“立即恢复”移动应用程序用于减轻灾后创伤后应激、情绪低落和睡眠障碍症状的随机对照试验。
Randomized Controlled Trial of "Bounce Back Now," a Mobile App to Reduce Post-Disaster Symptoms of Posttraumatic Stress, Depressed Mood, and Sleep Disturbance.
作者信息
Ruggiero Kenneth J, Andrews Arthur, Davidson Tatiana M, Gavrilova Yulia, Bunnell Brian E, Dahne Jennifer, Price Matthew, Brier Zoe M F, Cohen Gregory, Kilpatrick Dean, Acierno Ron, Galea Sandro
机构信息
Technology Applications Center for Healthful Lifestyles, Departments of Nursing and Psychiatry, College of Nursing (Ruggiero, Davidson), Department of Psychiatry and Behavioral Sciences (Gavrilova, Dahne, Brier, Kilpatrick), and Hollings Cancer Center (Dahne), Medical University of South Carolina, Charleston; Department of Psychology, University of Nebraska, Lincoln (Andrews); Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa (Bunnell); Department of Psychological Science, University of Vermont, Burlington (Price); Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto (Brier); School of Public Health, Boston University, Boston (Cohen); University of Texas Health Science Center at Houston (Acierno); School of Public Health, Washington University (Galea).
出版信息
Am J Psychiatry. 2025 May 1;182(5):463-472. doi: 10.1176/appi.ajp.20240232.
OBJECTIVE
There is tremendous public health interest in cost-efficient, scalable interventions to improve post-disaster mental health. The authors examined the efficacy of Bounce Back Now (BBN), a mobile application, versus an enhanced usual care app (EUC).
METHODS
A population-based trial was conducted with a diverse sample of 1,357 adults affected by Hurricane Harvey, Irma, Maria, Florence, or Michael in 2017 and 2018. Participants were eligible if they were ≥18 years of age, had access to an Internet-accessible device, were English speaking, and lived in a hurricane-affected area. BBN is designed to address symptoms of posttraumatic stress, depression, and sleep disturbance using evidence-based techniques grounded in behavioral and cognitive principles. Depressive, posttraumatic stress, and sleep symptoms were measured.
RESULTS
Participants' accessing of the BBN and EUC apps was similar. Active engagement was significantly greater among BBN users than EUC users (d=0.31), but BBN users engaged more actively in coping skills activities than in more time-intensive elements designed to promote behavior change. Moderate symptom reduction was observed in both conditions; Cohen's d values for the 3-month postbaseline assessment ranged from 0.49 to 0.60 in the BBN condition and from 0.36 to 0.41 in the EUC condition. Latent change models revealed that BBN users had significantly greater reductions in depression, sleep difficulty, and PTSD symptoms than EUC users, and these differences were maintained at the 6-month and 12-month postbaseline assessments.
CONCLUSIONS
Population impact is driven by reach and effectiveness. The potential reach of BBN is high, which heightens opportunity for population-level impact, but per-user symptom reduction was modest. Per-user impact may be improved by embedding digital health resources in the context of a broader health care strategy.
目的
对于具有成本效益且可扩展的改善灾后心理健康的干预措施，公众健康领域有着极大的兴趣。作者比较了一款移动应用程序“立即恢复”（Bounce Back Now，BBN）与一款强化常规护理应用程序（EUC）的疗效。
方法
开展了一项基于人群的试验，样本为2017年和2018年受飓风哈维、艾玛、玛丽亚、佛罗伦萨或迈克尔影响的1357名成年人，样本具有多样性。参与者需满足以下条件：年龄≥18岁，能使用可联网设备，说英语，且居住在受飓风影响地区。BBN旨在运用基于行为和认知原理的循证技术来解决创伤后应激、抑郁和睡眠障碍症状。对抑郁、创伤后应激和睡眠症状进行了测量。
结果
BBN和EUC应用程序的用户访问情况相似。BBN用户的积极参与度显著高于EUC用户（d = 0.31），但BBN用户在应对技能活动方面的参与度高于旨在促进行为改变的耗时更长的环节。两种情况下均观察到症状有中度减轻；基线后3个月评估的科恩d值在BBN组为0.49至0.60，在EUC组为0.36至0.41。潜在变化模型显示，BBN用户在抑郁、睡眠困难和创伤后应激障碍症状方面的减轻程度显著大于EUC用户，且这些差异在基线后6个月和12个月评估时仍保持。
结论
人群影响取决于覆盖面和有效性。BBN的潜在覆盖面很高，这增加了产生人群层面影响的机会，但每位用户的症状减轻程度较小。通过将数字健康资源融入更广泛的医疗保健策略中，可能会提高每位用户的影响。
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