Efficacy of Virtual Care for Depressive Disorders: Systematic Review and Meta-analysis.
Efficacy of Virtual Care for Depressive Disorders: Systematic Review and Meta-analysis.
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DOI：
10.2196/38955
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发表时间：
2023-01-09
影响因子：
5.2
通讯作者：
Gaynes, Bradley N.
中科院分区：
文献类型：
--
作者：
Schiller, Crystal Edler;Prim, Julianna;Bauer, Anna E.;Lux, Linda;Lundegard, Laura Claire;Kang, Michelle;Hellberg, Samantha;Thompson, Katherine;Webber, Theresa;Teklezghi, Adonay;Pettee, Noah;Gaffney, Katherine;Hodgins, Gabrielle;Rahman, Fariha;Steinsiek, J. Nikki;Modi, Anita;Gaynes, Bradley N.
关键词：
COVID-19大流行造成了抑郁症等与痛苦相关的精神障碍的流行，同时需要转向精神卫生保健的虚拟领域;然而，支持使用虚拟干预措施的证据尚不清楚。本研究的目的是通过解决三个关键问题来评估虚拟干预对抑郁症的疗效：（1）虚拟干预是否比不治疗或其他控制条件（即等待名单，照常治疗[TAU]或注意力控制）提供更好的结果？(2)面对面干预是否比虚拟干预提供更好的结果？(3)一种类型的虚拟干预是否比另一种提供更好的结果？我们检索了PubMed、EMBASE和PsycINFO数据库中2010年1月1日至2021年10月30日发表的试验。我们纳入了成年抑郁症患者的随机对照试验，这些试验测试了虚拟干预并使用了经验证的抑郁测量。主要结局定义为缓解（即不再符合抑郁症的临床临界值）、反应（即抑郁症状在临床上显着减轻）和治疗后的抑郁严重程度。两名研究人员使用PRISMA（系统评价和荟萃分析的首选报告项目）指南独立选择研究并提取数据。根据美国医疗保健和研究质量局指南评价偏倚风险。我们计算了二元结局的比值比（OR）和连续结局的标准化均值差（SMD）。我们确定了3797篇参考文献，其中24篇符合条件。与等待名单相比，虚拟干预具有更高的缓解几率（OR 10.30，95% CI 5.70-18.60; N=619例患者）和更低的治疗后症状严重程度（SMD 0.81，95% CI 0.52-1.10; N=1071）。与TAU和虚拟注意力控制条件相比，虚拟干预具有更高的缓解几率（OR 2.27，95% CI 1.10-3.35; N=512）和更低的治疗后症状严重程度（SMD 0.25，95% CI 0.09-0.42; N=573）。现场干预结果与虚拟干预结果无显著差异（例如，缓解OR 0.84，CI 0.51-1.37; N=789）。没有合格的研究直接比较了一种主动虚拟干预与另一种主动虚拟干预。虚拟干预是有效的控制条件相比，包括候补控制，TAU，注意力控制。虽然研究的数量相对较少，但证据的强度是中等的，即面对面干预并没有比虚拟干预产生更好的结果。
The COVID-19 pandemic has created an epidemic of distress-related mental disorders such as depression, while simultaneously necessitating a shift to virtual domains of mental health care; yet, the evidence to support the use of virtual interventions is unclear. The purpose of this study was to evaluate the efficacy of virtual interventions for depressive disorders by addressing three key questions: (1) Does virtual intervention provide better outcomes than no treatment or other control conditions (ie, waitlist, treatment as usual [TAU], or attention control)? (2) Does in-person intervention provide better outcomes than virtual intervention? (3) Does one type of virtual intervention provide better outcomes than another? We searched the PubMed, EMBASE, and PsycINFO databases for trials published from January 1, 2010, to October 30, 2021. We included randomized controlled trials of adults with depressive disorders that tested a virtual intervention and used a validated depression measure. Primary outcomes were defined as remission (ie, no longer meeting the clinical cutoff for depression), response (ie, a clinically significant reduction in depressive symptoms), and depression severity at posttreatment. Two researchers independently selected studies and extracted data using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Risk of bias was evaluated based on Agency for Healthcare and Research Quality guidelines. We calculated odds ratios (ORs) for binary outcomes and standardized mean differences (SMDs) for continuous outcomes. We identified 3797 references, 24 of which were eligible. Compared with waitlist, virtual intervention had higher odds of remission (OR 10.30, 95% CI 5.70-18.60; N=619 patients) and lower posttreatment symptom severity (SMD 0.81, 95% CI 0.52-1.10; N=1071). Compared with TAU and virtual attention control conditions, virtual intervention had higher odds of remission (OR 2.27, 95% CI 1.10-3.35; N=512) and lower posttreatment symptom severity (SMD 0.25, 95% CI 0.09-0.42; N=573). In-person intervention outcomes were not significantly different from virtual intervention outcomes (eg, remission OR 0.84, CI 0.51-1.37; N=789). No eligible studies directly compared one active virtual intervention to another. Virtual interventions were efficacious compared with control conditions, including waitlist control, TAU, and attention control. Although the number of studies was relatively small, the strength of evidence was moderate that in-person interventions did not yield significantly better outcomes than virtual interventions for depressive disorders.
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