Internet-delivered psychological treatments for mood and anxiety disorders: a systematic review of their efficacy, safety, and cost-effectiveness.
Internet-delivered psychological treatments for mood and anxiety disorders: a systematic review of their efficacy, safety, and cost-effectiveness.
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DOI：
10.1371/journal.pone.0098118
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Jonsson U
中科院分区：
文献类型：
--
作者：
Arnberg FK;Linton SJ;Hultcrantz M;Heintz E;Jonsson U
需要更多地获得循证心理治疗。本综述旨在评估互联网提供的情绪和焦虑障碍的心理治疗是否有效，非劣效于现有的治疗方法，安全，对儿童，青少年和成人具有成本效益。我们检索了截至2013年3月发表的文献。随机对照试验（RCT）被考虑用于评估短期疗效和安全性，并在荟萃分析中汇总。为了长期效果和成本效益，还考虑了其他设计。评价了与既定治疗的比较的非劣效性。两名评审员独立评估了相关研究的偏倚风险。证据的质量采用国际分级系统进行分级。共确定了52项相关RCT，其中12项因偏倚风险高而被排除。确定了5项成本效益研究，3项因偏倚风险高而被排除。纳入的试验主要评估了互联网提供的认知行为疗法（I-CBT）对成年志愿者的等待名单，其中88%在瑞典或澳大利亚进行。一项试验涉及儿童。对于成年人，I-CBT与轻度/中度抑郁症（d = 0.83; 95% CI 0.59，1.07）和社交恐惧症（d = 0.85; 95% CI 0.66，1.05）的等候名单相比的短期疗效的证据质量被评为中度，而互联网传递的注意力偏差修正与社交恐惧症的假治疗相比无疗效的证据质量被评为中度（d =-0.04; 95% CI-0.24，0.35）。 其他疾病、干预措施、儿童/青少年、非劣效性、不良事件和成本效益的证据质量被评为低/极低。I-CBT是一种可行的治疗选择，适用于患有抑郁症和一些焦虑症的成年人，他们需要这种治疗方式。在支持广泛执行之前，仍存在一些重要问题。未来的研究将受益于优先适应治疗儿童/青少年和使用非劣效性设计与既定的治疗形式。
Greater access to evidence-based psychological treatments is needed. This review aimed to evaluate whether internet-delivered psychological treatments for mood and anxiety disorders are efficacious, noninferior to established treatments, safe, and cost-effective for children, adolescents and adults. We searched the literature for studies published until March 2013. Randomized controlled trials (RCTs) were considered for the assessment of short-term efficacy and safety and were pooled in meta-analyses. Other designs were also considered for long-term effect and cost-effectiveness. Comparisons against established treatments were evaluated for noninferiority. Two reviewers independently assessed the relevant studies for risk of bias. The quality of the evidence was graded using an international grading system. A total of 52 relevant RCTs were identified whereof 12 were excluded due to high risk of bias. Five cost-effectiveness studies were identified and three were excluded due to high risk of bias. The included trials mainly evaluated internet-delivered cognitive behavioral therapy (I-CBT) against a waiting list in adult volunteers and 88% were conducted in Sweden or Australia. One trial involved children. For adults, the quality of evidence was graded as moderate for the short-term efficacy of I-CBT vs. waiting list for mild/moderate depression (d = 0.83; 95% CI 0.59, 1.07) and social phobia (d = 0.85; 95% CI 0.66, 1.05), and moderate for no efficacy of internet-delivered attention bias modification vs. sham treatment for social phobia (d = −0.04; 95% CI −0.24, 0.35). The quality of evidence was graded as low/very low for other disorders, interventions, children/adolescents, noninferiority, adverse events, and cost-effectiveness. I-CBT is a viable treatment option for adults with depression and some anxiety disorders who request this treatment modality. Important questions remain before broad implementation can be supported. Future research would benefit from prioritizing adapting treatments to children/adolescents and using noninferiority designs with established forms of treatment.
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