背景:人们对开发可扩展的干预措施越来越感兴趣,包括基于互联网的认知行为疗法(iCBT),以满足日益增长的精神卫生服务需求。鉴于全球多样性的增长,iCBT治疗抑郁症的临床试验必须包括不同的样本,至少,报告比赛信息,种族,或其样本的其他背景指标。不幸的是,该领域缺乏关于目前在iCBT文献中报道和代表多样性的数据.
目标:因此,本系统综述的主要目的是研究已发表的iCBT治疗抑郁症的临床试验中有关种族和族裔身份的总体报告.我们还旨在审查特定种族和族裔少数族裔群体的代表性,并纳入替代背景指标,如移民身份或居住国。
方法:如果是将iCBT与等待名单进行比较的随机对照试验,照常护理,主动控制,或另一个iCBT。纳入的论文还必须关注急性治疗(例如,4周至6个月)的抑郁症,通过互联网在网站或智能手机应用程序上交付,并使用有指导或无指导的自助。研究最初是从METAPSY数据库(n=59)中确定的,然后扩展到包括2022年之前的论文,论文从Embase检索,PubMed,PsycINFO,和Cochrane(n=3)。偏倚风险评估表明,由于使用自我报告结果测量,报告的研究至少有一些偏倚风险。
结果:本研究总结了总共62项iCBT随机对照试验,代表17,210名参与者。在这62篇论文中,只有17(27%)的试验报告种族,只有12人(19%)报告了种族。美国以外的报道非常糟糕,在17项报告种族的研究中,美国占15项(88%),在12项报告种族的研究中,美国占9项(75%)。在系统评价中报告的3,623名参与者中,报告最多的种族类别是白人(n=2716,74.9%),其次是亚洲(n=209,5.8%)和黑人(n=274,7.6%)。此外,在美国以外进行的46篇论文中,只有25篇(54%)报道了其他背景人口统计数据.
结论:重要的是要注意,在本研究中观察到的漏报并不一定表明在实际研究人群中存在漏报。然而,这些发现凸显了文献中发现的iCBT抑郁症试验中种族和民族的不良报道.这种缺乏多样性报告可能对这些干预措施的可扩展性产生重大影响。
BACKGROUND: There is a growing interest in developing scalable interventions, including internet-based cognitive behavioral therapy (iCBT), to meet the increasing demand for mental health services. Given the growth in diversity worldwide, it is essential that the clinical trials of iCBT for depression include diverse samples or, at least, report information on the race, ethnicity, or other background indicators of their samples. Unfortunately, the field lacks data on how well diversity is currently reported and represented in the iCBT literature.
OBJECTIVE: Thus, the main objective of this systematic
review was to examine the overall reporting of racial and ethnic identities in published clinical trials of iCBT for depression. We also aimed to
review the representation of specific racial and ethnic minoritized groups and the inclusion of alternative background indicators such as migration status or country of residence.
METHODS: Studies were included if they were randomized controlled trials in which iCBT was compared to a waiting list, care-as-usual, active control, or another iCBT. The included papers also had to have a focus on acute treatment (eg, 4 weeks to 6 months) of depression, be delivered via the internet on a website or a smartphone app and use guided or unguided self-help. Studies were initially identified from the METAPSY database (n=59) and then extended to include papers up to 2022, with papers retrieved from Embase, PubMed, PsycINFO, and Cochrane (n=3). Risk of bias assessment suggested that reported studies had at least some risk of bias due to use of self-report outcome measures.
RESULTS: A total of 62 iCBT randomized controlled trials representing 17,210 participants are summarized in this study. Out of those 62 papers, only 17 (27%) of the trials reported race, and only 12 (19%) reported ethnicity. Reporting outside of the United States was very poor, with the United States accounting for 15 (88%) out of 17 of studies that reported race and 9 (75%) out of 12 for ethnicity. Out of 3,623 participants whose race was reported in the systematic
review, the racial category reported the most was White (n=2716, 74.9%), followed by Asian (n=209, 5.8%) and Black (n=274, 7.6%). Furthermore, only 25 (54%) out of the 46 papers conducted outside of the United States reported other background demographics.
CONCLUSIONS: It is important to note that the underreporting observed in this study does not necessarily indicate an underrepresentation in the actual study population. However, these findings highlight the poor reporting of race and ethnicity in iCBT trials for depression found in the literature. This lack of diversity reporting may have significant implications for the scalability of these interventions.