Okumura Yasuyuki, Ichikura Kanako
Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo 105-0003, Japan.
Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8519, Japan; Japan Society for the Promotion of Science, Tokyo 102-0083, Japan.
J Affect Disord. 2014 Aug;164:155-64. doi: 10.1016/j.jad.2014.04.023. Epub 2014 Apr 19.
Despite treatment guidelines for depression placing group cognitive behavioral therapy (group CBT) between low- and high-intensity evidence-based psychological interventions, the validity of the placement remains unknown. We aimed to systematically review evidence for the efficacy and acceptability of group CBT in patients with depression compared to four intensity levels of psychosocial interventions.
We searched the Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, and Web of Science and hand-searched the references in identified publications. We selected randomized controlled trials comparing group CBT with four levels of interventions for adult patients with depression. Two authors independently assessed risk of bias.
From 7953 records, we identified 35 studies that compared group CBT to non-active (k=30), low-intensity (k=2), middle-intensity (k=8), and high-intensity (k=1) interventions. Group CBT had a superior efficacy (standardized mean difference [SMD]=-0.68) and a similar acceptability compared to non-active controls. Pooled results showed a small but non-significant excess of group CBT relative to middle-intensity interventions (SMD=-0.21).
Over 60% of studies did not report enough information to judge selection and selective reporting bias.
These results suggest the need for high-quality trials of group CBT compared to low- and high-intensity interventions.
尽管抑郁症治疗指南将团体认知行为疗法（团体CBT）置于低强度和高强度循证心理干预之间，但这种排序的有效性尚不清楚。我们旨在系统评价团体CBT与四种强度水平的社会心理干预相比，在抑郁症患者中的疗效和可接受性证据。
我们检索了Cochrane对照试验中央注册库、MEDLINE、PsycINFO和科学网，并手工检索了已识别出版物中的参考文献。我们选择了比较团体CBT与四种干预水平的成年抑郁症患者的随机对照试验。两位作者独立评估偏倚风险。
从7953条记录中，我们识别出35项研究，这些研究将团体CBT与非活性干预（k=30）、低强度干预（k=2）、中等强度干预（k=8）和高强度干预（k=1）进行了比较。与非活性对照相比，团体CBT具有更好的疗效（标准化均数差[SMD]=-0.68）和相似的可接受性。汇总结果显示，与中等强度干预相比，团体CBT略多但无显著差异（SMD=-0.21）。
超过60%的研究未报告足够信息来判断选择和选择性报告偏倚。
这些结果表明，需要进行高质量试验，比较团体CBT与低强度和高强度干预。
