Welton Nicky J, Caldwell D M, Adamopoulos E, Vedhara K
Department of Community Based Medicine, University of Bristol, Bristol, United Kingdom.
Am J Epidemiol. 2009 May 1;169(9):1158-65. doi: 10.1093/aje/kwp014. Epub 2009 Mar 3.
Meta-analyses of psychological interventions typically find a pooled effect of "psychological intervention" compared with usual care. This answers the research question, "Are psychological interventions in general effective?" In fact, psychological interventions are usually complex with several different components. The authors propose that mixed treatment comparison meta-analysis methods may be a valuable tool when exploring the efficacy of interventions with different components and combinations of components, as this allows one to answer the research question, "Are interventions with a particular component (or combination of components) effective?" The authors illustrate the methods using a meta-analysis of psychological interventions for patients with coronary heart disease for a variety of outcomes. The authors carried out systematic literature searches to update an earlier Cochrane review and classified components of interventions into 6 types: usual care, educational, behavioral, cognitive, relaxation, and support. Most interventions were a combination of these components. There was some evidence that psychological interventions were effective in reducing total cholesterol and standardized mean anxiety scores, that interventions with behavioral components were effective in reducing the odds of all-cause mortality and nonfatal myocardial infarction, and that interventions with behavioral and/or cognitive components were associated with reduced standardized mean depression scores.
心理干预的荟萃分析通常发现，与常规护理相比，“心理干预”具有综合效应。这回答了研究问题：“一般来说，心理干预有效吗？”事实上，心理干预通常很复杂，包含几个不同的组成部分。作者提出，在探索具有不同组成部分及其组合的干预措施的疗效时，混合治疗比较荟萃分析方法可能是一种有价值的工具，因为这使人们能够回答研究问题：“具有特定组成部分（或组成部分组合）的干预措施有效吗？”作者通过对冠心病患者心理干预的各种结果进行荟萃分析来说明这些方法。作者进行了系统的文献检索，以更新早期的Cochrane综述，并将干预措施的组成部分分为6类：常规护理、教育、行为、认知、放松和支持。大多数干预措施都是这些组成部分的组合。有证据表明，心理干预在降低总胆固醇和标准化平均焦虑评分方面有效，具有行为组成部分的干预措施在降低全因死亡率和非致命性心肌梗死的几率方面有效，具有行为和/或认知组成部分的干预措施与降低标准化平均抑郁评分相关。
