Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
PLoS Med. 2013;10(5):e1001454. doi: 10.1371/journal.pmed.1001454. Epub 2013 May 28.
Previous meta-analyses comparing the efficacy of psychotherapeutic interventions for depression were clouded by a limited number of within-study treatment comparisons. This study used network meta-analysis, a novel methodological approach that integrates direct and indirect evidence from randomised controlled studies, to re-examine the comparative efficacy of seven psychotherapeutic interventions for adult depression.
We conducted systematic literature searches in PubMed, PsycINFO, and Embase up to November 2012, and identified additional studies through earlier meta-analyses and the references of included studies. We identified 198 studies, including 15,118 adult patients with depression, and coded moderator variables. Each of the seven psychotherapeutic interventions was superior to a waitlist control condition with moderate to large effects (range d = -0.62 to d = -0.92). Relative effects of different psychotherapeutic interventions on depressive symptoms were absent to small (range d = 0.01 to d = -0.30). Interpersonal therapy was significantly more effective than supportive therapy (d = -0.30, 95% credibility interval [CrI] [-0.54 to -0.05]). Moderator analysis showed that patient characteristics had no influence on treatment effects, but identified aspects of study quality and sample size as effect modifiers. Smaller effects were found in studies of at least moderate (Δd = 0.29 [-0.01 to 0.58]; p = 0.063) and large size (Δd = 0.33 [0.08 to 0.61]; p = 0.012) and those that had adequate outcome assessment (Δd = 0.38 [-0.06 to 0.87]; p = 0.100). Stepwise restriction of analyses by sample size showed robust effects for cognitive-behavioural therapy, interpersonal therapy, and problem-solving therapy (all d>0.46) compared to waitlist. Empirical evidence from large studies was unavailable or limited for other psychotherapeutic interventions.
Overall our results are consistent with the notion that different psychotherapeutic interventions for depression have comparable benefits. However, the robustness of the evidence varies considerably between different psychotherapeutic treatments.
之前比较心理治疗干预对抑郁症疗效的荟萃分析受到研究内治疗比较数量有限的影响。本研究使用网络荟萃分析，一种整合来自随机对照研究的直接和间接证据的新方法，重新检验七种心理治疗干预对成人抑郁症的比较疗效。
我们在 PubMed、PsycINFO 和 Embase 中进行了系统的文献检索，截至 2012 年 11 月，并通过早期荟萃分析和纳入研究的参考文献确定了其他研究。我们确定了 198 项研究，包括 15118 名患有抑郁症的成年患者，并对调节变量进行了编码。七种心理治疗干预中的每一种都优于等待对照条件，具有中等到较大的效果（范围 d=-0.62 至 d=-0.92）。不同心理治疗干预对抑郁症状的相对疗效不存在或较小（范围 d=0.01 至 d=-0.30）。人际治疗明显比支持性治疗更有效（d=-0.30，95%可信度区间[CrI] [-0.54 至 -0.05]）。调节分析表明，患者特征对治疗效果没有影响，但确定了研究质量和样本大小的某些方面为效应修饰剂。在研究规模至少中等（Δd=0.29[-0.01 至 0.58]；p=0.063）和较大（Δd=0.33[0.08 至 0.61]；p=0.012）以及具有足够的结果评估的研究中发现了较小的效果（Δd=0.38[-0.06 至 0.87]；p=0.100）。按样本大小逐步限制分析表明，认知行为疗法、人际治疗和解决问题治疗（所有 d>0.46）与等待对照相比具有稳健的效果。其他心理治疗干预的大型研究的实证证据尚不可用或有限。
总体而言，我们的结果与不同心理治疗干预对抑郁症具有可比益处的观点一致。然而，不同心理治疗方法之间的证据稳健性差异很大。
