针对学龄青少年压力的简易认知行为疗法（BESST）的临床效果和成本效益

通过认知行为疗法，提升自我认知和应对压力的能力 #生活知识# #生活心理学# #青少年心理辅导#

June Brown, Kirsty James, Stephen Lisk, James Shearer, Sarah Byford, Paul Stallard, Jessica Deighton, David Saunders, Jynna Yarrum, Peter Fonagy, Timothy Weaver, Irene Sclare, Crispin Day, Claire Evans, Ben Carter

引用次数: 0

摘要

背景介绍抑郁和焦虑在青少年中越来越普遍。中学简短教育研讨会试验调查了针对 16-18 岁青少年的简短无障碍压力研讨会计划的有效性。我们的目的是调查 DISCOVER 认知行为疗法 (CBT) 工作坊在 6 个月后对 16-18 岁青少年抑郁症状的临床疗效和成本效益，并与常规治疗进行比较：我们在英国的学校或六年级学院开展了一项多中心、分组随机对照试验，以评估简短的 CBT 工作坊（DISCOVER）与常规治疗相比的临床效果和成本效益。我们计划招募 60 所学校和 900 名青少年，采用自我转介系统招募参与者。学校按1:1的比例随机分配参加者接受DISCOVER工作坊或常规治疗，并根据学校规模和多重贫困指数进行分层。参与者年龄在16-18岁之间，在校时间为整个学年，因压力而寻求帮助，英语流利并能提供书面知情同意书。结果评估员、高级卫生经济学家、高级统计师和首席研究员均被蒙面。有生活经验的人参与了研究。主要研究结果是在随访 6 个月时，在所有具有完整协变量数据的参与者的意向治疗人群中，使用 "情绪和感觉问卷"（MFQ）测量抑郁症状。该试验已在 ISRCTN 登记处登记（ISRCTN90912799）：111所学校受邀参与研究，7所学校被认为不符合条件，47所学校未提供同意书。2021 年 10 月 4 日至 2022 年 11 月 10 日期间，57 所学校的 933 名学生通过了资格筛选，7 名学生不符合纳入条件，26 名学生未参加基线会议和评估，最终有 900 名青少年参与了研究。DISCOVER组包括443名参与者（295名[67%]女性和136名[31%]男性），"常规治疗 "组包括457名参与者（346名[76%]女性和92名[20%]男性）。900 名参与者中有 468 人（52%）为白人，总体年龄为 17-2 岁（SD 0-6）。在意向治疗人群中，有 873 名（97%）青少年接受了随访。主要的意向治疗分析（n=854）发现，随访 6 个月时，MFQ 的调整后平均差异为 -2-06 (95% CI -3-35 to -0-76; Cohen's d=-0-17; p=0-0019)，表明 DISCOVER 组的临床症状有所改善。在每质量调整生命年阈值为2万至3万英镑时，DISCOVER与常规治疗相比具有成本效益的概率为61%至78%。DISCOVER组报告了9例不良事件（其中2例为严重不良事件），而常规治疗组报告了14例不良事件（其中2例为严重不良事件）：我们的研究结果表明，DISCOVER 干预方法在临床上略有成效，在经济上也是可行的，可以作为一种有前途的学校早期干预方法。鉴于在青少年群体中尽早解决心理健康需求的重要性，有必要开展更多的研究来探索这种干预措施：国家健康与护理研究所健康技术评估计划。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Clinical effectiveness and cost-effectiveness of a brief accessible cognitive behavioural therapy programme for stress in school-aged adolescents (BESST): a cluster randomised controlled trial in the UK.

Background: Depression and anxiety are increasingly prevalent in adolescents. The Brief Educational Workshops in Secondary Schools Trial investigated the effectiveness of a brief accessible stress workshop programme for 16-18-year-olds. We aimed to investigate the clinical effectiveness and cost-effectiveness of the DISCOVER cognitive behavioural therapy (CBT) workshop on symptoms of depression in 16-18-year-olds at 6 months compared with treatment-as-usual.

Methods: We conducted a multicentre, cluster randomised controlled trial in UK schools or colleges with sixth forms to evaluate clinical effectiveness and cost-effectiveness of a brief CBT workshop (DISCOVER) compared with treatment-as-usual. We planned to enrol 60 schools and 900 adolescents, using a self-referral system to recruit participants. Schools were randomised in a 1:1 ratio for participants to receive either the DISCOVER workshop or treatment-as-usual, stratified by site and balanced on school size and index of multiple deprivation. Participants were included if they were 16-18 years old, attending for the full school year, seeking help for stress, and fluent in English and able to provide written informed consent. The outcome assessors, senior health economist, senior statistician, and chief investigator were masked. People with lived experience were involved in the study. The primary outcome was depression symptoms measured with the Mood and Feelings Questionnaire (MFQ) at 6-month follow-up, in the intention-to-treat population of all participants with full covariate data. The trial was registered with the ISRCTN registry (ISRCTN90912799).

Findings: 111 schools were invited to participate in the study, seven were deemed ineligible, and 47 did not provide consent. Between Oct 4, 2021, and Nov 10, 2022, 933 students at 57 schools were screened for eligibility, seven were not eligible for inclusion, and 26 did not attend the baseline meeting and assessment, resulting in 900 adolescents participating in the study. The DISCOVER group included 443 participants (295 [67%] female and 136 [31%] male) and the treatment-as-usual group included 457 participants (346 [76%] female and 92 [20%] male). 468 (52%) of the 900 participants were White, and the overall age of the participants was 17·2 years (SD 0·6). 873 (97%) adolescents were followed up in the intention-to-treat population. The primary intention-to-treat analysis (n=854) found an adjusted mean difference in MFQ of -2·06 (95% CI -3·35 to -0·76; Cohen's d=-0·17; p=0·0019) at the 6-month follow-up, indicating a clinical improvement in the DISCOVER group. The probability that DISCOVER is cost- effective compared with treatment-as-usual ranged from 61% to 78% at a £20 000 to £30 000 per quality-adjusted life-year threshold. Nine adverse events (two of which were classified as serious) were reported in the DISCOVER group and 14 (two of which were classified as serious) were reported in the treatment-as-usual group.

Interpretation: Our findings indicate that the DISCOVER intervention is modestly clinically effective and economically viable and could be a promising early intervention in schools. Given the importance of addressing mental health needs early in this adolescent population, additional research is warranted to explore this intervention.

Funding: National Institute for Health and Care Research Health Technology Assessment Programme.

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