Huang Alice X, Delucchi Kevin, Dunn Laura B, Nelson J Craig
University of California, Department of Psychiatry and Langley Porter Psychiatric Institute, San Francisco, CA.
University of California, Department of Psychiatry and Langley Porter Psychiatric Institute, San Francisco, CA; University of California, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.
Am J Geriatr Psychiatry. 2015 Mar;23(3):261-73. doi: 10.1016/j.jagp.2014.04.003. Epub 2014 Apr 23.
To determine the efficacy of psychotherapy in late-life depression and to determine the effect of the type of control group on the magnitude of psychotherapy effects.
A systematic review and meta-analysis of randomized controlled psychotherapy trials for late-life depression.
Outpatient clinics or in subjects' home.
Subjects aged 55 years or older with acute-phase depressive disorder.
Change in depressive symptoms was measured with validated scales. Standardized mean differences (SMD) were calculated for each therapy-control contrast, as meta-analytic summaries for contrasts using a similar control, and for all contrasts combined.
The search identified 27 trials with 37 therapy-control contrasts and 2,245 subjects. Trials utilized five types of control groups (waitlist, treatment-as-usual, attention, supportive therapy, placebo). In the combined contrasts, psychotherapy was effective (SMD: 0.73; 95% confidence interval [CI]: 0.51, 0.95; z=6.42, p<0.00001). The SMD varied widely (from 0.05 to 1.36) and significantly (χ2=35.67, df=4, p<0.00001) between subgroups by type of control. In five trials that compared psychotherapy with supportive therapy, the SMD was 0.39 (95% CI: 0.16, 0.61; z=3.37, p<0.0007; I2=0%). The SMD was 0.11 within the waitlist controls and 1.10 within the supportive therapy subgroup.
Psychotherapy is effective for late-life depression, but the magnitude of the effect varies widely with the type of control group. Supportive therapy appears to best control for the nonspecific elements of psychotherapy and is associated with considerable change itself, but few trials have utilized it as a control.
确定心理治疗对老年期抑郁症的疗效，并确定对照组类型对心理治疗效果大小的影响。
对老年期抑郁症的随机对照心理治疗试验进行系统评价和荟萃分析。
门诊诊所或受试者家中。
年龄在55岁及以上的急性期抑郁症患者。
用经过验证的量表测量抑郁症状的变化。计算每种治疗与对照对比的标准化均值差（SMD），作为使用相似对照的对比以及所有合并对比的荟萃分析总结。
检索到27项试验，有37个治疗与对照对比，共2245名受试者。试验使用了五种类型的对照组（等待名单、常规治疗、注意力、支持性治疗、安慰剂）。在合并对比中，心理治疗是有效的（SMD：0.73；95%置信区间[CI]：0.51，0.95；z = 6.42，p < 0.00001）。根据对照类型，亚组间的SMD差异很大（从0.05到1.36）且具有显著性（χ2 = 35.67，自由度 = 4，p < 0.00001）。在5项将心理治疗与支持性治疗进行比较的试验中，SMD为0.39（95%CI：0.16，0.61；z = 3.37，p < 0.0007；I2 = 0%）。在等待名单对照组中SMD为0.11，在支持性治疗亚组中为1.10。
心理治疗对老年期抑郁症有效，但效果大小因对照组类型而异。支持性治疗似乎能最好地控制心理治疗的非特异性因素，其本身也会带来相当大的变化，但很少有试验将其用作对照。
