Effectiveness of a freely available computerised cognitive behavioural therapy programme (MoodGYM) for depression: Meta-analysis
Effectiveness of a freely available computerised cognitive behavioural therapy programme (MoodGYM) for depression: Meta-analysis
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免费提供的计算机化认知行为治疗计划 (MoodGYM) 对抑郁症的有效性：荟萃分析
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
G. O’Reilly
中科院分区：
文献类型：
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作者：
C. Twomey;G. O’Reilly
目的：探讨一种可免费获得的计算机认知行为治疗方案（MoodGYM）对成人抑郁症（主要结局）、焦虑症和一般心理困扰的有效性。方法：检索PsycINFO、CINAHL Plus、MEDLINE、EMBASE、Social Science Citation Index及相关文献。为了评估MoodGYM的有效性，我们对已确定的随机对照试验进行了随机效应荟萃分析。结果：11项研究的比较表明，MoodGYM在干预后对抑郁症状有效，但效应量较小（g = 0.36, 95%可信区间：0.17-0.56;I2 = 78%）。删除质量最低的研究（k = 3）影响最小；然而，调整发表偏倚后，效应大小降至非显著水平（g = 0.17, 95%置信区间：- 0.01至0.38）。六项研究的比较表明，MoodGYM在干预后对焦虑症状有效，具有中等效应量（g = 0.57, 95%可信区间：0.20-0.94;I2 = 85%）。虽然六项研究的比较对MoodGYM对一般心理困扰症状的有效性没有产生显著性，但小效应量接近显著性（g = 0.34, 95%可信区间：−0.04至0.68;I2 = 79%）。在随机对照试验中，环境类型（临床与非临床）和moodgym开发者作者对结果没有显著影响；然而，结果受到控制类型、临床医生指导水平、试验的国际区域和对MoodGYM的依从性的影响。结论：几个变量的混杂影响，以及发表偏倚的存在，意味着本荟萃分析的结果应谨慎解释。初步支持MoodGYM对抑郁症状和一般心理困扰的有效性。该方案对焦虑症状的中等效果证明了它对有这种困难的人的效用。MoodGYM的好处在于它可以在互联网上免费使用，但坚持率可能会有问题，在极端情况下可能会低于10%。我们得出的结论是，MoodGYM最适合作为一种人口水平的干预，可能会使相当大的少数用户受益。
Objective: To investigate the effectiveness of a freely available computerised cognitive behavioural therapy programme (MoodGYM) for depression (primary outcome), anxiety and general psychological distress in adults. Method: We searched PsycINFO, CINAHL Plus, MEDLINE, EMBASE, Social Science Citation Index and references from identified papers. To assess MoodGYM’s effectiveness, we conducted random effects meta-analysis of identified randomised controlled trials. Results: Comparisons from 11 studies demonstrated MoodGYM’s effectiveness for depression symptoms at post-intervention, with a small effect size (g = 0.36, 95% confidence interval: 0.17–0.56; I2 = 78%). Removing the lowest quality studies (k = 3) had minimal impact; however, adjusting for publication bias reduced the effect size to a non-significant level (g = 0.17, 95% confidence interval: −0.01 to 0.38). Comparisons from six studies demonstrated MoodGYM’s effectiveness for anxiety symptoms at post-intervention, with a medium effect size (g = 0.57, 95% confidence interval: 0.20–0.94; I2 = 85%). Although comparisons from six studies did not yield significance for MoodGYM’s effectiveness for general psychological distress symptoms, the small effect size approached significance (g = 0.34, 95% confidence interval: −0.04 to 0.68; I2 = 79%). Both the type of setting (clinical vs non-clinical) and MoodGYM-developer authorship in randomised controlled trials had no meaningful influence on results; however, the results were confounded by the type of control deployed, level of clinician guidance, international region of trial and adherence to MoodGYM. Conclusions: The confounding influence of several variables, and presence of publication bias, means that the results of this meta-analysis should be interpreted with caution. Tentative support is provided for MoodGYM’s effectiveness for symptoms of depression and general psychological distress. The programme’s medium effect on anxiety symptoms demonstrates its utility for people with this difficulty. MoodGYM benefits from its free accessibility over the Internet, but adherence rates can be problematic and at the extreme can fall below 10%. We conclude that MoodGYM is best placed as a population-level intervention that is likely to benefit a sizeable minority of its users.