研究表明,怀孕期间抑郁症的患病率很高,也有证据表明认知行为疗法(CBT)是最有效的心理社会干预措施之一。来自随机对照试验(RCT)的新证据表明,技术已被成功地用于为其他人群提供CBT干预措施。然而,很少有研究关注他们在怀孕期间的使用。由于COVID-19大流行,这种方法在许多临床领域变得越来越重要,我们的研究旨在扩大这一特定临床领域的知识。
我们的系统评价旨在汇集有关妊娠期抑郁症状的数字化CBT干预措施的现有研究证据。
对WebofScience的系统评价,Cochrane中央控制试验登记册,CINAHL,MEDLINE,Embase,PsycINFO,Scopus,ClinicalTrials.gov,EBSCO公开论文数据库是从最早的可用证据到2021年10月27日进行的。仅考虑以英文发表的RCT研究。遵循PRISMA(系统审查和荟萃分析的首选报告项目)指南,并且该方案已在前瞻性系统审查登记册上注册。使用修订后的Cochrane偏倚风险工具对偏倚风险进行随机试验评估。
该综述确定了来自5个国家的7项研究(美国,中国,澳大利亚,挪威,和瑞典)于2015年至2021年出版。样本量为25至1342名参与者。干预措施使用了各种技术元素,包括文本,images,视频,游戏,交互式功能,和同行小组讨论。它们包括2个有指导的方法和5个无指导的方法。使用数字化CBT干预措施对妊娠期抑郁症显示出有希望的疗效,引导干预显示出比非引导干预(Hedgesg=0.14-0.99)更高的效果大小(Hedgesg=1.21)。数字化CBT干预措施的可接受性非常令人鼓舞,基于用户反馈。指导干预的损耗率较低(4.5%),但非指导干预的损耗率较高(22.1%-46.5%)。7项研究中有6项存在较高的总体偏倚风险。
我们的搜索仅发现了少量针对孕妇的数字化CBT干预措施。尽管这种方法有潜力。当谈到抑郁症状的疗效和积极结果时,这些证据显示了有希望的证据,和用户反馈是积极的。然而,偏倚的总体风险提示需要谨慎解释干预措施的疗效.未来的研究需要考虑如何减轻这些偏见的来源。数字化的CBT干预可以提供及时的,有效,对孕妇的循证干预措施。这篇综述增加了我们对怀孕期间数字化干预的重要性的理解。包括在COVID-19大流行期间。
PROSPERO国际系统评价前瞻性注册CRD42020216159;https://www.crd.约克。AC.uk/prospro/display_record.php?RecordID=216159。
Studies have shown a high prevalence of depression during pregnancy, and there is also evidence that cognitive behavioral therapy (CBT) is one of the most effective psychosocial interventions. Emerging evidence from randomized controlled trials (RCTs) has shown that technology has been successfully harnessed to provide CBT interventions for other populations. However, very few studies have focused on their use during pregnancy. This approach has become increasingly important in many clinical areas due to the COVID-19 pandemic, and our study aimed to expand the knowledge in this particular clinical area.
Our systematic
review aimed to bring together the available research-based evidence on digitalized CBT interventions for depression symptoms during pregnancy.
A systematic
review of the Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, Embase, PsycINFO, Scopus, ClinicalTrials.gov, and EBSCO Open Dissertations databases was carried out from the earliest available evidence to October 27, 2021. Only RCT studies published in English were considered. The PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-analyses) guidelines were followed, and the protocol was registered on the Prospective Register of Systematic Reviews. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials.
The
review identified 7 studies from 5 countries (the United States, China, Australia, Norway, and Sweden) published from 2015 to 2021. The sample sizes ranged from 25 to 1342 participants. The interventions used various technological elements, including text, images, videos, games, interactive features, and peer group discussions. They comprised 2 guided and 5 unguided approaches. Using digitalized CBT interventions for depression during pregnancy showed promising efficacy, with guided intervention showing higher effect sizes (Hedges g=1.21) than the unguided interventions (Hedges g=0.14-0.99). The acceptability of the digitalized CBT interventions was highly encouraging, based on user feedback. Attrition rates were low for the guided intervention (4.5%) but high for the unguided interventions (22.1%-46.5%). A high overall risk of bias was present for 6 of the 7 studies.
Our search only identified a small number of digitalized CBT interventions for pregnant women, despite the potential of this approach. These showed promising evidence when it came to efficacy and positive outcomes for depression symptoms, and user feedback was positive. However, the overall risk of bias suggests that the efficacy of the interventions needs to be interpreted with caution. Future studies need to consider how to mitigate these sources of biases. Digitalized CBT interventions can provide prompt, effective, evidence-based interventions for pregnant women. This
review increases our understanding of the importance of digitalized interventions during pregnancy, including during the COVID-19 pandemic.
PROSPERO International Prospective Register of Systematic Reviews CRD42020216159; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216159.