心理治疗对于不积极寻求帮助的抑郁症患者是否有效？来自元分析的证据

分享一篇《临床心理学栏目》瑞瑛最新发表在《Psychological Medicine; 2021 impact factor 10.592 》的文章，恭喜！！！

Effects of psychological treatment for depression among people not actively seeking help: a meta-analysis

Ruiying Zhao, Arpana Amarnath, Eirini Karyotaki, Sascha Y. Struijs, Pim Cuijpers

                 Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

Abstract

[Opens in a new window][在新窗口中打开]Although psychological treatments have been found to be effective for depression in adults, many individuals with depression do not actively seek help. It is currently unclear whether psychological treatments are effective among those not actively seeking help. Besides, little is known about the proportion of patients who completed a screening questionnaire who end up in a clinical trial. Therefore, we conducted a meta-analysis of 52 randomized trials comparing psychotherapies for adults with a diagnosis or elevated symptoms of depression against control conditions (care-as-usual, waiting list, and other inactive treatment). Only studies recruiting participants who do not actively seek help (participants who have been recruited through screening instead of advertisements and clinical referrals) were included. To obtain an overall effect estimate of psychotherapy, we pooled all post-test differences with a random-effects model. We found that psychological treatments had a moderate to high effect on reducing depressive symptoms compared to control groups [g = 0.55; 95% confidence interval (CI) 0.41–0.69]. Heterogeneity was high (I2 = 75%; 95% CI 68–80). At 12 months' follow-up, the effects were small but significant (6–8 months: g = 0.33; 95% CI 0.14–0.52; 9–12 months: g = 0.24; 95% CI 0.11–0.37). As a secondary outcome, we found that 13% of patients who completed a screening questionnaire met the inclusion criteria for depression and agreed to be randomized in the trial. Based on the current evidence, psychological treatments for depression might be effective for depressed patients who are not actively seeking help.

Keywords 

Depression , meta-analysis , not actively seeking help , psychological treatment
摘要尽管已有研究发现心理治疗对成人抑郁症有效，但许多抑郁症患者并不会积极寻求帮助。目前尚不清楚心理治疗对那些不积极寻求帮助的人是否有效。此外，对于完成筛选问卷的患者最终参加临床试验的比例知之甚少。因此，我们对 52 项随机试验进行了元分析，将对诊断为抑郁症或抑郁症症状加重的成年人的心理治疗与对照条件（照常护理、等候名单和其他无效治疗）进行比较。本文仅包括招募不积极寻求帮助的参与者（通过筛选而不是广告和临床转诊招募的参与者）的研究。为了获得心理治疗的总体效果估计，我们将所有测试后差异与随机效应模型汇总在一起。本文发现，与对照组相比，心理治疗对减轻抑郁症状有中度到高度的影响 [g = 0.55；95% 置信区间 (CI) 0.41–0.69]。异质性很高（I2 = 75%；95% CI 68–80）。在 12 个月的随访中，效果虽小但显著（6-8 个月：g = 0.33；95% CI 0.14-0.52；9-12 个月：g = 0.24；95% CI 0.11-0.37）。作为次要结果，我们发现完成筛查问卷的患者中有 13% 符合抑郁症的纳入标准，并同意在试验中随机分组。根据目前的证据，抑郁症的心理治疗可能对没有积极寻求帮助的抑郁症患者有效。


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