Pinquart M, Duberstein P R, Lyness J M
Department of Psychology, Philipps University Marburg, Germany.
Aging Ment Health. 2007 Nov;11(6):645-57. doi: 10.1080/13607860701529635.
The goal of the present study was to assess the effects of psychotherapy and other behavioral interventions on depressive symptoms in clinically depressed older patients.
We used meta-analysis to examine the effects of 57 controlled intervention studies.
On average, self-rated depression improved by d=0.84 standard deviation units and clinician-rated depression improved by d=0.93. Effect sizes were large for cognitive and behavioral therapy (CBT) and reminiscence; and medium for psychodynamic therapy, psychoeducation, physical exercise and supportive interventions. Age differences in treatment effects were not observed. Weaker effects were found in studies that used an active control group and in studies of physically ill or cognitively impaired patients. Studies of samples comprised exclusively of patients suffering from major depression (versus other mood disorders) also yielded weaker intervention effects. On average, 18.9% of participants did not complete the intervention, with higher dropout rates reported in group (versus individual) interventions and in longer interventions.
We conclude that cognitive-behavioral therapy and reminiscence are particularly well-established and acceptable forms of depression treatment. Interventions with 7-12 sessions may optimize effectiveness while minimizing dropout rates. For physically and cognitively impaired patients, modifications in treatment format and/or content might be useful, such as combining psychotherapy with social work interventions and pharmacotherapy.
本研究的目的是评估心理治疗和其他行为干预对临床抑郁症老年患者抑郁症状的影响。
我们采用荟萃分析来检验57项对照干预研究的效果。
平均而言，自评抑郁改善了d = 0.84个标准差单位，临床医生评定的抑郁改善了d = 0.93。认知行为疗法（CBT）和回忆疗法的效应量较大；心理动力疗法、心理教育、体育锻炼和支持性干预的效应量为中等。未观察到治疗效果的年龄差异。在使用积极对照组的研究以及对身体疾病或认知障碍患者的研究中发现效应较弱。仅由重度抑郁症患者（相对于其他情绪障碍）组成样本的研究也产生了较弱的干预效果。平均而言，18.9%的参与者未完成干预，团体（相对于个体）干预和较长干预的脱落率较高。
我们得出结论，认知行为疗法和回忆疗法是已确立且可接受的抑郁症治疗形式。7 - 12次治疗的干预可能在优化疗效的同时将脱落率降至最低。对于身体和认知受损的患者，调整治疗形式和/或内容可能有用，例如将心理治疗与社会工作干预及药物治疗相结合。
