TY - JOUR AU - Lundgren, Johan Gustav AU - Dahlström， Örjan AU - Andersson, Gerhard AU - Jaarsma, Tiny AU - Kärner Köhler, Anita AU - Johansson, Peter PY - 2016 DA - 2016/08/03 TI -基于网络的导向认知行为治疗对抑郁症状和心力衰竭患者的影响:试验随机对照试验JO - J Med Internet Res SP - e194 VL - 18 IS - 8kw -心力衰竭KW -抑郁KW -基于互联网的认知行为治疗KW -认知行为治疗KW -互联网KW - eHealth AB -背景:抑郁症状以及相关的焦虑症状和生活质量下降(QoL)共存在心力衰竭(HF)患者中很常见。然而，心衰患者抑郁症状的治疗策略仍有待确定。基于网络的认知行为疗法(ICBT)是一种引导自助的认知行为疗法，在治疗抑郁症方面表现出良好的效果。到目前为止，ICBT尚未在伴有抑郁症状的心衰患者中进行评估。目的:本研究的目的是(1)评价9周指导ICBT计划对心衰患者抑郁症状的影响;(2)探讨ICBT项目对心脏焦虑和生活质量的影响;(3)评估与抑郁症状改变相关的因素。方法:50名参与者被随机分为2个治疗组:ICBT或基于网络的主持讨论论坛(DF)。患者健康问卷-9用于测量抑郁症状，心脏焦虑问卷(CAQ)用于测量心脏相关焦虑，明尼苏达州心衰患者生活问卷用于测量生活质量。 Data were collected at baseline and at follow-up at the end of the 9-week intervention. Intention-to-treat analysis was used, and missing data were imputed by the Expectation-Maximization method. Between-group differences were determined by analysis of covariance with control for baseline score and regression to the mean. Results: No significant difference in depressive symptoms between the ICBT and the DF group at the follow-up was found, [F(1,47)=1.63, P=.21] and Cohen´s d=0.26. Secondary within-group analysis of depressive symptoms showed that such symptoms decreased significantly in the ICBT group from baseline to the follow-up (baseline M=10.8, standard deviation [SD]=5.7 vs follow-up M=8.6, SD=4.6, t(24)=2.6, P=.02, Cohen´s d=0.43), whereas in the DF group, there was no significant change (baseline M=10.6, SD=5.0, vs follow-up M=9.8, SD=4.3, t(24)=0.93, P=.36. Cohen´s d=0.18). With regard to CAQ and QoL no significant differences were found between the groups (CAQ [d(1,47)=0.5, P=.48] and QoL [F(1,47)=2.87, P=.09]). In the ICBT group in the CAQ subscale of fear, a significant within-group decrease was shown (baseline M=1.55 vs follow-up M=1.35, P=.04). In the ICBT group, the number of logins to the Web portal correlated significantly with improvement in depressive symptoms (P=.02), whereas higher age (P=.01) and male sex (P=.048) were associated with less change in depressive symptoms. This study is underpowered because of difficulties in the recruitment of patients. Conclusions: Guided ICBT adapted for persons with HF and depressive symptoms was not statistically superior to participation in a Web-based DF. However, within the ICBT group, a statically significant improvement of depressive symptoms was detected. ClinicalTrial: Clinicaltrials.gov NCT01681771; https://clinicaltrials.gov/ct2/show/NCT01681771 (Archived by WebCite at http://www.webcitation.org/6ikzbcuLN) SN - 1438-8871 UR - //www.mybigtv.com/2016/8/e194/ UR - https://doi.org/10.2196/jmir.5556 UR - http://www.ncbi.nlm.nih.gov/pubmed/27489077 DO - 10.2196/jmir.5556 ID - info:doi/10.2196/jmir.5556 ER -