Yan Bo1, Zheng Xiaohui1, Luo Shiyun1, Lai Yuting1, Tan Jingyi1, Lin Aihua
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.
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