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":"黎巴嫩抑郁症引导数字健康干预:随机试验","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":"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Findings: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Clinical implications: </strong>Guided digital mental health interventions should be considered for implementation in LMICs.</p><p><strong>Trial registration number: </strong>ClinicalTrials.gov NCT03720769.</p>","PeriodicalId":12233,"journal":{"name":"Evidence Based Mental Health","volume":null,"pages":null},"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":"{\"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\":\"<p><strong>Background: </strong>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.</p><p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Findings: </strong>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). 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Guided digital health intervention for depression in Lebanon: randomised trial.
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.
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.
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