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低收入和中等收入国家艾滋病毒感染者常见精神障碍的心理干预措施:系统评价

Psychological interventions for Common Mental Disorders for People Living With HIV in Low- and Middle-Income Countries: systematic review.

作者信息

Chibanda Dixon, Cowan Frances M, Healy Jessica L, Abas Melanie, Lund Crick

机构信息

University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.

CeSHHAR Zimbabwe, Avondale West, Zimbabwe.

出版信息

Trop Med Int Health. 2015 Jul;20(7):830-9. doi: 10.1111/tmi.12500. Epub 2015 Mar 20.

Abstract

OBJECTIVE

To assess the effectiveness of structured psychological interventions against common mental disorders (CMD) in people living with HIV infection (PLWH), in low- and middle-income countries (LMIC).

METHODS

Systematic review of psychological interventions for CMD from LMIC for PLWH, with two-stage screening carried out independently by 2 authors.

RESULTS

Of 190 studies, 5 met inclusion criteria. These were randomised-controlled trials based on the principles of cognitive behaviour therapy (CBT) and were effective in reducing CMD symptoms in PLWH. Follow-up of study participants ranged from 6 weeks to 12 months with multiple tools utilised to measure the primary outcome. Four studies showed a high risk of bias, while 1 study from Iran met low risk of bias in all 6 domains of the Cochrane risk of bias tool and all 22 items of the CONSORT instrument.

CONCLUSION

There is a need for more robust and adequately powered studies to further explore CBT-based interventions in PLWH. Future studies should report on components of the psychological interventions, fidelity measurement and training, including supervision of delivering agents, particularly where lay health workers are the delivering agent.

摘要

目的

评估在低收入和中等收入国家(LMIC),针对感染艾滋病毒者(PLWH)常见精神障碍(CMD)的结构化心理干预措施的有效性。

方法

对来自LMIC的针对PLWH的CMD心理干预措施进行系统评价,由两名作者独立进行两阶段筛选。

结果

在190项研究中,有5项符合纳入标准。这些是基于认知行为疗法(CBT)原则的随机对照试验,对减轻PLWH的CMD症状有效。研究参与者的随访时间从6周到12个月不等,使用了多种工具来测量主要结局。四项研究显示存在高偏倚风险,而来自伊朗的一项研究在Cochrane偏倚风险工具的所有6个领域以及CONSORT工具的所有22项中均符合低偏倚风险。

结论

需要进行更有力且有足够样本量的研究,以进一步探索针对PLWH的基于CBT的干预措施。未来的研究应报告心理干预的组成部分、保真度测量和培训情况,包括对实施人员的监督,特别是在非专业卫生工作者作为实施人员的情况下。

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