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首页> 外文期刊>Journal of medical Internet research >Digital Interventions for Screening and Treating Common Mental Disorders or Symptoms of Common Mental Illness in Adults: Systematic Review and Meta-analysis
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Digital Interventions for Screening and Treating Common Mental Disorders or Symptoms of Common Mental Illness in Adults: Systematic Review and Meta-analysis

机译：用于筛选和治疗成人常见精神疾病或常见精神疾病的常见精神障碍或症状的数字干预措施：系统评价和荟萃分析

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Background Digital interventions targeting common mental disorders (CMDs) or symptoms of CMDs are growing rapidly and gaining popularity, probably in response to the increased prevalence of CMDs and better awareness of early help-seeking and self-care. However, no previous systematic reviews that focus on these novel interventions were found. Objective This systematic review aims to scope entirely web-based interventions that provided screening and signposting for treatment, including self-management strategies, for people with CMDs or subthreshold symptoms. In addition, a meta-analysis was conducted to evaluate the effectiveness of these interventions for mental well-being and mental health outcomes. Methods Ten electronic databases including MEDLINE, PsycINFO, and EMBASE were searched from January 1, 1999, to early April 2020. We included randomized controlled trials (RCTs) that evaluated a digital intervention (1) targeting adults with symptoms of CMDs, (2) providing both screening and signposting to other resources including self-care, and (3) delivered entirely through the internet. Intervention characteristics including target population, platform used, key design features, and outcome measure results were extracted and compared. Trial outcome results were included in a meta-analysis on the effectiveness of users’ well-being and mental health outcomes. We also rated the meta-analysis results with the Grading of Recommendations, Assessment, Development, and Evaluations approach to establish the quality of the evidence. Results The electronic searches yielded 21 papers describing 16 discrete digital interventions. These interventions were investigated in 19 unique trials including 1 (5%) health economic study. Most studies were conducted in Australia and North America. The targeted populations varied from the general population to allied health professionals. All interventions offered algorithm-driven screening with measures to assess symptom levels and to assign treatment options including automatic web-based psychoeducation, self-care strategies, and signposting to existing services. A meta-analysis of usable trial data showed that digital interventions improved well-being (3 randomized controlled trials [RCTs]; n=1307; standardized mean difference [SMD] 0.40; 95% CI 0.29 to 0.51; I ~(2)=28%; fixed effect), symptoms of mental illness (6 RCTs; n=992; SMD ?0.29; 95% CI ?0.49 to ?0.09; I ~(2)=51%; random effects), and work and social functioning (3 RCTs; n=795; SMD ?0.16; 95% CI ?0.30 to ?0.02; I ~(2)=0%; fixed effect) compared with waitlist or attention control. However, some follow-up data failed to show any sustained effects beyond the post intervention time point. Data on mechanisms of change and cost-effectiveness were also lacking, precluding further analysis. Conclusions Digital mental health interventions to assess and signpost people experiencing symptoms of CMDs appear to be acceptable to a sufficient number of people and appear to have enough evidence for effectiveness to warrant further study. We recommend that future studies incorporate economic analysis and process evaluation to assess the mechanisms of action and cost-effectiveness to aid scaling of the implementation.
机译：背景技术靶向常见精神障碍（CMDS）或CMDS的症状的数字干预越来越迅速，越来越受欢迎，可能是为了应对CMDS的普及和更好地了解早期帮助寻求和自我护理的普遍性。但是，没有先前发现专注于这些新的干预措施的系统审查。目的这一系统审查旨在为具有CMDS或亚阈值症状的人提供筛选和路标，提供基于网络的干预措施，为治疗提供筛选和路标，包括自我管理策略。此外，进行了荟萃分析，以评估这些干预措施对心理健康和心理健康结果的有效性。方法从1999年1月1日至4月1日到4月1日到2020年初，我们将包括Medline，Psycinfo和Embase在内的十种电子数据库。我们包括随机对照试验（RCT），该试验（RCT）评估了靶向成年人的数字干预（1）患有CMDS的症状，（2）为其他资源提供筛选和路标，包括自我护理，（3）完全通过互联网交付。提取和比较包括目标群体，使用的平台，关键设计特征和结果测量结果的干预特性。试验结果结果纳入了用户福祉和心理健康结果的有效性的荟萃分析中。我们还评估了荟萃分析结果随着建议，评估，发展和评估方法的评分，以确定证据的质量。结果电子搜索产生了21篇论文，描述了16个分立数字干预措施。这些干预措施在19项独特的试验中调查，包括1（5％）的健康经济研究。大多数研究是在澳大利亚和北美进行的。目标人群从一般人口到盟军卫生专业人士不同。所有干预措施都提供了算法驱动的筛选，采取措施评估症状水平，并分配包括自动网络的心理教育，自我护理策略以及向现有服务的公开展示的处理选项。可用试验数据的元分析表明，数字干预措施改善了福祉（3个随机对照试验[RCTS]; n = 1307;标准化平均差异[SMD] 0.40; 95％CI 0.29至0.51; I〜（2）= 28％;固定效果），精神疾病的症状（6个RCT; n = 992; SMD？0.29; 95％CI？0.49至0.49; I〜（2）= 51％;随机效果，以及工作和社会功能（3个RCT; n = 795; SMD？0.16; 95％CI？0.30至0.30; 02; I〜（2）= 0％;固定效果）与候补人或注意控制相比。但是，一些后续数据未能显示出在后期介入时间点之外的任何持续影响。还缺乏改变和成本效益机制的数据，排尿进一步分析。结论评估和路标患者的数字心理健康干预措施似乎是足够数量的人似乎可以接受，并且似乎有足够的证据来获得进一步研究的有效性。我们建议未来的研究纳入经济分析和过程评估，以评估行动和成本效益的机制，以援助实施的扩大。

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