Efficacy of Self-guided Internet-Based Cognitive Behavioral Therapy in the Treatment of Depressive Symptoms A Meta-analysis of Individual Participant Data
Efficacy of Self-guided Internet-Based Cognitive Behavioral Therapy in the Treatment of Depressive Symptoms A Meta-analysis of Individual Participant Data
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DOI：
10.1001/jamapsychiatry.2017.0044
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发表时间：
2017-04-01
期刊：
影响因子：
25.8
通讯作者：
Cuijpers, Pim
中科院分区：
文献类型：
--
作者：
Karyotaki, Eirini;Riper, Heleen;Cuijpers, Pim
自我指导的基于互联网的认知行为疗法（iCBT）有可能增加循证治疗的可及性，并降低抑郁症治疗的成本。目的评估自我引导iCBT治疗成人抑郁症状的效果，并与对照组进行比较，评估治疗结果和反应的调节作用。数据来源系统检索PubMed、Embase、PsycINFO和Cochrane图书馆自建库至2016年1月1日的文献，共检索到文献摘要13 384篇。研究选择在有抑郁症状的个体中，将自我引导的iCBT与对照组（常规护理、等候名单或注意力控制）进行比较的随机临床试验。数据提取和综合主要作者提供了来自16项合格研究中的13项的3876名参与者的个人数据。缺失的数据使用多次输入处理。在研究中嵌套参与者的混合效应模型用于检查治疗结果和调节因子。主要结果和测量结果包括贝克抑郁量表、流行病学研究中心抑郁量表和9项患者健康问卷得分。所有纳入研究的量表都是标准化的。结果3876名研究参与者的平均（SD）年龄为42.0（11.7）岁，3832名参与者中2531名（66.0%）为女性，2574名参与者中有1368名（53.1%）完成中等教育，3146名参与者中有2262名（71.9%）就业。自我引导iCBT在抑郁症状严重程度（beta = -0.21; Hedges g = 0.27）和治疗反应（beta = 0.53；优势比，1.95;95% CI, 1.52-2.50；需要治疗的人数，8）方面显著优于对照组。坚持治疗与较低的抑郁症状（β = -0.19; P = .001）和较好的治疗反应（β = 0.90; P < .001）相关。被检查的参与者和研究水平变量都没有调节治疗结果。结论与意义自我引导iCBT治疗抑郁症状有效。个体参与者数据的荟萃分析的使用为临床和政策决策提供了大量证据，因为自我引导的iCBT可以被认为是治疗抑郁症症状的循证第一步方法。在将iCBT推广到常规护理之前，应解决iCBT的几个局限性。
IMPORTANCE Self-guided internet-based cognitive behavioral therapy (iCBT) has the potential to increase access and availability of evidence-based therapy and reduce the cost of depression treatment.OBJECTIVES To estimate the effect of self-guided iCBT in treating adults with depressive symptoms compared with controls and evaluate the moderating effects of treatment outcome and response.DATA SOURCES A total of 13 384 abstracts were retrieved through a systematic literature search in PubMed, Embase, PsycINFO, and Cochrane Library from database inception to January 1, 2016.STUDY SELECTION Randomized clinical trials in which self-guided iCBT was compared with a control (usual care, waiting list, or attention control) in individuals with symptoms of depression.DATA EXTRACTION AND SYNTHESIS Primary authors provided individual participant data from 3876 participants from 13 of 16 eligible studies. Missing data were handled using multiple imputations. Mixed-effects models with participants nested within studies were used to examine treatment outcomes and moderators.MAIN OUTCOMES AND MEASURES Outcomes included the Beck Depression Inventory, Center for Epidemiological Studies-Depression Scale, and 9-item Patient Health Questionnaire scores. Scales were standardized across the pool of the included studies.RESULTS Of the 3876 study participants, the mean (SD) age was 42.0 (11.7) years, 2531 (66.0%) of 3832 were female, 1368 (53.1%) of 2574 completed secondary education, and 2262 (71.9%) of 3146 were employed. Self-guided iCBT was significantly more effective than controls on depressive symptoms severity (beta = -0.21; Hedges g = 0.27) and treatment response (beta = 0.53; odds ratio, 1.95; 95% CI, 1.52-2.50; number needed to treat, 8). Adherence to treatment was associated with lower depressive symptoms (beta = -0.19; P = .001) and greater response to treatment (beta = 0.90; P < .001). None of the examined participant and study-level variables moderated treatment outcomes.CONCLUSIONS AND RELEVANCE Self-guided iCBT is effective in treating depressive symptoms. The use of meta-analyses of individual participant data provides substantial evidence for clinical and policy decision making because self-guided iCBT can be considered as an evidence-based first-step approach in treating symptoms of depression. Several limitations of the iCBT should be addressed before it can be disseminated into routine care.