Catty J, Burns T, Knapp M, Watt H, Wright C, Henderson J, Healey A
Department of Psychiatry, St George's Hospital Medical School, London.
Psychol Med. 2002 Apr;32(3):383-401. doi: 10.1017/s0033291702005299.
Concerns have been raised about the scope and generalizability of much community mental health research. In particular, both experimental and control services are poorly characterized.
To review the effectiveness of 'home treatment' for mental health problems in terms of hospitalization, we conducted a systematic review, using Cochrane methodology but with a wider remit. Non-randomized studies were included in response to concerns about RCTs' generalizability. All authors were followed up for data on service components. 'Home treatment' was defined broadly for the purposes of the literature search, but included studies were then assessed against service components specifically focused on delivering treatment at home. The study tested components and other features for associations with days in hospital, as well as conducting a conventional meta-analysis of data on days in hospital.
We found 91 studies, 18 comparing home to in-patient treatment. Sixty per cent of authors responded to follow-up. The vast majority of the services studied had a 'home treatment function' and regularly visited patients at home. The heterogeneity of control services made meta-analysis problematical as did the limited availability of data. There was some evidence that 'regular' home visiting and combined responsibility for health and social care were associated with reduced hospitalization. The inclusion of non-randomized studies rarely affected the findings.
Evidence concerning the effectiveness of home treatment remains inconclusive. A centrally coordinated research strategy is recommended, with attention to study design. Experimental and control service components should be prospectively recorded and reported to enable meaningful analysis.
人们对许多社区心理健康研究的范围和可推广性提出了担忧。特别是，实验性服务和对照服务的特征都不明确。
为了从住院治疗的角度评估“家庭治疗”对心理健康问题的有效性，我们采用Cochrane方法进行了一项系统综述，但范围更广。由于对随机对照试验（RCT）可推广性的担忧，纳入了非随机研究。对所有作者进行随访以获取服务组成部分的数据。为了文献检索的目的，对“家庭治疗”进行了广泛定义，但随后根据专门针对在家提供治疗的服务组成部分对纳入的研究进行评估。该研究测试了各组成部分和其他特征与住院天数的关联，并对住院天数的数据进行了传统的荟萃分析。
我们找到了91项研究，其中18项比较了家庭治疗与住院治疗。60%的作者回复了随访。绝大多数所研究的服务都具有“家庭治疗功能”，并定期上门探访患者。对照服务的异质性使得荟萃分析存在问题，数据的可用性也有限。有一些证据表明，“定期”上门探访以及健康和社会护理的联合责任与住院率降低有关。纳入非随机研究很少影响研究结果。
关于家庭治疗有效性的证据仍然不确凿。建议采用集中协调的研究策略，并关注研究设计。应前瞻性地记录和报告实验性服务和对照服务的组成部分，以便进行有意义的分析。
