Kählke Fanny, Buntrock Claudia, Smit Filip, Berger Thomas, Baumeister Harald, Ebert David Daniel
School of Medicine and Health, Department Health and Sport Sciences, Professorship for Psychology and Digital Mental Health Care, Technical University Munich, Munich, Germany.
Institute for Social Medicine and Health Systems Research, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany.
Depress Anxiety. 2023 Nov 17;2023:7912017. doi: 10.1155/2023/7912017. eCollection 2023.
Social anxiety disorder (SAD) is widespread among university students and is associated with high costs for the society. While unguided internet- and mobile-based interventions (IMIs) may have short-term effects in reducing SAD symptoms, evidence for their long-term efficacy and cost-effectiveness is still limited. The aim of this study is to examine the 6-month outcomes of an IMI for university students with SAD. Participants were recruited via mass mails sent to enrolled students and included if they were at least 18 years old, met the diagnostic criteria of SAD in a structured clinical interview for DSM-IV axis I disorders (SCID-I), and provided written informed consent. In a prospective study designed as a two-armed randomized-controlled trial, 200 students (mean age 26.7 years) diagnosed with SAD were randomly assigned to an IMI or a waitlist control (WLC) condition. The IMI consisted of nine weekly sessions based on the cognitive-behavioral treatment model for social phobia by Clark and Wells. The primary outcome was SAD symptom severity assessed via the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS). A health economic evaluation from a societal and healthcare perspective examined the costs related to the symptom-free status and quality-adjusted life years (QALYs) gained. Statistically significant differences in SAD symptom severity previously found at posttreatment favoring the IMI were maintained at a 6-month follow-up [SIAS (Cohen's = 0.59; 95% CI, 0.30, 0.87) and SPS (Cohen's = 0.83; 95% CI, 0.54, 1.1)]. From a societal perspective, at a willingness to pay (WTP) of €0, the intervention was found to have a 92% and 93% probability of cost-effectiveness compared with the WLC per symptom-free status and QALY gained, respectively. From a healthcare perspective, the likelihood of cost-effectiveness of the intervention was 97% per symptom-free status at a WTP of €1000 (US$1326) and 96% per QALY gained at a WTP of €6000 (US$7956). This IMI is effective in treating university students with SAD and has an acceptable likelihood of cost-effectiveness compared with WLC from a societal perspective. This intervention can be integrated into university healthcare to reach students with SAD as it is scalable, shows a high probability of cost-effectiveness, and overcomes known treatment barriers. This trial is registered with DRKS00011424.
社交焦虑障碍（SAD）在大学生中普遍存在，且给社会带来高昂成本。虽然基于互联网和移动设备的无指导干预措施（IMIs）可能在减轻社交焦虑障碍症状方面有短期效果，但其长期疗效和成本效益的证据仍然有限。本研究的目的是检验针对患有社交焦虑障碍的大学生进行的IMI干预6个月后的效果。通过向注册学生发送群发邮件招募参与者，纳入标准为年龄至少18岁、在针对《精神疾病诊断与统计手册》第四版轴I障碍的结构化临床访谈（SCID - I）中符合社交焦虑障碍的诊断标准，并提供书面知情同意书。在一项设计为双臂随机对照试验的前瞻性研究中，200名被诊断为社交焦虑障碍的学生（平均年龄26.7岁）被随机分配到IMI组或等待列表对照组（WLC）。IMI由基于Clark和Wells的社交恐惧症认知行为治疗模型的九个每周一次的课程组成。主要结局是通过社交恐惧症量表（SPS）和社交互动焦虑量表（SIAS）评估的社交焦虑障碍症状严重程度。从社会和医疗保健角度进行的健康经济评估考察了与无症状状态相关的成本以及获得的质量调整生命年（QALYs）。先前在治疗后发现有利于IMI组的社交焦虑障碍症状严重程度的统计学显著差异在6个月随访时仍然存在[社交互动焦虑量表（Cohen's = 0.59；95%置信区间，0.30，0.87）和社交恐惧症量表（Cohen's = 0.83；95%置信区间，0.54，1.1）]。从社会角度来看，在支付意愿（WTP）为0欧元时，与WLC组相比，该干预措施分别针对每个无症状状态和获得的QALY具有92%和93%的成本效益概率。从医疗保健角度来看，在支付意愿为1000欧元（1326美元）时，该干预措施针对每个无症状状态的成本效益可能性为97%，在支付意愿为6000欧元（7956美元）时，针对每个获得的QALY的成本效益可能性为96%。这种IMI在治疗患有社交焦虑障碍的大学生方面是有效的，并且从社会角度来看与WLC组相比具有可接受的成本效益可能性。这种干预措施可以整合到大学医疗保健中以惠及患有社交焦虑障碍的学生，因为它具有可扩展性，显示出高成本效益概率，并且克服了已知的治疗障碍。本试验已在DRKS00011424注册。
