Background: Evidence on technology-based psychological interventions (TBIs) for the treatment of depression is rapidly growing and covers a broad scope of research. Despite extensive research in this field, guideline recommendations are still limited to the general effectiveness of TBIs. Objective: This study aims to structure evidence on TBIs by considering different application areas (eg, TBIs for acute treatment and their implementation in health care, such as stand-alone interventions) and treatment characteristics (eg, therapeutic rationale of TBIs) to provide a comprehensive evidence base and to identify research gaps in TBIs for diagnosed depression. Moreover, the reporting of negative events in the included studies is investigated in this review to enable subsequent safety assessment of the TBIs. Methods: Randomized controlled trials on adults diagnosed with unipolar depression receiving any kind of psychotherapeutic treatment, which was at least partly delivered by a technical medium, were eligible for inclusion in our preregistered systematic review. We searched for trials in CENTRAL (Cochrane Central Register of Controlled Trials; until August 2020), MEDLINE, PsycINFO, PSYNDEX, CINAHL; until the end of January 2018), clinical trial registers, and sources of gray literature (until the end of January 2019). Study selection and data extraction were conducted by 2 review authors independently. Results: Database searches resulted in 15,546 records, of which 241 publications were included, representing 83 completed studies and 60 studies awaiting classification (ie, preregistered studies, study protocols). Almost all completed studies (78/83, 94%) addressed the acute treatment phase, being largely either implemented as stand-alone interventions (66/83, 80%) or blended treatment approaches (12/83, 14%). Studies on TBIs for aftercare (4/83, 5%) and for bridging waiting periods (1/83, 1%) were scarce. Most TBI study arms (n=107) were guided (59/107, 55.1%), delivered via the internet (80/107, 74.8%), and based on cognitive behavioral treatment approaches (88/107, 79.4%). Almost all studies (77/83, 93%) reported information on negative events, considering dropouts from treatment as a negative event. However, reports on negative events were heterogeneous and largely unsystematic. Conclusions: Research has given little attention to studies evaluating TBIs for aftercare and for bridging waiting periods in people with depression, even though TBIs are seen as highly promising in these application areas; thus, high quality studies are urgently needed. In addition, the variety of therapeutic rationales on TBIs has barely been represented by identified studies hindering the consideration of patient preferences when planning treatment. Finally, future studies should use specific guidelines to systematically assess and report negative events. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42016050413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016050413.

中文翻译：

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基于技术的心理干预对诊断抑郁症的证据：系统评价


背景：基于技术的心理干预（TBI）治疗抑郁症的证据正在迅速增加，并涵盖广泛的研究范围。尽管该领域进行了广泛的研究，但指南建议仍然仅限于 TBI 的一般有效性。目的：本研究旨在通过考虑不同的应用领域（例如，用于急性治疗的 TBI 及其在医疗保健中的实施，例如独立干预措施）和治疗特征（例如，TBI 的治疗原理）来构建 TBI 的证据，以提供全面的证据基础，并确定 TBI 诊断抑郁症的研究差距。此外，本次综述还对纳入研究中负面事件的报告进行了调查，以便对 TBI 进行后续安全评估。方法：对被诊断为单相抑郁症的成人接受任何类型的心理治疗（至少部分由技术媒介提供）的随机对照试验有资格纳入我们预先注册的系统评价。我们检索了 CENTRAL（Cochrane 对照试验中央注册库；截至 2020 年 8 月）、MEDLINE、PsycINFO、PSYNDEX、CINAHL 中的试验；截至 2018 年 1 月底）、临床试验登记册和灰色文献来源（截至 2019 年 1 月底）。研究选择和数据提取由 2 名综述作者独立进行。结果：数据库检索得到 15,546 条记录，其中纳入 241 份出版物，代表 83 项已完成的研究和 60 项等待分类的研究（即预先注册的研究、研究方案）。 几乎所有已完成的研究（78/83，94%）都涉及急性治疗阶段，大部分是作为独立干预措施（66/83，80%）或混合治疗方法（12/83，14%）实施的。关于 TBI 用于术后护理（4/83，5%）和桥接等待期（1/83，1%）的研究很少。大多数 TBI 研究组 (n=107) 均接受指导 (59/107, 55.1%)，通过互联网进行 (80/107, 74.8%)，并基于认知行为治疗方法 (88/107, 79.4%)。几乎所有研究（77/83，93%）都报告了有关负面事件的信息，并将退出治疗视为负面事件。然而，有关负面事件的报道多种多样，而且基本上不系统。结论：尽管 TBI 在这些应用领域被认为非常有前景，但研究很少关注评估 TBI 在抑郁症患者的术后护理和缩短等待期方面的研究；因此，迫切需要高质量的研究。此外，已确定的研究几乎没有体现 TBI 的各种治疗原理，这阻碍了在计划治疗时考虑患者的偏好。最后，未来的研究应使用具体的指南来系统地评估和报告负面事件。试验注册：国际前瞻性系统评价注册库（PROSPERO）CRD42016050413； https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016050413。