Minami Takuya, Wampold Bruce E, Serlin Ronald C, Hamilton Eric G, Brown George S Jeb, Kircher John C
Department of Educational Psychology, University of Utah, Salt Lake City, UT 84112, USA.
J Consult Clin Psychol. 2008 Feb;76(1):116-24. doi: 10.1037/0022-006X.76.1.116.
This preliminary study evaluated the effectiveness of psychotherapy treatment for adult clinical depression provided in a natural setting by benchmarking the clinical outcomes in a managed care environment against effect size estimates observed in published clinical trials. Overall results suggest that effect size estimates of effectiveness in a managed care context were comparable to effect size estimates of efficacy observed in clinical trials. Relative to the 1-tailed 95th-percentile critical effect size estimates, effectiveness of treatment provided in this setting was observed to be between 80% (patients with comorbidity and without antidepressants) and 112% (patients without comorbidity concurrently on antidepressants) as compared to the benchmarks. Because the nature of the treatments delivered in the managed care environment were unknown, it was not possible to make conclusions about treatments. However, while replications are warranted, concerns that psychotherapy delivered in a naturalistic setting is inferior to treatments delivered in clinical trials appear unjustified.
这项初步研究通过将管理式医疗环境中的临床结果与已发表临床试验中观察到的效应量估计值进行对比，评估了在自然环境中为成年临床抑郁症患者提供心理治疗的有效性。总体结果表明，管理式医疗环境中有效性的效应量估计值与临床试验中观察到的疗效效应量估计值相当。相对于单尾第95百分位数的临界效应量估计值，与基准相比，在此环境中提供的治疗有效性在80%（患有合并症且未服用抗抑郁药的患者）至112%（未患合并症且同时服用抗抑郁药的患者）之间。由于在管理式医疗环境中所提供治疗的性质不明，因此无法对治疗方法得出结论。然而，虽然有必要进行重复研究，但认为在自然环境中提供的心理治疗不如临床试验中提供的治疗有效的担忧似乎并无根据。
