互联网为基础的跨诊断心理治疗对患有抑郁、焦虑或两者兼具的个体的效果：一项随机对照试验的系统综述和荟萃分析。

Internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety or both: a systematic review with meta-analysis of randomised controlled trials.

机构信息

Centre for Psychiatry Research, Karolinska Institute Department of Clinical Neuroscience, Stockholm, Stockholm, Sweden

Liljeholmen University Primary Health Care Center, Region Stockholm, Academic Primary Care Centre, Stockholm, Stockholm, Sweden.

出版信息

BMJ Open. 2024 Apr 3;14(4):e075796. doi: 10.1136/bmjopen-2023-075796.

DOI:10.1136/bmjopen-2023-075796

PMID:38569713

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11015301/

Abstract

OBJECTIVE

Depression and anxiety are major public health problems. This study evaluated the effects of internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety, or both.

DESIGN

Systematic review with meta-analysis.

DATA SOURCES

Medline (Ovid), Cochrane Library (Wiley), the Web of Science Core Collection (Clarivate), and PsycInfo (EBSCO) were searched on 24 May 2021, with an update on 6 February 2023.

ELIGIBILITY CRITERIA

Randomised controlled trials of internet-delivered transdiagnostic psychological treatments, open to both participants with primary depression and participants with primary anxiety. This review concerned all treatment frameworks, both guided and unguided formats and all age groups.

DATA EXTRACTION AND SYNTHESIS

In random-effects meta-analysis, we estimated pooled effects on depression symptoms and anxiety in terms of Hedges' with 95% CIs. Absolute and relative heterogeneity was quantified as the τ and .

RESULTS

We included 57 trials with 21 795 participants. Nine trials (16%) recruited exclusively from routine care, and three (5%) delivered treatment via video. For adults, large within-group reductions were seen in depression (=0.90; 95% CI 0.81 to 0.99) and anxiety (=0.87; 95% CI 0.78 to 0.96). Compared with rudimentary passive controls, the added effects were moderate (depression: =0.52; 95% CI 0.42 to 0.63; anxiety: =0.45; 95% CI 0.34 to 0.56) and larger in trials that required all participants to meet full diagnostic criteria for depression or an anxiety disorder. Compared with attention/engagement controls, the added effects were small (depression: =0.30; 95% CI 0.07 to 0.53; anxiety: =0.21; 95% CI 0.01 to 0.42). Heterogeneity was substantial, and the certainty of the evidence was very low. Two trials concerned adolescents and reported mixed results. One trial concerned older adults and reported promising results.

CONCLUSION

Internet-delivered transdiagnostic treatments for depression and anxiety show small-to-moderate added effects, varying by control condition. Research is needed regarding routine care, the video format, children and adolescents and older adults.

PROSPERO REGISTRATION NUMBER

CRD42021243172.

摘要

目的

抑郁和焦虑是主要的公共卫生问题。本研究评估了针对抑郁、焦虑或两者共病的互联网传递的跨诊断心理治疗的效果。

设计

系统评价和荟萃分析。

数据来源

2021 年 5 月 24 日在 Medline（Ovid）、Cochrane 图书馆（Wiley）、Web of Science 核心合集（Clarivate）和 PsycInfo（EBSCO）进行检索，2023 年 2 月 6 日进行更新。

纳入标准

互联网传递的跨诊断心理治疗的随机对照试验，对原发性抑郁和原发性焦虑的参与者均开放。本综述涉及所有治疗框架，包括有指导和无指导的格式以及所有年龄组。

数据提取和综合

在随机效应荟萃分析中，我们根据 Hedges' 以 95%CI 估计了抑郁症状和焦虑的汇总效应。以 τ 和量化绝对和相对异质性。

结果

我们纳入了 57 项试验，涉及 21795 名参与者。9 项试验（16%）仅从常规护理中招募参与者，3 项试验（5%）通过视频提供治疗。对于成年人，抑郁（=0.90；95%CI 0.81 至 0.99）和焦虑（=0.87；95%CI 0.78 至 0.96）的组内降幅较大。与基本的被动对照相比，附加效应适度（抑郁：=0.52；95%CI 0.42 至 0.63；焦虑：=0.45；95%CI 0.34 至 0.56），在要求所有参与者都符合抑郁或焦虑障碍的完整诊断标准的试验中更大。与注意力/参与对照相比，附加效应较小（抑郁：=0.30；95%CI 0.07 至 0.53；焦虑：=0.21；95%CI 0.01 至 0.42）。异质性很大，证据的确定性非常低。两项试验涉及青少年，报告了混合结果。一项试验涉及老年人，报告了有希望的结果。