背景:与患有酒精使用障碍(AUD)的伴侣一起生活的人比没有患有AUD的伴侣的人可能会经历严重的心理困扰并更多地使用医疗保健。然而,目前的治疗系统对伴侣和个人障碍的关注限制了这些人自己获得帮助。关于自我指导的初步工作,基于网络的应对技能培训计划,停止旋转我的车轮(SSMW),在扩大这一人群的可用治疗方面显示出希望。在这项研究中,我们对SSMW主要结局进行了稳健评估.
目的:该研究旨在测试是否有伴侣AUD分配给SSMW的女性在负面影响(抑郁和愤怒)方面的减少(1)比通常的网络护理(UWC)控制和(2)有简短的电话教练支持(SSMW教练)而不是没有(仅SSMW),以及(3)基线负面影响是否影响适度的治疗效果。
方法:女性(平均年龄45.7,SD10.8岁;黑人:17/456,3.7%;白人:408/456,89.5%)仅随机分为SSMW,SSMW+教练,或UWC。在基线时评估抑郁(贝克抑郁量表-II)和愤怒(状态特征愤怒表达量表2-状态愤怒),12周后测,以及6个月和12个月的随访。
结果:所有情况下的参与者从基线到测后,从基线到随访,抑郁都有所下降;仅SSMW和SSMW+教练参与者的愤怒有所下降,但UWC参与者没有。与UWC参与者相比,仅SSMW的参与者经历了更大的愤怒减少(P=0.03),和SSMW+教练参与者经历了更大的抑郁症(P<.001)从基线到后测。然而,从基线到随访,只有更大的,但无统计学意义(P=.052),与UWC相比,SSMW+教练的愤怒减少。尽管SSMW条件在负面影响结果方面没有差异(P=.06-.57),SSMW+教练有更高的项目参与度和满意度(所有P<.004)。基线负面影响并没有缓和影响,尽管基线临床相关抑郁症状的缓解(贝克抑郁量表≥14)仅在SSMW(33/67,49%;比值比2.13,95%CI1.05-4.30;P=.03)和SSMW+教练(46/74,62%;比值比3.60,95%CI1.79-7.23;P<.001)高于UMW(21WC/67,31%);
结论:结果部分支持假设。SSMW条件比UWC有更早的影响,但是UWC的积极变化减轻了假设的长期SSMW-UWC差异。结果突出了在基于网络的临床试验中纳入主动对照的重要性。尽管SSMW+教练仅在参与和满意度措施以及需要治疗的数量上显示出优于SSMW的优势(仅SSMW为5.6;SSMW+教练为3.2),在抑郁症状缓解水平上,SSMW条件与UWC相当且优于UWC。总的来说,有或没有教练的SSMW可以减少临床上有意义的痛苦,并为这个大的,服务不足的群体。
背景:ClinicalTrials.govNCT02984241;https://www.clinicaltrials.gov/研究/NCT02984241。
BACKGROUND: Individuals living with a partner with an alcohol use disorder (AUD) can experience significant psychological distress and use health care more than those without a partner with an AUD. However, the prevailing treatment system\'s focus on the partner and personal barriers limit these individuals from getting help for themselves. Preliminary work on a self-directed, web-based coping skills training program, Stop Spinning My Wheels (SSMW), shows promise in broadening available treatments for this population. In this study, we conducted a robust evaluation of SSMW primary outcomes.
OBJECTIVE: The study aims to test whether women with a partner with an AUD assigned to SSMW experienced a greater reduction in negative affect (depression and anger) (1) than a usual web care (UWC) control and (2) with brief phone coach support (SSMW+coach) rather than without (SSMW only) and (3) whether baseline negative affect moderated treatment effects.
METHODS: Women (mean age 45.7, SD 10.8 years; Black: 17/456, 3.7%; White: 408/456, 89.5%) were randomized to SSMW only, SSMW+coach, or UWC. Depression (Beck Depression Inventory-II) and anger (State-Trait Anger Expression Inventory 2-State Anger) were assessed at baseline, 12-week posttest, and 6- and 12-month follow-ups.
RESULTS: Participants in all conditions decreased in depression from baseline to posttest and from baseline to follow-up; SSMW-only and SSMW+coach participants decreased in anger, but UWC participants did not. Compared to UWC participants, SSMW-only participants experienced greater anger reduction (P=.03), and SSMW+coach participants experienced a greater reduction in depression (P<.001) from baseline to posttest. However, from baseline to follow-up, only a greater, but not statistically significant (P=.052), reduction in anger occurred in SSMW+coach compared to UWC. Although the SSMW conditions did not differ from each other in negative affect outcomes (P=.06-.57), SSMW+coach had higher program engagement and satisfaction (all P<.004). Baseline negative affect did not moderate effects, although remission from baseline clinically relevant depressive symptoms (Beck Depression Inventory≥14) was higher in SSMW only (33/67, 49%; odds ratio 2.13, 95% CI 1.05-4.30; P=.03) and SSMW+coach (46/74, 62%; odds ratio 3.60, 95% CI 1.79-7.23; P<.001) than in UWC (21/67, 31%); remission rates did not differ between the SSMW conditions (P=.12).
CONCLUSIONS: The results partially supported the hypotheses. The SSMW conditions had earlier effects than UWC, but positive change in UWC mitigated the hypothesized long-term SSMW-UWC differences. The results highlight the importance of incorporating active controls in web-based clinical trials. Although SSMW+coach showed benefits over SSMW only on engagement and satisfaction measures and in the number needed to treat (5.6 for SSMW only; 3.2 for SSMW+coach), the SSMW conditions were comparable and superior to UWC on depressive symptom remission levels. Overall, SSMW with or without a coach can reduce clinically meaningful distress and add to available treatment options for this large, underserved group.
BACKGROUND: ClinicalTrials.gov NCT02984241; https://www.clinicaltrials.gov/study/NCT02984241.