent a scalable approach to improve mental health care, however, evidence so far is inconclusive and systematic reports on negative effects are missing. Four data-bases were searched for randomized controlled trials evaluating internet- and mobile-based interventions (IMIs) targeting anxiety disorders or depression in children and adolescents up to 18 years exhibiting clinically relevant symptoms. Meta-analytic evaluations were conducted in comparison to active and passive control groups, furthermore, pre-defined sub-groups were explored and reported negative effects examined. Pooled estimates showed a moderate positive effect for IMIs targeting anxiety disorders compared to passive control groups (g = -0.69; CI -0.94 to -0.45; k = 8; n = 559; p ≤ 0,001), but not for depression. Pooled estimates compared to active control groups remained non-significant. Subgroup analyses were largely omitted due to an insufficient number of trials or were non-significant. Negative effects were mainly reported as drop-out rates and (non)-response rates, while additional negative effects, such as deterioration rates or the development of additional symptoms, were reported by only one third of included studies. The focus on children and adolescents with clinically relevant symptoms allowed the present findings to complement previous work, however, the limited amount of trials hindered many planned comparisons. The overview of reported negative effects highlighted that negative effects are being neglected in the majority of RCTs. Hence, in the future RCTs should include more information about potential negative effects, at best a combination of quantitative and qualitative information. Open Science Framework (osf.io/ch5nj).
精神障碍在儿童和青少年中很普遍，最常见的是焦虑症，抑郁症位居第四。基于互联网和移动设备的干预措施可能是一种可扩展的改善心理健康护理的方法，然而，目前的证据尚无定论，且缺乏关于负面影响的系统性报告。我们检索了四个数据库，以查找针对18岁及以下有临床相关症状的儿童和青少年焦虑症或抑郁症的基于互联网和移动设备的干预措施（IMIs）的随机对照试验。与积极和消极对照组相比进行了荟萃分析评估，此外，还探索了预定义的亚组并检查了报告的负面影响。汇总估计显示，与消极对照组相比，针对焦虑症的IMIs有中度积极效果（g = -0.69；CI -0.94至-0.45；k = 8；n = 559；p≤0.001），但对抑郁症则没有。与积极对照组相比的汇总估计仍然不显著。由于试验数量不足，亚组分析大多被省略或无显著意义。负面影响主要报告为退出率和（无）反应率，而只有三分之一的纳入研究报告了其他负面影响，如恶化率或出现额外症状。关注有临床相关症状的儿童和青少年使本研究结果能够补充先前的工作，然而，试验数量有限阻碍了许多计划中的比较。报告的负面影响概述突出表明，大多数随机对照试验中都忽略了负面影响。因此，未来的随机对照试验应包括更多关于潜在负面影响的信息，最好是定量和定性信息的结合。开放科学框架（osf.io/ch5nj）。
