Mediators of digital depression prevention in patients with chronic back pain: Findings from a multicenter randomized clinical trial.

IF 4.5 1区心理学 Q1 PSYCHOLOGY, CLINICAL

Journal of consulting and clinical psychology Pub Date : 2023-08-01 DOI:10.1037/ccp0000808

Matthias Domhardt, Arne Lutsch, Lasse B Sander, Sarah Paganini, Kerstin Spanhel, David D Ebert, Yannik Terhorst, Harald Baumeister

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引用次数: 1

Abstract

Objective: The mechanisms of change in digital interventions for the prevention of depression are largely unknown. Here, we explored whether five theoretically derived intervening variables (i.e., pain intensity, pain-related disability, pain self-efficacy, quality of life [QoL], and work capacity) were mediating the effectiveness of a digital intervention specifically designed to prevent depression in patients with chronic back pain (CBP).

Method: This study is a secondary analysis of a pragmatic, observer-masked randomized clinical trial conducted at 82 orthopedic clinics in Germany. A total of 295 adults with a diagnosis of CBP and subclinical depressive symptoms were randomized to either the intervention group (n = 149) or treatment-as-usual (n = 146). Longitudinal mediation analyses were conducted with structural equation modeling and depression symptom severity as primary outcome (Patient Health Questionnaire-9 [PHQ-9]; 6 months after randomization) on an intention-to-treat basis.

Results: Beside the effectiveness of the digital intervention in preventing depression, we found a significant causal mediation effect for QoL as measured with the complete scale of Assessment of Quality of Life (AQoL-6D; axb: -0.234), as well as for the QoL subscales mental health (axb: -0.282) and coping (axb: -0.249). All other potential intervening variables were not significant.

Conclusion: Our findings suggest a relevant role of QoL, including active coping, as change mechanism in the prevention of depression. Yet, more research is needed to extend and specify our knowledge on empirically supported processes in digital depression prevention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

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慢性背痛患者的数字抑郁预防介质:来自一项多中心随机临床试验的发现

目的:数字干预预防抑郁症的变化机制在很大程度上是未知的。在这里，我们探讨了五个理论推导的干预变量(即疼痛强度、疼痛相关残疾、疼痛自我效能、生活质量和工作能力)是否介导了专门设计用于预防慢性背痛(CBP)患者抑郁的数字干预的有效性。方法:本研究是对在德国82家骨科诊所进行的一项实用的、观察者屏蔽的随机临床试验的二次分析。共有295名诊断为CBP和亚临床抑郁症状的成年人被随机分为干预组(n = 149)和常规治疗组(n = 146)。以结构方程模型和抑郁症状严重程度为主要结局进行纵向中介分析(Patient Health Questionnaire-9 [PHQ-9];随机化后6个月)在意向治疗基础上。结果:除了数字干预在预防抑郁方面的有效性外，我们还发现生活质量(QoL- 6d)量表测量的生活质量(QoL- 6d;axb: -0.234)，以及生活质量亚量表心理健康(axb: -0.282)和应对(axb: -0.249)。其他所有可能的干预变量均不显著。结论:生活质量(包括积极应对)在抑郁症的预防中起着重要的作用。然而，需要更多的研究来扩展和具体我们对经验支持的数字抑郁症预防过程的知识。(PsycInfo数据库记录(c) 2023 APA，版权所有)。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of consulting and clinical psychology PSYCHOLOGY, CLINICAL-

CiteScore

9.00

自引率

3.40%

发文量

期刊介绍： The Journal of Consulting and Clinical Psychology® (JCCP) publishes original contributions on the following topics: the development, validity, and use of techniques of diagnosis and treatment of disordered behaviorstudies of a variety of populations that have clinical interest, including but not limited to medical patients, ethnic minorities, persons with serious mental illness, and community samplesstudies that have a cross-cultural or demographic focus and are of interest for treating behavior disordersstudies of personality and of its assessment and development where these have a clear bearing on problems of clinical dysfunction and treatmentstudies of gender, ethnicity, or sexual orientation that have a clear bearing on diagnosis, assessment, and treatmentstudies of psychosocial aspects of health behaviors. Studies that focus on populations that fall anywhere within the lifespan are considered. JCCP welcomes submissions on treatment and prevention in all areas of clinical and clinical–health psychology and especially on topics that appeal to a broad clinical–scientist and practitioner audience. JCCP encourages the submission of theory–based interventions, studies that investigate mechanisms of change, and studies of the effectiveness of treatments in real-world settings. JCCP recommends that authors of clinical trials pre-register their studies with an appropriate clinical trial registry (e.g., ClinicalTrials.gov, ClinicalTrialsRegister.eu) though both registered and unregistered trials will continue to be considered at this time.