Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500, USA.
J Behav Med. 2010 Feb;33(1):1-14. doi: 10.1007/s10865-009-9227-2. Epub 2009 Sep 27.
This meta-analysis examined whether effects of psychosocial interventions on psychological distress in cancer patients are conditional upon pre-intervention distress levels. Published articles and unpublished dissertations between 1980 and 2005 were searched for interventions reporting the Hospital Anxiety and Depression Scale (HADS) or the Spielberger State-Trait Anxiety Inventory (STAI). Multilevel mixed-effects modeling was used to meta-analyze effect-sizes separately for the HADS (27 trials, 2,424 patients) and STAI (34 trials, 2,029 patients). Pre-intervention distress significantly moderated intervention effects, explaining up to 50% of the between-study effect-size variance: effects on anxiety and depression were generally negligible when pre-intervention distress was low and pronounced when it was high. These results could not be explained by differences in intervention type, setting, dose, and whether intervention was targeted at distressed patients. Psychosocial interventions may be most beneficial for cancer patients with elevated distress. Future research should identify which treatment components are most effective for these patients to facilitate optimal treatment tailoring and cost-effective health care.
本荟萃分析旨在考察心理干预对癌症患者心理困扰的效果是否取决于干预前的困扰程度。检索了 1980 年至 2005 年间发表的文章和未发表的论文，寻找报告使用医院焦虑和抑郁量表（HADS）或 Spielberger 状态-特质焦虑量表（STAI）的干预措施。使用多级混合效应模型分别对 HADS（27 项试验，2424 名患者）和 STAI（34 项试验，2029 名患者）的效应大小进行荟萃分析。干预前的困扰显著调节了干预效果，解释了研究间效应大小差异的高达 50%：当干预前的困扰较低时，干预对焦虑和抑郁的影响通常可以忽略不计，而当困扰较高时，干预的影响则较为显著。这些结果不能用干预类型、设置、剂量以及干预是否针对困扰患者的差异来解释。心理社会干预对困扰程度较高的癌症患者可能最有益。未来的研究应该确定哪些治疗成分对这些患者最有效，以促进最佳的治疗定制和具有成本效益的医疗保健。
