Effectiveness of a Web-Based Guided Self-help Intervention for Outpatients With a Depressive Disorder: Short-term Results From a Randomized Controlled Trial
Effectiveness of a Web-Based Guided Self-help Intervention for Outpatients With a Depressive Disorder: Short-term Results From a Randomized Controlled Trial
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DOI：
10.2196/jmir.4861
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发表时间：
2016-03-01
影响因子：
7.4
通讯作者：
van Straten, Annemieke
中科院分区：
文献类型：
--
作者：
Kenter, Robin Maria Francisca;Cuijpers, Pim;van Straten, Annemieke
背景：研究令人信服地表明，抑郁症的症状可以通过基于互联网的指导性干预来减少。然而，大多数研究招募的是普通人群。有没有足够的证据的有效性时，在常规的临床实践在门诊clinics.Objective：本随机对照试验的目的是研究抑郁症患者（定义的诊断和统计手册的疾病，第四版），评估由训练有素的采访者与复合国际诊断访谈，谁登记治疗门诊心理健康诊所。我们的目的是在开始面对面治疗之前检查基于互联网的指导性自助的有效性。方法：我们从门诊招募了269名年龄在18岁至79岁之间的门诊患者，并将他们随机分配到基于互联网的问题解决治疗组（n = 136），每周提供学生支持，或对照组，他们仍在等待名单上，并提供自助手册对照组133例。这两种情况的参与者都被允许在门诊接受面对面的治疗。我们测量的主要结果，抑郁症状，流行病学研究中心抑郁量表（CES-D）。次要结局指标为医院焦虑和抑郁量表焦虑子量表（HADS-A）、抑郁严重程度指数问卷（ISI）和EuroQol视觉模拟量表（EQ-5D VAS）。所有结果均在后测（基线后8周）通过电话进行评估。结果：184名（68.4%）参与者完成了后测测量。我们发现，干预组（d = 0.75）和对照组（d = 0.69）的组内效应量均为中等至较大。然而，组间效应量非常小（d = 0.07），治疗后CES-D评分的回归分析显示组间无显著差异（B = 1.134，95% CI-2.495至4.763）。符合方案分析（完成>= 4次治疗）结果也不显著（B = 1.154，95% CI-1.978至7.637）。组间差异较小，所有次要结局均不显著。对干预措施的依从性很低。只有36%（49/136）的患者接受了足够剂量的干预（>= 4/5次）。整体治疗的满意度是moderate.Conclusions：基于互联网的解决问题的治疗是不是更有效地减少抑郁症的症状比在门诊心理健康诊所的等待名单期间接受一个无指导的自助书。效应量远小于早期在一般人群中的研究，并且依从率低表明在抑郁症门诊患者治疗的这个阶段干预的可接受性低。然而，考虑到有很多证据表明基于互联网的治疗有效，现在就得出关于这些治疗在门诊诊所整体上的有效性的确切结论还为时过早。
Background: Research has convincingly demonstrated that symptoms of depression can be reduced through guided Internet-based interventions. However, most of those studies recruited people form the general population. There is insufficient evidence for the effectiveness when delivered in routine clinical practice in outpatient clinics.Objective: The objective of this randomized controlled trial was to study patients with a depressive disorder (as defined by the Diagnostic and Statistical Manual of Disorders, fourth edition), as assessed by trained interviewers with the Composite International Diagnostic Interview, who registered for treatment at an outpatient mental health clinic. We aimed to examine the effectiveness of guided Internet-based self-help before starting face-to-face treatment.Methods: We recruited 269 outpatients, aged between 18 and 79 years, from outpatient clinics and randomly allocated them to Internet-based problem solving therapy (n = 136), with weekly student support, or to a control condition, who remained on the waitlist with a self-help booklet (control group; n = 133). Participants in both conditions were allowed to take up face-to-face treatment at the outpatient clinics afterward. We measured the primary outcome, depressive symptoms, by Center for Epidemiological Studies Depression scale (CES-D). Secondary outcome measures were the Hospital Anxiety and Depression Scale Anxiety subscale (HADS-A), Insomnia Severity Index questionnaire (ISI), and EuroQol visual analog scale (EQ-5D VAS). All outcomes were assessed by telephone at posttest (8 weeks after baseline).Results: Posttest measures were completed by 184 (68.4%) participants. We found a moderate to large within-group effect size for both the intervention (d = 0.75) and the control (d = 0.69) group. However, the between-group effect size was very small (d = 0.07), and regression analysis on posttreatment CES-D scores revealed no significant differences between the groups (b = 1.134, 95% CI-2.495 to 4.763). The per-protocol analysis (>= 4 sessions completed) results were also not significant (b = 1.154, 95% CI-1.978 to 7.637). Between-group differences were small and not significant for all secondary outcomes. Adherence to the intervention was low. Only 36% (49/136) received an adequate dosage of the intervention (>= 4 of 5 sessions). The overall treatment satisfaction was moderate.Conclusions: Internet-based problem solving therapy is not more effective in reducing symptoms of depression than receiving an unguided self-help book during the waitlist period at outpatient mental health clinics. The effect sizes are much smaller than those found in earlier research in the general population, and the low rates of adherence indicate that the acceptability of the intervention at this stage of treatment for depressed outpatients is low. However, taking into account that there is much evidence for the efficacy of Internet-based treatments, it is too early to draw firm conclusions about the effectiveness of these treatments in outpatient clinics as a whole.