Efficacy of an Internet- and Mobile-Based Intervention for Subclinical Anxiety and Depression (ICare Prevent) with Two Guidance Formats: Results from a Three-Armed Randomized Controlled Trial.

IF 16.3 1区医学 Q1 PSYCHIATRY Psychotherapy and Psychosomatics Pub Date : 2024-01-01 Epub Date: 2024-04-30 DOI:10.1159/000536149

Anna-Carlotta Zarski, Kiona K Weisel, Thomas Berger, Tobias Krieger, Michael P Schaub, Matthias Berking, Dennis Görlich, Corinna Jacobi, David D Ebert

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Abstract

Introduction: Limited research exists on intervention efficacy for comorbid subclinical anxiety and depressive disorders, despite their common co-occurrence. Internet- and mobile-based interventions (IMIs) are promising to reach individuals facing subclinical symptoms.

Objective: This study aimed to evaluate the efficacy of a transdiagnostic and self-tailored IMI in reducing subclinical anxiety and depressive symptom severity with either individualized (IG-IMI) or automated (AG-IMI) guidance compared to a waitlist control group with care-as-usual access (WLC).

Methods: Participants included 566 adults with subclinical anxiety (GAD-7 ≥ 5) and/or depressive (CES-D ≥16) symptoms, who did not meet criteria for a full-syndrome depressive or anxiety disorder. In a three-arm randomized clinical trial, participants were randomized to a cognitive behavioral 7-session IMI plus booster session with IG-IMI (n = 186) or AG-IMI (n = 189) or WLC (n = 191). Primary outcomes included observer-rated anxiety (HAM-A) and depressive (QIDS) symptom severity 8 weeks after randomization assessed by blinded raters via telephone. Follow-up outcomes at 6 and 12 months are reported.

Results: Symptom severity was significantly lower with small to medium effects in IG-IMI (anxiety: d = 0.45, depression: d = 0.43) and AG-IMI (anxiety: d = 0.31, depression: d = 0.32) compared to WLC. No significant differences emerged between guidance formats in primary outcomes. There was a significant effect in HAM-A after 6 months favoring AG-IMI. On average, participants completed 85.38% of IG-IMI and 77.38% of AG-IMI.

Conclusions: A transdiagnostic, self-tailored IMI can reduce subclinical anxiety and depressive symptom severity, but 12-month long-term effects were absent. Automated guidance holds promise for enhancing the scalability of IMIs in broad prevention initiatives.

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基于互联网和移动设备的亚临床焦虑症和抑郁症干预措施（ICare Prevent）的疗效：三臂随机对照试验的结果。

导言：尽管亚临床焦虑症和抑郁症经常并发，但有关这两种疾病的干预效果的研究却十分有限。基于互联网和移动设备的干预（IMIs）有望帮助亚临床症状患者：本研究旨在评估在个体化（IG-IMI）或自动化（AG-IMI）指导下，跨诊断和自我定制的 IMI 在降低亚临床焦虑症和抑郁症状严重程度方面的疗效，并与照常就诊（WLC）的候补对照组进行比较：参与者包括 566 名有亚临床焦虑（GAD-7 ≥ 5）和/或抑郁（CES-D ≥16）症状的成年人，他们不符合全症状抑郁或焦虑障碍的标准。在一项三臂随机临床试验中，参与者被随机分配到认知行为 7 节 IMI 加 IG-IMI （n = 186）或 AG-IMI（n = 189）或 WLC（n = 191）的强化课程中。主要结果包括随机分组 8 周后观察者评定的焦虑（HAM-A）和抑郁（QIDS）症状严重程度，由盲法评定者通过电话进行评估。报告了 6 个月和 12 个月的随访结果：结果：与 WLC 相比，IG-IMI（焦虑：d = 0.45，抑郁：d = 0.43）和 AG-IMI（焦虑：d = 0.31，抑郁：d = 0.32）的症状严重程度明显降低，影响程度为轻微至中等。在主要结果方面，不同指导方式之间没有明显差异。6 个月后，HAM-A 有明显效果，AG-IMI 更优。参与者平均完成了 85.38% 的 IG-IMI 和 77.38% 的 AG-IMI：跨诊断、自我定制的 IMI 可以减轻亚临床焦虑和抑郁症状的严重程度，但 12 个月的长期效果并不明显。自动指导有望在广泛的预防措施中提高 IMI 的可扩展性。

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来源期刊

Psychotherapy and Psychosomatics 医学-精神病学

CiteScore

29.40

自引率

6.10%

发文量

期刊介绍： Psychotherapy and Psychosomatics is a reputable journal that has been published since 1953. Over the years, it has gained recognition for its independence, originality, and methodological rigor. The journal has been at the forefront of research in psychosomatic medicine, psychotherapy research, and psychopharmacology, and has contributed to the development of new lines of research in these areas. It is now ranked among the world's most cited journals in the field. As the official journal of the International College of Psychosomatic Medicine and the World Federation for Psychotherapy, Psychotherapy and Psychosomatics serves as a platform for discussing current and controversial issues and showcasing innovations in assessment and treatment. It offers a unique forum for cutting-edge thinking at the intersection of medical and behavioral sciences, catering to both practicing clinicians and researchers. The journal is indexed in various databases and platforms such as PubMed, MEDLINE, Web of Science, Science Citation Index, Social Sciences Citation Index, Science Citation Index Expanded, BIOSIS Previews, Google Scholar, Academic Search, and Health Research Premium Collection, among others.

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