Cargando…
Effectiveness and Cost-Effectiveness of a Self-Guided Internet Intervention for Social Anxiety Symptoms in a General Population Sample: Randomized Controlled Trial
BACKGROUND: Many people are accessing digital self-help for mental health problems, often with little evidence of effectiveness. Social anxiety is one of the most common sources of mental distress in the population, and many people with symptoms do not seek help for what represents a significant pub...
Autores principales: | , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
JMIR Publications
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996778/ https://www.ncbi.nlm.nih.gov/pubmed/31821151 http://dx.doi.org/10.2196/16804 |
_version_ | 1783493574148489216 |
---|---|
author | Powell, John Williams, Veronika Atherton, Helen Bennett, Kylie Yang, Yaling Davoudianfar, Mina Hellsing, Annika Martin, Angela Mollison, Jill Shanyinde, Milensu Yu, Ly-Mee Griffiths, Kathleen M |
author_facet | Powell, John Williams, Veronika Atherton, Helen Bennett, Kylie Yang, Yaling Davoudianfar, Mina Hellsing, Annika Martin, Angela Mollison, Jill Shanyinde, Milensu Yu, Ly-Mee Griffiths, Kathleen M |
author_sort | Powell, John |
collection | PubMed |
description | BACKGROUND: Many people are accessing digital self-help for mental health problems, often with little evidence of effectiveness. Social anxiety is one of the most common sources of mental distress in the population, and many people with symptoms do not seek help for what represents a significant public health problem. OBJECTIVE: This study aimed to evaluate the effectiveness of a self-guided cognitive behavioral internet intervention for people with social anxiety symptoms in the general population. METHODS: We conducted a two-group randomized controlled trial in England between May 11, 2016, and June 27, 2018. Adults with social anxiety symptoms who were not receiving treatment for social anxiety were recruited using online advertisements. All participants had unrestricted access to usual care and were randomized in a 1:1 ratio to either a Web-based unguided self-help intervention based on cognitive behavioral principles or a waiting list control group. All outcomes were collected through self-report online questionnaires. The primary outcome was the change in 17-item Social Phobia Inventory (SPIN-17) score from baseline to 6 weeks using a linear mixed-effect model that used data from all time points (6 weeks, 3 months, 6 months, and 12 months). RESULTS: A total of 2122 participants were randomized, and 6 were excluded from analyses because they were ineligible. Of the 2116 eligible randomized participants (mean age 37 years; 80.24%, 1698/2116 women), 70.13% (1484/2116) had follow-up data available for analysis, and 56.95% (1205/2116) had data on the primary outcome, although attrition was higher in the intervention arm. At 6 weeks, the mean (95% CI) adjusted difference in change in SPIN-17 score in the intervention group compared with control was −1.94 (−3.13 to −0.75; P=.001), a standardized mean difference effect size of 0.2. The improvement was maintained at 12 months. Given the high dropout rate, sensitivity analyses explored missing data assumptions, with results that were consistent with those of the primary analysis. The economic evaluation demonstrated cost-effectiveness with a small health status benefit and a reduction in health service utilization. CONCLUSIONS: For people with social anxiety symptoms who are not receiving other forms of help, this study suggests that the use of an online self-help tool based on cognitive behavioral principles can provide a small improvement in social anxiety symptoms compared with no intervention, although dropout rates were high. TRIAL REGISTRATION: ClinicalTrials.gov NCT02451878; https://clinicaltrials.gov/ct2/show/NCT02451878 |
format | Online Article Text |
id | pubmed-6996778 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | JMIR Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-69967782020-02-20 Effectiveness and Cost-Effectiveness of a Self-Guided Internet Intervention for Social Anxiety Symptoms in a General Population Sample: Randomized Controlled Trial Powell, John Williams, Veronika Atherton, Helen Bennett, Kylie Yang, Yaling Davoudianfar, Mina Hellsing, Annika Martin, Angela Mollison, Jill Shanyinde, Milensu Yu, Ly-Mee Griffiths, Kathleen M J Med Internet Res Original Paper BACKGROUND: Many people are accessing digital self-help for mental health problems, often with little evidence of effectiveness. Social anxiety is one of the most common sources of mental distress in the population, and many people with symptoms do not seek help for what represents a significant public health problem. OBJECTIVE: This study aimed to evaluate the effectiveness of a self-guided cognitive behavioral internet intervention for people with social anxiety symptoms in the general population. METHODS: We conducted a two-group randomized controlled trial in England between May 11, 2016, and June 27, 2018. Adults with social anxiety symptoms who were not receiving treatment for social anxiety were recruited using online advertisements. All participants had unrestricted access to usual care and were randomized in a 1:1 ratio to either a Web-based unguided self-help intervention based on cognitive behavioral principles or a waiting list control group. All outcomes were collected through self-report online questionnaires. The primary outcome was the change in 17-item