Cognitive and behavioural skills to prevent major depression among adults with subthreshold depression: 50-week follow-up analysis of smartphone CBT randomised trials (RESiLIENT trial)

作者：Tatsuo Akechi, Hisashi Noma, Aran Tajika, Rie Toyomoto, Masatsugu Sakata, Yan Luo, Masaru Horikoshi, Norito Kawakami, Takeo Nakayama, Naoki Kondo, Shingo Fukuma, Toshi A. Furukawa · 发表于：The British Journal of Psychiatry · 年份：2026 · DOI：10.1192/bjp.2026.10630 · 被引用次数：1 · 研究领域：Digital Mental Health Interventions、Sleep and related disorders、Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes

BACKGROUND: Major depression is a common and disabling disorder, and individuals with subthreshold depression represent a key at-risk group. We previously demonstrated that specific cognitive behavioural therapy (CBT) skills training delivered via a smartphone app (behavioural activation, cognitive restructuring, problem solving, assertion training and behavioural therapy for insomnia) improved depressive symptoms for up to 26 weeks. AIMS: To evaluate the long-term effects (up to 50 weeks) of CBT skills and their combinations for preventing major depressive episodes and reducing the total burden of depression (TBD). METHOD: Participants were adults from the general population with subthreshold depression. A master protocol trial with four 2 × 2 factorial trials was used to randomise 3280 participants to one of nine intervention arms or a self-check control group. The primary outcome was time to onset of major depression by week 50. RESULTS: Hazard ratios for the interventions ranged from 0.52 (95% CI: 0.29-0.94) to 0.63 (95% CI: 0.36-1.10), with behavioural activation + assertion training showing the greatest preventive effect (number needed to treat: 23.3 (95% CI: 12.2 to 250)), followed by behavioural therapy for insomnia, behavioural activation + behavioural therapy for insomnia and cognitive restructuring. All interventions reduced TBD scores compared with control, with behavioural activation + cognitive restructuring exhibiting the largest reduction. Effect sizes at week...