基于互联网的自助干预对青少年抑郁疗效的系统评价与meta分析

doi:10.3969/j.issn.1006-5253.2023.04.015

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摘要目的评价基于互联网的自助干预对青少年抑郁疗效是否优于阴性对照组和常规治疗组。方法检索PubMed、CNKI等14个数据库。收集符合纳入和排除标准的随机对照试验（RCT），干预措施为基于互联网的自助干预，对照组为常规治疗或阴性对照。检索时间为建库至2023年1月1日。由2名研究人员独立进行文献筛选和信息收集。采用ROB 2.0及Jadad评分量表对文献质量进行评估。采用CMA 3.0 软件进行meta分析（随机效应模型），以SMD及95% CI为效应指标。使用I²评价异质性，采用亚组分析探索异质性来源。采用 GRADE证据分级进行证据质量的评价。结果本文按照PRISMA 2020标准报告研究结果。最终纳入8篇RCT，包括1 947名经抑郁量表筛查或临床医师诊断的10~19岁研究对象。meta分析结果显示，基于互联网的自助干预可能有助于降低青少年抑郁量表得分(SMD=-0.33，95%CI: -0.57~-0.08，I²=73.41)。Egger′s检验提示无发表偏倚(P=0.25)。与阴性对照组相比，基于互联网的自助干预可能有效(SMD=-0.41，95%CI: -0.72~-0.10)。疗程>6周的干预提示可能有效(SMD=-0.67，95%CI: -0.97~-0.38)。干预结束后，短期随访结果提示干预效果仍有可能维持(SMD=-0.21，95%CI: -0.41~-0.01)，而长期随访结果未见干预效果。非临床招募的患者中显示干预可能有效 (SMD=-0.45，95%CI:-0.75~-0.15)，而临床招募的患者中未见干预效果。GRADE证据分级为中等质量证据，提示研究结果与实际效应有可能接近。结论基于互联网的自助干预对青少年抑郁疗效优于阴性对照组，可能有助于改善青少年抑郁症状。值得关注的是，当前纳入的研究多开展于发达国家和地区。未来可考虑针对我国青少年开展相关研究，尤其是设计精良、关注长期随访结果的RCT研究，进一步丰富和完善现有证据。

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关键词 ：互联网, 自助, 抑郁症, 随机对照试验, meta分析

Abstract：Objective To evaluate efficacy of Internet-based self-help interventions on adolescent depression compared with the negative control group and the conventional treatment group.Methods Fourteen databases (including Pubmed, CNKI, etc.) were retrieved to collect the randomized controlled trials (RCTS) meeting the inclusion and exclusion criteria. The intervention was the Internet-based self-help intervention, and the control groups were the conventional treatment group and the negative control group. The search time was from the establishment of the databases to January 1, 2023. Two researchers independently screened references according to inclusion and exclusion criteria, and assessed references with ROB 2.0 and Jadad. Related information was collected according to the study protocol. The Meta-analysis was performed by CMA 3.0 software (using random effects model). SMD and 95%CI were used as effect indicators. Subgroup analysis was used to explore possible sources of heterogeneity (indicated by I²). GRADE was used to rate the certainty of evidence.Results The results were reported according to the PRISMA 2020 criteria. Eight RCTs (1 947 subjects aged from 10 to 19 who were screened for depression scales or diagnosed by clinicians) were finally included. The results of meta-analysis showed that Internet-based self-helped interventions may help to lower the score of measured depression scale among adolescent patients (SMD=-0.33, 95%CI: -0.57, -0.08; I²=73.41). Egger′s tests suggested no significant publication bias(P=0.25). Internet-based self-help interventions may modify depressive symptoms in adolescents compared with the negative control group (SMD=-0.41, 95%CI: -0.72, -0.10). Intervention with longer duration (>6 weeks) may be effective (SMD=-0.67 , 95%CI: -0.97, -0.38). After the intervention, a short-term follow-up (within six months) showed that the beneficial effect might be maintained (SMD=-0.21, 95%CI: -0.41,-0.01), while the long-term follow-up results showed no intervention effect. The intervention based on non-clinical recruitment might be effective (SMD=-0.45, 95% CI:-0.75, -0.15), while the intervention based on clinical recruitment did not show an intervention effect. The evidence was of moderate quality, suggesting that the study results might be close to the actual effect.Conclusion Internet-based self-help intervention is more effective than that the negative control group in adolescents with depression, and may help to relieve the symptoms of depression in adolescents. It is worth noting that most of the included studies were conducted in developed countries and regions. In the future, relevant studies on Chinese adolescents should be considered, especially well-designed RCT studies with long-term follow-up to further enrich and improve the current evidence.

Key words： Internet self-help depression RCTs meta-analysis

收稿日期: 2023-02-16

基金资助:中山大学新华学院大学生创新训练计划项目（202113902117）；
广东省大学生创新训练计划项目（S2013902013/FS2013902013）；
广东省高等教育教学改革研究项目（F2019J010）；
中山大学新华学院教学质量与教学改革工程项目（2019CY002）

通讯作者: 林爱华，Email：linaihua@mail.sysu.edu.cn

引用本文:

严波，郑晓晖，罗诗韵，赖雨婷，谭静仪，林爱华. 基于互联网的自助干预对青少年抑郁疗效的系统评价与meta分析[J]. 中国医院统计, 2023, 30(4): 312-320.
Yan Bo1, Zheng Xiaohui1, Luo Shiyun1, Lai Yuting1, Tan Jingyi1, Lin Aihua. Efficacy of internet-based self-help interventions on addescents with depression: a systematic review and meta-analysis. journal1, 2023, 30(4): 312-320.

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