ABSTRACT

Background: While Internet- and mobile-based interventions (IMIs) are potential options to increase the access to evidence-based therapies for post-traumatic stress disorder (PTSD), comprehensive knowledge on their working mechanisms is still scarce.

Objective: We aimed to evaluate studies investigating the efficacy and mechanisms of change in IMIs for adults with PTSD.

Method: In this systematic review and meta-analysis (PROSPERO CRD42019130314), five databases were consulted to identify relevant studies, complemented by forward (i.e. citation search) and backward (i.e. review of reference lists from included studies) searches. Randomized controlled trials (RCTs) investigating the efficacy of IMIs compared to active controls, as well as component and mediation studies were included. Two independent reviewers extracted the data and assessed the risk of bias and requirements for process research. Random-effects meta-analyses on PTSD symptom severity as primary outcome were conducted and further information was synthesized qualitatively.

Results: In total, 33 RCTs were included (N = 5421). The meta-analysis comparing IMIs to non-bonafide active controls yielded a significant standardized mean difference (SMD) of −0.36 (95%CI −0.53 to −0.19) favouring IMIs. Although meta-analytic pooling was not possible for the component and mediation studies, evidence suggests no differential effects regarding PTSD symptom reduction between different levels of support and personalization and between different types of exposure. Moreover, mediation studies revealed significant intervening variable effects for self-efficacy beliefs, perceived physical impairment, social acknowledgement, and trauma disclosure.

Conclusions: Results indicate that IMIs for PTSD are superior to active controls. Furthermore, findings may contribute to the development of new interventions by outlining important directions for future research (e.g. regarding requirements for process research) and highlighting potential mechanisms of change (i.e. self-efficacy, perceived physical impairment, social acknowledgement, and trauma disclosure).

摘要

背景：虽然基于互联网和移动设备的干预措施 (IMI) 是增加创伤后应激障碍 (PTSD) 循证疗法可及性的潜在选择，但对其工作机制的全面了解仍然很少。

目的：我们旨在评估调查 IMIs 变化对患有 PTSD 成人的疗效和机制的研究。

方法：在这项系统评价和荟萃分析 (PROSPERO CRD42019130314) 中，查阅了五个数据库以确定相关研究，并辅之以正向（即引文搜索）和反向（即审查纳入研究的参考文献列表）搜索。随机对照试验 (RCT) 调查了 IMI 与活性对照相比的疗效，以及成分和中介研究。两名独立审查员提取数据并评估偏倚风险和过程研究的要求。对作为主要结果的 PTSD 症状严重程度进行了随机效应荟萃分析，并定性地综合了进一步的信息。

结果：总共纳入了 33 项随机对照试验 (N = 5421)。将 IMI 与非真实活性对照进行比较的荟萃分析产生了显着的标准化均值差 (SMD)，为 -0.36（95%CI -0.53 至 -0.19），有利于 IMI。虽然元分析汇集无法用于成分和中介研究，但证据表明，不同水平的支持和个性化之间以及不同类型的暴露之间对 PTSD 症状减轻没有差异影响。此外，调解研究揭示了对自我效能信念、感知身体损伤、社会承认和创伤披露的显着干预变量效应。

结论：结果表明，针对 PTSD 的 IMI 优于主动控制。此外，通过概述未来研究的重要方向（例如关于过程研究的要求）和强调潜在的变化机制（即自我效能、感知身体损伤、社会承认和创伤披露），研究结果可能有助于新干预措施的发展。