Social Phobia Inventory (SPIN-17) score from baseline to 6 weeks using a linear mixed-effect model that used data from all time points (6 weeks, 3 months, 6 months, and 12 months). RESULTS: A total of 2122 participants were randomized, and 6 were excluded from analyses because they were ineligible. Of the 2116 eligible randomized participants (mean age 37 years; 80.24%, 1698/2116 women), 70.13% (1484/2116) had follow-up data available for analysis, and 56.95% (1205/2116) had data on the primary outcome, although attrition was higher in the intervention arm. At 6 weeks, the mean (95% CI) adjusted difference in change in SPIN-17 score in the intervention group compared with control was −1.94 (−3.13 to −0.75; P=.001), a standardized mean difference effect size of 0.2. The improvement was maintained at 12 months. Given the high dropout rate, sensitivity analyses explored missing data assumptions, with results that were consistent with those of the primary analysis. The economic evaluation demonstrated cost-effectiveness with a small health status benefit and a reduction in health service utilization. CONCLUSIONS: For people with social anxiety symptoms who are not receiving other forms of help, this study suggests that the use of an online self-help tool based on cognitive behavioral principles can provide a small improvement in social anxiety symptoms compared with no intervention, although dropout rates were high. TRIAL REGISTRATION: ClinicalTrials.gov NCT02451878; https://clinicaltrials.gov/ct2/show/NCT02451878 JMIR Publications 2020-01-10 /pmc/articles/PMC6996778/ /pubmed/31821151 http://dx.doi.org/10.2196/16804 Text en ©John Powell, Veronika Williams, Helen Atherton, Kylie Bennett, Yaling Yang, Mina Davoudianfar, Annika Hellsing, Angela Martin, Jill Mollison, Milensu Shanyinde, Ly-Mee Yu, Kathleen M Griffiths. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 10.01.2020. https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included. |
spellingShingle | Original Paper Powell, John Williams, Veronika Atherton, Helen Bennett, Kylie Yang, Yaling Davoudianfar, Mina Hellsing, Annika Martin, Angela Mollison, Jill Shanyinde, Milensu Yu, Ly-Mee Griffiths, Kathleen M Effectiveness and Cost-Effectiveness of a Self-Guided Internet Intervention for Social Anxiety Symptoms in a General Population Sample: Randomized Controlled Trial |
title | Effectiveness and Cost-Effectiveness of a Self-Guided Internet Intervention for Social Anxiety Symptoms in a General Population Sample: Randomized Controlled Trial |
title_full | Effectiveness and Cost-Effectiveness of a Self-Guided Internet Intervention for Social Anxiety Symptoms in a General Population Sample: Randomized Controlled Trial |
title_fullStr | Effectiveness and Cost-Effectiveness of a Self-Guided Internet Intervention for Social Anxiety Symptoms in a General Population Sample: Randomized Controlled Trial |
title_full_unstemmed | Effectiveness and Cost-Effectiveness of a Self-Guided Internet Intervention for Social Anxiety Symptoms in a General Population Sample: Randomized Controlled Trial |
title_short | Effectiveness and Cost-Effectiveness of a Self-Guided Internet Intervention for Social Anxiety Symptoms in a General Population Sample: Randomized Controlled Trial |
title_sort | effectiveness and cost-effectiveness of a self-guided internet intervention for social anxiety symptoms in a general population sample: randomized controlled trial |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996778/ https://www.ncbi.nlm.nih.gov/pubmed/31821151 http://dx.doi.org/10.2196/16804 |
work_keys_str_mv | AT powelljohn effectivenessandcosteffectivenessofaselfguidedinternetinterventionforsocialanxietysymptomsinageneralpopulationsamplerandomizedcontrolledtrial AT williamsveronika effectivenessandcosteffectivenessofaselfguidedinternetinterventionforsocialanxietysymptomsinageneralpopulationsamplerandomizedcontrolledtrial AT athertonhelen effectivenessandcosteffectivenessofaselfguidedinternetinterventionforsocialanxietysymptomsinageneralpopulationsamplerandomizedcontrolledtrial AT bennettkylie effectivenessandcosteffectivenessofaselfguidedinternetinterventionforsocialanxietysymptomsinageneralpopulationsamplerandomizedcontrolledtrial AT yangyaling effectivenessandcosteffectivenessofaselfguidedinternetinterventionforsocialanxietysymptomsinageneralpopulationsamplerandomizedcontrolledtrial AT davoudianfarmina effectivenessandcosteffectivenessofaselfguidedinternetinterventionforsocialanxietysymptomsinageneralpopulationsamplerandomizedcontrolledtrial AT hellsingannika effectivenessandcosteffectivenessofaselfguidedinternetinterventionforsocialanxietysymptomsinageneralpopulationsamplerandomizedcontrolledtrial AT martinangela effectivenessandcosteffectivenessofaselfguidedinternetinterventionforsocialanxietysymptomsinageneralpopulationsamplerandomizedcontrolledtrial AT mollisonjill effectivenessandcosteffectivenessofaselfguidedinternetinterventionforsocialanxietysymptomsinageneralpopulationsamplerandomizedcontrolledtrial AT shanyindemilensu effectivenessandcosteffectivenessofaselfguidedinternetinterventionforsocialanxietysymptomsinageneralpopulationsamplerandomizedcontrolledtrial AT yulymee effectivenessandcosteffectivenessofaselfguidedinternetinterventionforsocialanxietysymptomsinageneralpopulationsamplerandomizedcontrolledtrial AT griffithskathleenm effectivenessandcosteffectivenessofaselfguidedinternetinterventionforsocialanxietysymptomsinageneralpopulationsamplerandomizedcontrolledtrial |