Guided digital health intervention for depression in Lebanon: randomised trial.

IF 6.6 2区医学 Q1 PSYCHIATRY Evidence Based Mental Health Pub Date : 2022-12-01 DOI:10.1136/ebmental-2021-300416

Pim Cuijpers, Eva Heim, Jinane Abi Ramia, Sebastian Burchert, Kenneth Carswell, Ilja Cornelisz, Christine Knaevelsrud, Philip Noun, Chris van Klaveren, Edith Van't Hof, Edwina Zoghbi, Mark van Ommeren, Rabih El Chammay

{"title":"Guided digital health intervention for depression in Lebanon: randomised trial.","authors":"Pim Cuijpers, Eva Heim, Jinane Abi Ramia, Sebastian Burchert, Kenneth Carswell, Ilja Cornelisz, Christine Knaevelsrud, Philip Noun, Chris van Klaveren, Edith Van't Hof, Edwina Zoghbi, Mark van Ommeren, Rabih El Chammay","doi":"10.1136/ebmental-2021-300416","DOIUrl":null,"url":null,"abstract":"Background: Most people with mental disorders in communities exposed to adversity in low-income and middle-income countries (LMICs) do not receive effective care. Digital mental health interventions are scalable when digital access is adequate, and can be safely delivered during the COVID-19 pandemic.Objective: To examine the effects of a new WHO-guided digital mental health intervention, Step-by-Step, supported by a non-specialist helper in Lebanon, in the context of concurring economic, humanitarian and political crises, a large industrial disaster and the COVID-19 pandemic.Methods: We conducted a single-blind, two-arm pragmatic randomised trial, comparing guided Step-by-Step with enhanced care as usual (ECAU) among people suffering from depression and impaired functioning. Primary outcomes were depression (Patient Health Questionnaire 9 (PHQ-9)) and impaired functioning (WHO Disability Assessment Schedule-12 (WHODAS)) at post-treatment.Findings: 680 people with depression (PHQ-9>10) and impaired functioning (WHODAS>16) were randomised to Step-by-Step or ECAU. Intention-to-treat analyses showed effects on depression (standardised mean differences, SMD: 0.71; 95% CI: 0.45 to 0.97), impaired functioning (SMD: 0.43; 95% CI: 0.21 to 0.65), post-traumatic stress (SMD: 0.53; 95% CI: 0.27 to 0.79), anxiety (SMD: 0.74; 95% CI: 0.49 to 0.99), subjective well-being (SMD: 0.37; 95% CI: 0.12 to 0.62) and self-identified personal problems (SMD: 0.56; 95% CI 0.29 to 0.83). Significant effects on all outcomes were retained at 3-month follow-up.Conclusions: Guided digital mental health interventions can be effective in the treatment of depression in communities exposed to adversities in LMICs, although some uncertainty remains because of high attrition.Clinical implications: Guided digital mental health interventions should be considered for implementation in LMICs.Trial registration number: ClinicalTrials.gov NCT03720769.","PeriodicalId":12233,"journal":{"name":"Evidence Based Mental Health","volume":"25 e1","pages":"e34-e40"},"PeriodicalIF":6.6000,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cc/4e/ebmental-2021-300416.PMC9811068.pdf","citationCount":"10","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Evidence Based Mental Health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/ebmental-2021-300416","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PSYCHIATRY","Score":null,"Total":0}

引用次数: 10

Abstract

Background: Most people with mental disorders in communities exposed to adversity in low-income and middle-income countries (LMICs) do not receive effective care. Digital mental health interventions are scalable when digital access is adequate, and can be safely delivered during the COVID-19 pandemic.

Objective: To examine the effects of a new WHO-guided digital mental health intervention, Step-by-Step, supported by a non-specialist helper in Lebanon, in the context of concurring economic, humanitarian and political crises, a large industrial disaster and the COVID-19 pandemic.

