Division of eHealth in Clinical Psychology, Department of Clinical Psychology, Philipps University of Marburg, Marburg, Germany.
Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
Psychother Psychosom. 2024;93(3):155-168. doi: 10.1159/000536149. Epub 2024 Apr 30.
Limited research exists on intervention efficacy for comorbid subclinical anxiety and depressive disorders, despite their common co-occurrence. Internet- and mobile-based interventions (IMIs) are promising to reach individuals facing subclinical symptoms.
This study aimed to evaluate the efficacy of a transdiagnostic and self-tailored IMI in reducing subclinical anxiety and depressive symptom severity with either individualized (IG-IMI) or automated (AG-IMI) guidance compared to a waitlist control group with care-as-usual access (WLC).
Participants included 566 adults with subclinical anxiety (GAD-7 ≥ 5) and/or depressive (CES-D ≥16) symptoms, who did not meet criteria for a full-syndrome depressive or anxiety disorder. In a three-arm randomized clinical trial, participants were randomized to a cognitive behavioral 7-session IMI plus booster session with IG-IMI (n = 186) or AG-IMI (n = 189) or WLC (n = 191). Primary outcomes included observer-rated anxiety (HAM-A) and depressive (QIDS) symptom severity 8 weeks after randomization assessed by blinded raters via telephone. Follow-up outcomes at 6 and 12 months are reported.
Symptom severity was significantly lower with small to medium effects in IG-IMI (anxiety: d = 0.45, depression: d = 0.43) and AG-IMI (anxiety: d = 0.31, depression: d = 0.32) compared to WLC. No significant differences emerged between guidance formats in primary outcomes. There was a significant effect in HAM-A after 6 months favoring AG-IMI. On average, participants completed 85.38% of IG-IMI and 77.38% of AG-IMI.
A transdiagnostic, self-tailored IMI can reduce subclinical anxiety and depressive symptom severity, but 12-month long-term effects were absent. Automated guidance holds promise for enhancing the scalability of IMIs in broad prevention initiatives.
尽管亚临床焦虑和抑郁障碍经常同时发生，但针对这些共病的干预效果的研究还很有限。基于互联网和移动的干预措施（IMIs）有望为面临亚临床症状的个体提供帮助。
本研究旨在评估一种跨诊断和自我定制的 IMI 在减少亚临床焦虑和抑郁症状严重程度方面的疗效，该 IMI 采用个体化指导（IG-IMI）或自动化指导（AG-IMI），与提供常规护理的等待名单对照组（WLC）相比。
参与者包括 566 名有亚临床焦虑（GAD-7≥5）和/或抑郁（CES-D≥16）症状但不符合全面综合征性抑郁或焦虑障碍标准的成年人。在一项三臂随机临床试验中，参与者被随机分配到一个认知行为 7 节 IMI 加强化课程，分别接受 IG-IMI（n=186）或 AG-IMI（n=189）或 WLC（n=191）的治疗。主要结局包括在随机分组后 8 周通过电话由盲法评估者评估的焦虑（HAM-A）和抑郁（QIDS）症状严重程度。报告了 6 个月和 12 个月的随访结局。
与 WLC 相比，IG-IMI（焦虑：d=0.45，抑郁：d=0.43）和 AG-IMI（焦虑：d=0.31，抑郁：d=0.32）的症状严重程度显著降低，且具有较小到中等的效果。两种指导方式在主要结局上没有显著差异。AG-IMI 在 6 个月时在 HAM-A 上的效果显著更好。平均而言，参与者完成了 IG-IMI 的 85.38%和 AG-IMI 的 77.38%。
一种跨诊断、自我定制的 IMI 可以降低亚临床焦虑和抑郁症状的严重程度，但 12 个月的长期效果并不存在。自动化指导有望增强 IMIs 在广泛的预防计划中的可扩展性。
