El-Malahi Ouahiba, Mohajeri Darya, Bäuerle Alexander, Mincu Raluca Ileana, Rammos Christos, Jansen Christoph, Teufel Martin, Rassaf Tienush, Lortz Julia
Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstr. 55, Essen, 45147, Germany, 49 201-723 849.
Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
J Med Internet Res. 2025 Jun 2;27:e67118. doi: 10.2196/67118.
Chronic stress is a critical factor influencing both physical and mental health. It can weaken the immune system, affect cardiovascular health, and lower quality of life, often leading to psychological disorders like anxiety and depression.
This study aims to evaluate the effectiveness of eHealth stress management interventions on psychological health parameters, specifically anxiety, depression, stress, and quality of life in patients with cardiovascular disease (CVD).
A comprehensive search was conducted across several databases, including the Cochrane Library, APA PsycInfo, Web of Science, PubMed, Embase, and clinical trial registers. Randomized controlled trials assessing the impact of eHealth stress management interventions, namely internet-based cognitive behavioral therapy (CBT), telephone-delivered CBT, internet-based stress management training, or telephone-delivered stress management training, on the specified psychological outcomes in patients with CVD were included. The control group comprised no intervention, a waitlist, (enhanced) usual care, or a web-based intervention not focusing on stress management. To evaluate potential bias, the Risk-of-Bias 2 tool was applied. A random-effects meta-analysis was performed using standard mean difference (SMD) as the effect size, with a sensitivity analysis using mean difference (MD).
A total of 6 randomized controlled studies were considered in the meta-analysis. In 5 studies internet-based CBT interventions were examined, while one study used an eHealth intervention based on a CBT approach. The control groups received either usual care, were placed on a waitlist, or participated in a web-based discussion forum. After the intervention period, which ranged from 8 weeks to 6 months, a significant reduction in depressive symptoms (SMD=-0.46, MD=-2.33; P<.001), as assessed by the Patient Health Questionnaire-9, was observed in the intervention group compared with the control group. Mental health-related quality of life, assessed by the subscale of the 12-Item Short-Form Health Survey, showed significant improvement (SMD=0.38, MD=3.89; P<.001) in the intervention group in comparison to the control group following the intervention period.
The meta-analysis demonstrates that eHealth stress management interventions substantially improve psychological health parameters in patients with CVD. Given the significant positive impact, health care providers should consider integrating eHealth stress management programs into standard care for patients with CVD. These programs can be a valuable tool in mitigating the psychological burdens associated with chronic cardiovascular conditions, ultimately improving overall patient outcomes and quality of life.
慢性应激是影响身心健康的关键因素。它会削弱免疫系统，影响心血管健康，降低生活质量，常导致焦虑和抑郁等心理障碍。
本研究旨在评估电子健康压力管理干预措施对心血管疾病（CVD）患者心理健康参数的有效性，特别是焦虑、抑郁、压力和生活质量。
在多个数据库中进行了全面检索，包括Cochrane图书馆、美国心理学会心理学文摘数据库（APA PsycInfo）、科学引文索引（Web of Science）、医学期刊数据库（PubMed）、荷兰医学文摘数据库（Embase）和临床试验注册库。纳入评估电子健康压力管理干预措施（即基于互联网的认知行为疗法（CBT）、电话提供的CBT、基于互联网的压力管理培训或电话提供的压力管理培训）对CVD患者特定心理结局影响的随机对照试验。对照组包括无干预、等待名单、（强化）常规护理或不专注于压力管理的基于网络的干预。为评估潜在偏倚，应用了偏倚风险2工具。使用标准平均差（SMD）作为效应量进行随机效应荟萃分析，并使用平均差（MD）进行敏感性分析。
荟萃分析共纳入6项随机对照研究。其中5项研究考察了基于互联网的CBT干预措施，1项研究使用了基于CBT方法的电子健康干预措施。对照组接受常规护理、被列入等待名单或参加基于网络的讨论论坛。在为期8周至6个月的干预期后，与对照组相比，干预组经患者健康问卷9评估的抑郁症状显著减轻（SMD=-0.46，MD=-2.33；P<0.001）。干预组在干预期后，经12项简短健康调查问卷子量表评估的心理健康相关生活质量显著改善（SMD=0.38，MD=3.89；P<0.001）。
荟萃分析表明，电子健康压力管理干预措施可显著改善CVD患者的心理健康参数。鉴于其显著的积极影响，医疗保健提供者应考虑将电子健康压力管理计划纳入CVD患者的标准护理中。这些计划可成为减轻与慢性心血管疾病相关心理负担的宝贵工具，最终改善患者的总体结局和生活质量。
