优化智能手机在癌症患者抑郁症状中的心理治疗作用：使用去中心化多中心随机临床试验的多阶段优化策略（J-SUPPORT 2001 研究）。

Optimizing smartphone psychotherapy for depressive symptoms in patients with cancer: Multiphase optimization strategy using a decentralized multicenter randomized clinical trial (J-SUPPORT 2001 Study).

机构信息

Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

Center for Palliative Care and Psycho-oncology, Nagoya City University Hospital, Nagoya, Japan.

出版信息

Psychiatry Clin Neurosci. 2024 Jun;78(6):353-361. doi: 10.1111/pcn.13657. Epub 2024 Mar 11.

DOI:10.1111/pcn.13657

PMID:38468404

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11488626/

Abstract

AIM

Patients with cancer experience various forms of psychological distress, including depressive symptoms, which can impact quality of life, elevate morbidity risk, and increase medical costs. Psychotherapy and pharmacotherapy are effective for reducing depressive symptoms among patients with cancer, but most patients prefer psychotherapy. This study aimed to develop an efficient and effective smartphone psychotherapy component to address depressive symptom.

METHODS

This was a decentralized, parallel-group, multicenter, open, individually randomized, fully factorial trial. Patients aged ≥20 years with cancer were randomized by the presence/absence of three cognitive-behavioral therapy (CBT) skills (behavioral activation [BA], assertiveness training [AT], and problem-solving [PS]) on a smartphone app. All participants received psychoeducation (PE). The primary outcome was change in the patient health questionnaire-9 (PHQ-9) total score between baseline and week 8. Secondary outcomes included anxiety.

RESULTS

In total, 359 participants were randomized. Primary outcome data at week 8 were obtained for 355 participants (99%). The week 8 PHQ-9 total score was significantly reduced from baseline for all participants by -1.41 points (95% confidence interval [CI] -1.89, -0.92), but between-group differences in change scores were not significant (BA: -0.04, 95% CI -0.75, 0.67; AT: -0.16, 95% CI -0.87, 0.55; PS: -0.19, 95% CI -0.90, 0.52).

CONCLUSION

As the presence of any of the three intervention components did not contribute to a significant additive reduction of depressive symptoms, we cannot make evidence-based recommendations regarding the use of specific smartphone psychotherapy.

摘要

目的

癌症患者会经历各种形式的心理困扰，包括抑郁症状，这会影响生活质量、增加发病风险并增加医疗费用。心理治疗和药物治疗对减轻癌症患者的抑郁症状有效，但大多数患者更喜欢心理治疗。本研究旨在开发一种有效的智能手机心理治疗组件来解决抑郁症状。

方法

这是一项去中心化、平行组、多中心、开放、个体随机、完全析因试验。年龄≥20 岁的癌症患者根据智能手机应用程序上是否存在三种认知行为疗法（CBT）技能（行为激活[BA]、自信训练[AT]和解决问题[PS]）进行分组。所有参与者均接受心理教育（PE）。主要结局是基线至第 8 周时患者健康问卷-9（PHQ-9）总分的变化。次要结局包括焦虑。

结果

共 359 名参与者随机分组。355 名参与者（99%）获得了第 8 周的主要结局数据。所有参与者的第 8 周 PHQ-9 总分从基线显著降低了 1.41 分（95%置信区间[CI] -1.89，-0.92），但组间变化评分差异无统计学意义（BA：-0.04，95%CI -0.75，0.67；AT：-0.16，95%CI -0.87，0.55；PS：-0.19，95%CI -0.90，0.52）。