Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials.
Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials.
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DOI：
10.1371/journal.pdig.0000002
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发表时间：
2022-01-01
期刊：
影响因子：
--
通讯作者：
Sun, Shufang
中科院分区：
文献类型：
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作者：
Goldberg, Simon B;Lam, Sin U;Sun, Shufang
已提出以移动电话为基础的干预措施，作为减少与精神疾病有关的疾病负担的一种手段。虽然许多随机对照试验和荟萃分析调查了这种可能性，但证据尚不清楚。我们对随机对照试验中基于手机的干预措施的meta分析进行了系统的meta综述。我们综合了来自145项随机对照试验和47,940名参与者的14项荟萃分析的结果。我们确定了34个效应值，代表了参与者、干预、比较和结果（PICO）的独特配对，并使用总体评价方法对证据的强度进行了分级。我们未能找到令人信服的有效性证据（即n > 1000, p < 10-6, I 2 < 50%，无发表偏倚）；很少对代表性效应量的发表偏倚进行评估。8个效应量提供了极具启发性的证据（即，n > 1000, p < 10-6），包括智能手机干预在心理症状和生活质量测量方面优于非活动对照（ds = 0.32至0.47），基于短信的干预在戒烟方面优于非特定对照和积极对照（ds分别= 0.31和0.19）。随着比较条件变得更加严格（即，不活跃到活跃，非特异性到特异性），效果的大小和证据的强度趋于减少。4个效应量提供了暗示性证据，14个效应量提供了弱证据，8个效应量不显著。尽管存在很大的异质性，但没有发现调节因子。没有不良反应的报道。综上所述，这些结果支持了基于手机的干预的潜力，并强调了在该领域工作的提供者、政策制定者、临床试验学家和元分析人员的关键方向。
Mobile phone-based interventions have been proposed as a means for reducing the burden of disease associated with mental illness. While numerous randomized controlled trials and meta-analyses have investigated this possibility, evidence remains unclear. We conducted a systematic meta-review of meta-analyses examining mobile phone-based interventions tested in randomized controlled trials. We synthesized results from 14 meta-analyses representing 145 randomized controlled trials and 47,940 participants. We identified 34 effect sizes representing unique pairings of participants, intervention, comparisons, and outcome (PICO) and graded the strength of the evidence as using umbrella review methodology. We failed to find convincing evidence of efficacy (i.e., n > 1000, p < 10-6, I 2 < 50%, absence of publication bias); publication bias was rarely assessed for the representative effect sizes. Eight effect sizes provided highly suggestive evidence (i.e., n > 1000, p < 10-6), including smartphone interventions outperforming inactive controls on measures of psychological symptoms and quality of life (ds = 0.32 to 0.47) and text message-based interventions outperforming non-specific controls and active controls for smoking cessation (ds = 0.31 and 0.19, respectively). The magnitude of effects and strength of evidence tended to diminish as comparison conditions became more rigorous (i.e., inactive to active, non-specific to specific). Four effect sizes provided suggestive evidence, 14 effect sizes provided weak evidence, and eight effect sizes were non-significant. Despite substantial heterogeneity, no moderators were identified. Adverse effects were not reported. Taken together, results support the potential of mobile phone-based interventions and highlight key directions to guide providers, policy makers, clinical trialists, and meta-analysts working in this area.