Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data.
Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data.
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DOI：
10.1016/s2215-0366(21)00077-8
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发表时间：
2021-06
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影响因子：
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通讯作者：
Cuijpers P
中科院分区：
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作者：
Furukawa TA;Suganuma A;Ostinelli EG;Andersson G;Beevers CG;Shumake J;Berger T;Boele FW;Buntrock C;Carlbring P;Choi I;Christensen H;Mackinnon A;Dahne J;Huibers MJH;Ebert DD;Farrer L;Forand NR;Strunk DR;Ezawa ID;Forsell E;Kaldo V;Geraedts A;Gilbody S;Littlewood E;Brabyn S;Hadjistavropoulos HD;Schneider LH;Johansson R;Kenter R;Kivi M;Björkelund C;Kleiboer A;Riper H;Klein JP;Schröder J;Meyer B;Moritz S;Bücker L;Lintvedt O;Johansson P;Lundgren J;Milgrom J;Gemmill AW;Mohr DC;Montero-Marin J;Garcia-Campayo J;Nobis S;Zarski AC;O'Moore K;Williams AD;Newby JM;Perini S;Phillips R;Schneider J;Pots W;Pugh NE;Richards D;Rosso IM;Rauch SL;Sheeber LB;Smith J;Spek V;Pop VJ;Ünlü B;van Bastelaar KMP;van Luenen S;Garnefski N;Kraaij V;Vernmark K;Warmerdam L;van Straten A;Zagorscak P;Knaevelsrud C;Heinrich M;Miguel C;Cipriani A;Efthimiou O;Karyotaki E;Cuijpers P
互联网认知行为疗法（iCBT）是治疗抑郁症的一种可行的认知行为疗法实施形式。然而，iCBT项目通过不同的实施方法包含对多种认知和行为技能的训练，目前尚不清楚这些组成部分中哪些更有效以及对哪些人更有效。
我们对抑郁症的iCBT试验进行了系统综述和个体参与者数据成分网络荟萃分析（cNMA）。我们在PubMed、PsycINFO、Embase和Cochrane图书馆中检索了从数据库建立到2019年1月1日发表的随机对照试验（RCT），这些试验比较了任何形式的iCBT与其他形式或对照条件在成人（≥18岁）抑郁症急性治疗中的效果。排除了针对住院患者或双相抑郁症患者的研究。我们向原始作者寻求个体参与者数据。当无法获得这些数据时，我们使用汇总数据。两名独立研究人员确定了所包含的成分。主要结局是抑郁严重程度，以在治疗中添加一种成分时患者健康问卷 - 9（PHQ - 9）评分的增量平均差（iMD）来表示。我们开发了一个网络应用程序，根据基线患者特征估计任何两种成分组合之间的相对疗效。本研究在PROSPERO注册，注册号为CRD42018104683。
我们确定了76项RCT，包括48项提供个体参与者数据的试验（11704名参与者）和28项有汇总数据的试验（6474名参与者）。参与者的加权平均年龄为42.0岁，报告的17521人中有12406人（71%）为女性。有提示性证据表明行为激活可能有益（iMD -1.83 [95%可信区间（CrI）-2.90至 -0.80]），放松可能有害（1.20 [95% CrI 0.17至2.27]）。基线严重程度是终点抑郁最强的预后因素。人工和自动鼓励相结合可减少治疗脱落（增量优势比，0.32 [95% CrI 0.13至0.93]）。在大多数纳入研究中，随机化过程、缺失结局数据或报告结果的选择方面的偏倚风险较低，偏离预期干预的偏倚风险不确定，结局测量的偏倚风险较高。研究及其成分之间存在中到高度的异质性。
个体患者数据cNMA揭示了iCBT方案中潜在有益、不太有益或有害的成分和实施形式。旨在有效且高效的iCBT方案可能会选择包含有益成分并排除潜在有害的成分。我们的网络应用程序可以促进治疗师和患者在选择他们偏好的iCBT方案时共同决策。
日本学术振兴会
Internet cognitive behavioural therapy (iCBT) is a viable delivery format of CBT for depression. However, iCBT programmes include training in a wide array of cognitive and behavioural skills via different delivery methods, and it remains unclear which of these components are more efficacious and for whom. We did a systematic review and individual participant data component network meta-analysis (cNMA) of iCBT trials for depression. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomised controlled trials (RCTs) published from database inception to Jan 1, 2019, that compared any form of iCBT against another or a control condition in the acute treatment of adults (aged ≥18 years) with depression. Studies with inpatients or patients with bipolar depression were excluded. We sought individual participant data from the original authors. When these data were unavailable, we used aggregate data. Two independent researchers identified the included components. The primary outcome was depression severity, expressed as incremental mean difference (iMD) in the Patient Health Questionnaire-9 (PHQ-9) scores when a component is added to a treatment. We developed a web app that estimates relative efficacies between any two combinations of components, given baseline patient characteristics. This study is registered in PROSPERO, CRD42018104683. We identified 76 RCTs, including 48 trials contributing individual participant data (11 704 participants) and 28 trials with aggregate data (6474 participants). The participants’ weighted mean age was 42·0 years and 12 406 (71%) of 17 521 reported were women. There was suggestive evidence that behavioural activation might be beneficial (iMD −1·83 [95% credible interval (CrI) −2·90 to −0·80]) and that relaxation might be harmful (1·20 [95% CrI 0·17 to 2·27]). Baseline severity emerged as the strongest prognostic factor for endpoint depression. Combining human and automated encouragement reduced dropouts from treatment (incremental odds ratio, 0·32 [95% CrI 0·13 to 0·93]). The risk of bias was low for the randomisation process, missing outcome data, or selection of reported results in most of the included studies, uncertain for deviation from intended interventions, and high for measurement of outcomes. There was moderate to high heterogeneity among the studies and their components. The individual patient data cNMA revealed potentially helpful, less helpful, or harmful components and delivery formats for iCBT packages. iCBT packages aiming to be effective and efficient might choose to include beneficial components and exclude ones that are potentially detrimental. Our web app can facilitate shared decision making by therapist and patient in choosing their preferred iCBT package. Japan Society for the Promotion of Science.