Ski Chantal F, Jelinek Michael, Jackson Alun C, Murphy Barbara M, Thompson David R
Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia Department of Psychiatry, University of Melbourne, Melbourne, Australia.
Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia Department of Cardiology, St Vincent's Hospital, Melbourne, Australia.
Eur J Cardiovasc Nurs. 2016 Aug;15(5):305-16. doi: 10.1177/1474515115613204. Epub 2015 Oct 16.
Depression is common in patients with coronary heart disease, and together these conditions significantly affect health outcomes. Impaired social support is also considered an important predictor of coronary heart disease prognosis and, as there is a complex interplay between social isolation and depression, interventions to address both may be required. This review aimed to assess the effectiveness of psychosocial interventions addressing both depression and social support for people with coronary heart disease and depression.
PRISMA guidelines were used to search major health databases to identify randomised controlled trials that evaluated psychosocial interventions compared with usual care in patients with coronary heart disease and depression; the primary outcome was depressive symptoms and secondary outcomes were mortality (all-cause and cardiac), myocardial infarction, revascularisation, anxiety, social support and quality of life. Data, when suitable, were pooled using a random-effects meta-analysis model.
Five studies (n=1358 participants) were eligible and included. The psychosocial intervention group had significantly lower levels of depressive symptoms (standardised mean difference (SMD) -0.15, 95% confidence interval (CI) -0.27 to -0.03; P=0.02) and higher levels of social support (SMD 0.17; 95% CI 0.04 to 0.30; P=0.01) but no differences were found for mortality (all-cause and cardiac), myocardial infarction, revascularisation, anxiety or quality of life.
Psychosocial interventions for patients with coronary heart disease and depression result in modest reductions in depressive symptoms and improvements in social support. However, caution is warranted in view of the small number of studies included in the review and potential heterogeneity in outcomes and in differences in treatment.
抑郁症在冠心病患者中很常见，这两种情况共同对健康结果产生重大影响。社会支持受损也被认为是冠心病预后的重要预测因素，而且由于社会孤立与抑郁症之间存在复杂的相互作用，可能需要采取干预措施来同时解决这两个问题。本综述旨在评估针对冠心病合并抑郁症患者的心理社会干预措施在解决抑郁症和社会支持方面的有效性。
采用PRISMA指南检索主要健康数据库，以识别评估心理社会干预措施并与冠心病合并抑郁症患者常规护理进行比较的随机对照试验；主要结局是抑郁症状，次要结局是死亡率（全因和心脏相关）、心肌梗死、血运重建、焦虑、社会支持和生活质量。在合适的情况下，使用随机效应荟萃分析模型汇总数据。
五项研究（n = 1358名参与者）符合纳入标准并被纳入。心理社会干预组的抑郁症状水平显著较低（标准化均数差（SMD）-0.15，95%置信区间（CI）-0.27至-0.03；P = 0.02），社会支持水平较高（SMD 0.17；95% CI 0.04至0.30；P = 0.01），但在死亡率（全因和心脏相关）、心肌梗死、血运重建、焦虑或生活质量方面未发现差异。
针对冠心病合并抑郁症患者的心理社会干预措施可使抑郁症状适度减轻，社会支持得到改善。然而，鉴于本综述纳入的研究数量较少，以及结局的潜在异质性和治疗差异，仍需谨慎对待。
