■虽然基于互联网和移动的干预措施(IMI)对抑郁症的影响已得到广泛研究,没有关于治疗效果(HTE)异质性的系统证据,表明患者之间的相互作用在多大程度上存在,个性化的治疗模式可能是必要的。
■研究IMIs中的HTEs对抑郁症的疗效和有效性。
■在Embase中进行系统搜索,MEDLINE,中央,和PsycINFO的随机临床试验和补充参考检索于2019年10月13日进行,并于2022年3月25日更新.搜索字符串包括与数字心理治疗相关的各种术语,抑郁症,和随机临床试验。
■标题,摘要,全文由2名独立研究人员审查。对所有人群进行的研究符合资格,其中至少有1个干预组接受了抑郁症的IMI,至少有1个对照组。如果他们将抑郁严重程度评估为主要结局,并遵循随机临床试验(RCT)设计。
■本研究遵循系统评价和荟萃分析报告指南的首选报告项目。使用Cochrane偏差风险工具评估偏差风险。使用对数方差比(lnVR)和使用Hedgesg的效应大小来调查HTE。进行三级贝叶斯元回归。
■治疗效果的异质性是本研究的主要结果;治疗效果大小的大小是次要结果。在纳入的随机对照试验中,通过不同的自我报告和临床医生评估量表来衡量抑郁的严重程度。
■102项试验的系统评价包括19758名参与者(平均[SD]年龄,39.9[10.58]年),中度抑郁严重程度(患者健康问卷9分的平均值[SD],12.81[2.93])。在IMI中没有发现HTE的证据(lnVR=-0.02;95%可信区间[CrI],-0.07至0.03)。然而,在更严重的抑郁水平中,HTE更高(β=0.04;95%CrI,0.01至0.07)。IMI的效应大小为中等(g=-0.56;95%CrI,-0.46至-0.66)。发现了指导和基线严重程度之间的交互作用(β=-0.24,95%CrI,-0.03至-0.46)。
■在这篇RCT的系统综述和荟萃分析中,没有证据表明,在亚阈值至轻度抑郁患者中,IMIs的患者-治疗交互作用增加.指导没有增加该亚组的效应大小。然而,基线严重性与HTE的关联及其与指导的相互作用表明更敏感,引导,数字精度方法将使症状更严重的个体受益。需要对该人群进行未来研究,以探索个性化策略并充分利用IMI的潜力。
UNASSIGNED: While the effects of internet- and mobile-based interventions (IMIs) for depression have been extensively studied, no systematic evidence is available regarding the heterogeneity of treatment effects (HTEs), indicating to what extent patient-by-treatment interactions exist and personalized treatment models might be necessary.
UNASSIGNED: To investigate the HTEs in IMIs for depression as well as their efficacy and effectiveness.
UNASSIGNED: A systematic search in Embase, MEDLINE, Central, and PsycINFO for randomized clinical trials and supplementary reference searches was conducted on October 13, 2019, and updated March 25, 2022. The search string included various terms related to digital psychotherapy, depression, and randomized clinical trials.
UNASSIGNED: Titles, abstracts, and full texts were reviewed by 2 independent researchers. Studies of all populations with at least 1 intervention group receiving an IMI for depression and at least 1 control group were eligible, if they assessed depression severity as a primary outcome and followed a randomized clinical trial (RCT) design.
UNASSIGNED: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Risk of bias was evaluated using the Cochrane Risk of Bias Tool. HTE was investigated using logarithmic variance ratios (lnVR) and effect sizes using Hedges g. Three-level bayesian meta-regressions were conducted.
UNASSIGNED: Heterogeneity of treatment effects was the primary outcome of this study; magnitudes of treatment effect sizes were the secondary outcome. Depression severity was measured by different self-report and clinician-rated scales in the included RCTs.
UNASSIGNED: The systematic review of 102 trials included 19 758 participants (mean [SD] age, 39.9 [10.58] years) with moderate depression severity (mean [SD] in Patient Health Questionnaire-9 score, 12.81 [2.93]). No evidence for HTE in IMIs was found (lnVR = -0.02; 95% credible interval [CrI], -0.07 to 0.03). However, HTE was higher in more severe depression levels (β̂ = 0.04; 95% CrI, 0.01 to 0.07). The effect size of IMI was medium (g = -0.56; 95% CrI, -0.46 to -0.66). An interaction effect between guidance and baseline severity was found (β̂ = -0.24, 95% CrI, -0.03 to -0.46).
UNASSIGNED: In this systematic review and meta-analysis of RCTs, no evidence for increased patient-by-treatment interaction in IMIs among patients with subthreshold to mild depression was found. Guidance did not increase effect sizes in this subgroup. However, the association of baseline severity with HTE and its interaction with guidance indicates a more sensitive, guided, digital precision approach would benefit individuals with more severe symptoms. Future research in this population is needed to explore personalization strategies and fully exploit the potential of IMI.