TY -的盟Mathiasen金盟——成熟,本意非盟-安德森,托尼E AU - Roessler,克里斯汀•K PY - 2018 DA - 2018/11/28 TI -引导网络成人抑郁和焦虑的认知行为疗法在常规二级护理:观察研究乔- J地中海互联网Res SP - e10927六世- 20 KW - 11千瓦焦虑-认知疗法KW -群组研究KW -抑郁KW -互联网KW -二级护理AB -背景:基于网络的认知行为疗法(iCBT)是一种很有前途的治疗抑郁和焦虑的新方法。然而，在大规模实施之前，确定其结果是否可以在常规护理中复制是很重要的。尽管许多研究证明了iCBT在受控条件下的有效性，但只有少数研究调查了其在常规护理中的有效性。此外，iCBT的一些效果，如在常规护理中的治疗效果尚不清楚。目的:评价iCBT在常规二级护理中治疗抑郁和焦虑的临床效果。方法:在一项回顾性队列研究中，我们分析了在丹麦二级保健专门的iCBT诊所接受抑郁或焦虑治疗的患者。患者在治疗前和治疗后每周分别使用患者健康问卷-9和广泛性焦虑障碍-7量表对抑郁和焦虑进行诊断。初步分析采用随机斜率和截距的线性混合效应模型。采用基线特征作为预测因素(性别、年龄、最高教育水平、职业状况、婚姻状况、精神药物使用、酒精消费和休闲药物)进行二次分析。 Additionally, logistic regression analyses were used to predict noncompletion of treatment. Results: A total of 203 (depression, N=60; anxiety, N=143) patients were included. Participants were mainly female (78.3% with depression and 65.7% with anxiety), with a mean age of 36.03 (SD 10.97) years (range, 19-67 years) for patients with depression and 36.80 (SD 13.55) years (range, 19-69 years) for patients with anxiety. The completion rates were 62% (37) and 40% (57) for depression and anxiety treatments, respectively. The primary analyses revealed large and significant reductions in the symptom levels of depression (beta=-6.27, SE 0.83, P<.001, d=1.0) and anxiety (beta=-3.78, SE 0.43, P<.001, d=1.1). High baseline severity of the primary disorder was associated with high treatment gains (r=-0.31 for depression; r=-0.41 for anxiety). In patients with anxiety, high baseline severity also predicted a high risk of noncompletion (odds ratio=1.08, CI=1.01-1.16, P=.03). An increase in the baseline severity of the comorbid disorder slightly increased the risk of noncompletion for both disorders (depression: odds ratio=1.03, CI=1.01-1.06, P=.02; anxiety: odds ratio=1.08, CI=1.01-1.16, P=.03). Conclusions: iCBT can be clinically effective in routine care. Since depression and anxiety are costly and debilitating disorders that are vastly undertreated, this finding is important. Additionally, iCBT may help bridge the gap between the need for treatment and its provision. Our results are comparable to the within-group results of efficacy and effectiveness studies. Our noncompletion rates are similar to those observed in psychotherapy but are higher than those reported in similar clinics. Multiple factors predicted outcome and noncompletion. However, all predictor effects were statistically weak. SN - 1438-8871 UR - //www.mybigtv.com/2018/11/e10927/ UR - https://doi.org/10.2196/10927 UR - http://www.ncbi.nlm.nih.gov/pubmed/30487118 DO - 10.2196/10927 ID - info:doi/10.2196/10927 ER -