Efficacy and Moderators of Internet-Based Interventions in Adults with Subthreshold Depression: An Individual Participant Data Meta-Analysis of Randomized Controlled Trials
Efficacy and Moderators of Internet-Based Interventions in Adults with Subthreshold Depression: An Individual Participant Data Meta-Analysis of Randomized Controlled Trials
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DOI：
10.1159/000507819
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发表时间：
2021-02-01
影响因子：
22.8
通讯作者：
Ebert, David Daniel
中科院分区：
文献类型：
--
作者：
Reins, Jo Annika;Buntrock, Claudia;Ebert, David Daniel
简介：基于互联网的干预措施对治疗阈下抑郁症（sD）和预防重性抑郁症（MDD）发作的影响的证据不一致。目的：我们进行了一项个体参与者数据荟萃分析，以确定干预组和对照组（IG，CG）在抑郁症状严重程度（DSS），治疗反应，接近无症状状态，症状恶化和MDD发作以及干预结果的调节因素方面的差异。方法：通过PubMed、PsycINFO、Embase和科克伦图书馆系统检索随机对照试验。多水平回归分析用于检查疗效和调节因素。结果：纳入了7项试验（2，186名受试者）。在所有测量点，IG均上级DSS（治疗后：6-12周; Hedges g = 0.39 [95% CI：0.25-0.53];随访1：3-6个月; g = 0.30 [95% CI：0.15-0.45];随访2：12个月，g = 0.27 [95% CI：0.07-0.47]，与对照组比较。在所有测量点，IG中的参与者比CG中的参与者显著更多地达到响应和接近无障碍状态。在治疗后评估和随访2时，发现两组之间的症状恶化有显著差异。IG组12个月内MDD发作的发生率（19%）低于CG组（26%）。较高的初始DSS和年龄较大被确定为干预效果的调节剂DSS。结论：我们的研究结果为基于互联网的干预提供了证据，是一种合适的低阈值干预措施，用于治疗sD患者并降低MDD的发病率。这对于有大量症状负担的老年人尤其如此。
Introduction: Evidence on effects of Internet-based interventions to treat subthreshold depression (sD) and prevent the onset of major depression (MDD) is inconsistent. Objective: We conducted an individual participant data meta-analysis to determine differences between intervention and control groups (IG, CG) in depressive symptom severity (DSS), treatment response, close to symptom-free status, symptom deterioration and MDD onset as well as moderators of intervention outcomes. Methods: Randomized controlled trials were identified through systematic searches via PubMed, PsycINFO, Embase and Cochrane Library. Multilevel regression analyses were used to examine efficacy and moderators. Results: Seven trials (2,186 participants) were included. The IG was superior in DSS at all measurement points (posttreatment: 6-12 weeks; Hedges' g = 0.39 [95% CI: 0.25-0.53]; follow-up 1: 3-6 months; g = 0.30 [95% CI: 0.15-0.45]; follow-up 2: 12 months, g = 0.27 [95% CI: 0.07-0.47], compared with the CG. Significantly more participants in the IG than in the CG reached response and close to symptom-free status at all measurement points. A significant difference in symptom deterioration between the groups was found at the posttreatment assessment and follow-up 2. Incidence rates for MDD onset within 12 months were lower in the IG (19%) than in the CG (26%). Higher initial DSS and older age were identified as moderators of intervention effect on DSS. Conclusions: Our findings provide evidence for Internet-based interventions to be a suitable low-threshold intervention to treat individuals with sD and to reduce the incidence of MDD. This might be particularly true for older people with a substantial symptom burden.