Methods: We conducted a single-blind, two-arm pragmatic randomised trial, comparing guided Step-by-Step with enhanced care as usual (ECAU) among people suffering from depression and impaired functioning. Primary outcomes were depression (Patient Health Questionnaire 9 (PHQ-9)) and impaired functioning (WHO Disability Assessment Schedule-12 (WHODAS)) at post-treatment.

Findings: 680 people with depression (PHQ-9>10) and impaired functioning (WHODAS>16) were randomised to Step-by-Step or ECAU. Intention-to-treat analyses showed effects on depression (standardised mean differences, SMD: 0.71; 95% CI: 0.45 to 0.97), impaired functioning (SMD: 0.43; 95% CI: 0.21 to 0.65), post-traumatic stress (SMD: 0.53; 95% CI: 0.27 to 0.79), anxiety (SMD: 0.74; 95% CI: 0.49 to 0.99), subjective well-being (SMD: 0.37; 95% CI: 0.12 to 0.62) and self-identified personal problems (SMD: 0.56; 95% CI 0.29 to 0.83). Significant effects on all outcomes were retained at 3-month follow-up.

Conclusions: Guided digital mental health interventions can be effective in the treatment of depression in communities exposed to adversities in LMICs, although some uncertainty remains because of high attrition.

Clinical implications: Guided digital mental health interventions should be considered for implementation in LMICs.

Trial registration number: ClinicalTrials.gov NCT03720769.

Abstract Image

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

黎巴嫩抑郁症引导数字健康干预:随机试验

背景:在低收入和中等收入国家(LMICs)面临逆境的社区中，大多数精神障碍患者没有得到有效的治疗。在数字渠道充足的情况下，数字精神卫生干预措施是可扩展的，并且可以在COVID-19大流行期间安全提供。目的:在经济、人道主义和政治危机、大规模工业灾难和COVID-19大流行并存的背景下，研究在黎巴嫩由一名非专家助手支持的世卫组织指导的一项新的数字精神卫生干预措施的效果。方法:我们进行了一项单盲，双臂实用随机试验，比较了抑郁症和功能受损患者的指导逐步治疗和增强照护(ECAU)。治疗后的主要结局是抑郁(患者健康问卷9 (PHQ-9))和功能受损(世卫组织残疾评估表-12 (WHODAS))。研究结果:680名抑郁症患者(PHQ-9>10)和功能受损(WHODAS>16)被随机分配到逐步或ECAU组。意向治疗分析显示对抑郁症有影响(标准化平均差异，SMD: 0.71;95% CI: 0.45 ~ 0.97)，功能受损(SMD: 0.43;95% CI: 0.21 ~ 0.65)，创伤后应激(SMD: 0.53;95% CI: 0.27 ~ 0.79)，焦虑(SMD: 0.74;95% CI: 0.49 ~ 0.99)，主观幸福感(SMD: 0.37;95% CI: 0.12至0.62)和自我识别的个人问题(SMD: 0.56;95% CI 0.29 ~ 0.83)。在3个月的随访中，所有结果均有显著影响。结论:指导性数字心理健康干预措施可以有效地治疗中低收入国家面临逆境的社区的抑郁症，尽管由于人员流失率高，仍存在一些不确定性。临床意义:应考虑在中低收入国家实施指导性数字心理健康干预措施。试验注册号:ClinicalTrials.gov NCT03720769。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Evidence Based Mental Health PSYCHIATRY-

CiteScore

18.10

自引率

7.70%

发文量

期刊介绍： Evidence-Based Mental Health alerts clinicians to important advances in treatment, diagnosis, aetiology, prognosis, continuing education, economic evaluation and qualitative research in mental health. Published by the British Psychological Society, the Royal College of Psychiatrists and the BMJ Publishing Group the journal surveys a wide range of international medical journals applying strict criteria for the quality and validity of research. Clinicians assess the relevance of the best studies and the key details of these essential studies are presented in a succinct, informative abstract with an expert commentary on its clinical application.Evidence-Based Mental Health is a multidisciplinary, quarterly publication.