瑞典卡罗琳斯卡学院Eva Serlachius团队研究了网络阶梯式护理与认知行为治疗对儿童青少年强迫症症状的影响。2021年5月11日，该研究发表在《美国医学会杂志》上。

在大多数国家，患有强迫症的青少年接受一线治疗，即专家认知行为疗法（CBT）的机会有限。

为了探讨在阶梯式护理模式下实施互联网CBT治疗儿童强迫症是否优于面对面CBT，研究组在瑞典的两个儿童和青少年心理健康专科诊所进行了一项随机、临床、非劣效性试验。2017年10月-2019年5月，共招募了152名8至17岁的强迫症患者。

将参与者随机分组，其中阶梯式护理组74例，接受为期16周的互联网CBT，在3个月的随访中，无缓解者接受传统的面对面治疗。对照组78例，立即接受面对面CBT治疗16周，在3个月的随访中，无缓解者接受了额外的面对面治疗。主要结局是6个月随访时儿童耶鲁-布朗强迫症量表（CY-BOCS）得分，0到40分，得分越高表示越严重。在CY-BOCS上预定义的非劣效性边缘为4分。

152名参与者的平均年龄为13.4岁，62%为女孩，99%完成了试验。在3个月的随访中，阶梯式护理组中有34名参与者（46%）无缓解，面对面CBT组中有23名（30%）。在6个月的随访中，阶梯式护理组的CY-BOCS评分为11.57分，而面对面治疗组为10.57分，符合非劣效性标准。两组中最常见的不良事件分别为焦虑增加（30%和36%）和抑郁症状（20%和28%）。共发生2例研究无关的严重不良事件，每组1例。

研究结果表明，对于患有强迫症的儿童和青少年，使用互联网提供的CBT程序进行治疗，必要时进行面对面CBT，在6个月时的症状改善不劣于单独使用面对面CBT。

附：英文原文

Title: Effect of an Internet-Delivered Stepped-Care Program vs In-Person Cognitive Behavioral Therapy on Obsessive-Compulsive Disorder Symptoms in Children and Adolescents: A Randomized Clinical Trial

Author: Kristina Aspvall, Erik Andersson, Karin Melin, Lisa Norlin, Viktor Eriksson, Sarah Vigerland, Maral Jolstedt, Maria Silverberg-Mrse, Lena Wallin, Filipa Sampaio, Inna Feldman, Matteo Bottai, Fabian Lenhard, David Mataix-Cols, Eva Serlachius

Issue&Volume: 2021/05/11

Abstract:

Importance  In most countries, young people with obsessive-compulsive disorder have limited access to specialist cognitive behavioral therapy (CBT), a first-line treatment.

Objective  To investigate whether internet-delivered CBT implemented in a stepped-care model is noninferior to in-person CBT for pediatric obsessive-compulsive disorder.

Design, Setting and Participants  A randomized clinical noninferiority trial conducted at 2 specialist child and adolescent mental health clinics in Sweden. Participants included 152 individuals aged 8 to 17 years with obsessive-compulsive disorder. Enrollment began in October 2017 and ended in May 2019. Follow-up ended in April 2020.

Interventions  Participants randomized to the stepped-care group (n=74) received internet-delivered CBT for 16 weeks. Nonresponders at the 3-month follow-up were then offered a course of traditional face-to-face treatment. Participants randomized to the control group (n=78) immediately received in-person CBT for 16 weeks. Nonresponders at the 3-month follow-up received additional face-to-face treatment.

Main Outcomes and Measures  The primary outcome was the masked assessor–rated Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) score at the 6-month follow-up. The scale includes 10 items rated from 0(no symptoms) to 4(extreme symptoms), yielding a total score range of 0 to 40, with higher scores indicating greater severity. Assessors were masked to treatment allocation at pretreatment, posttreatment, 3-month follow-up, and 6-month follow-up assessments. The predefined noninferiority margin was 4 points on the CY-BOCS.

Results  Among the 152 randomized participants (mean age, 13.4 years; 94 [62%] females), 151 (99%) completed the trial. At the 3-month follow-up, 34 participants (46%) in the stepped-care group and 23 (30%) in the in-person CBT group were nonresponders. At the 6-month follow-up, the CY-BOCS score was 11.57 points in the stepped-care group vs 10.57 points in the face-to-face treatment group, corresponding to an estimated mean difference of 0.91 points ([1-sided 97.5% CI, ∞ to 3.28]; P for noninferiority=.02). Increased anxiety (30%-36%) and depressive symptoms (20%-28%) were the most frequently reported adverse events in both groups. There were 2 unrelated serious adverse events (1 in each group).

Conclusions and Relevance  Among children and adolescents with obsessive-compulsive disorder, treatment with an internet-delivered CBT program followed by in-person CBT if necessary compared with in-person CBT alone resulted in a noninferior difference in symptoms at the 6-month follow-up. Further research is needed to understand the durability and generalizability of these findings.

DOI: 10.1001/jama.2021.3839

Source: https://jamanetwork.com/journals/jama/article-abstract/2779829