共病抑郁症和冠心病的协作护理：随机对照试验的系统评价和荟萃分析

Collaborative care for comorbid depression and coronary heart disease: a systematic review and meta-analysis of randomised controlled trials.

作者信息

Tully Phillip J, Baumeister Harald

机构信息

Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia INSERM, U897-Epidemiology and Biostatistics, Bordeaux, France.

Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany Faculty of Medicine, Medical Psychology and Medical Sociology, University of Freiburg, Freiburg, Germany.

出版信息

BMJ Open. 2015 Dec 21;5(12):e009128. doi: 10.1136/bmjopen-2015-009128.

DOI:10.1136/bmjopen-2015-009128

PMID:26692557

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4691772/

Abstract

OBJECTIVES

To systematically review the efficacy of collaborative care (CC) for depression in adults with coronary heart disease (CHD) and depression.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Electronic databases (Cochrane Central Register of Controlled Trials MEDLINE, EMBASE, PsycINFO and CINAHL) were searched until April 2014.

INCLUSION CRITERIA

Population, depression comorbid with CHD; intervention, randomised controlled trial (RCT) of CC; comparison, either usual care, wait-list control group or no further treatment; and outcome, (primary) major adverse cardiac events (MACE), (secondary) standardised measure of depression, anxiety, quality of life (QOL) and cost-effectiveness.

DATA EXTRACTION AND ANALYSIS

RevMan V.5.3 was used to synthesise the data as risk ratios (RRs), ORs and standardised mean differences (SMD) with 95% CIs in random effect models.

RESULTS

Six RCTs met the inclusion criteria and comprised 655 participants randomised to CC and 629 participants randomised to the control group (total 1284). Collaborative depression care led to a significant reduction in MACE in the short term (three trials, RR 0.54; 95% CI 0.31 to 0.95, p=0.03) that was not sustained in the longer term. Small reductions in depressive symptoms were evident in the short term (6 trials, pooled SMD -0.31; 95% CI -0.43 to -0.19, p<0.00001) and depression remission was more likely to be achieved with CC (5 trials, OR 1.77; 95% CI 1.28 to 2.44, p=0.0005). Likewise, a significant effect was observed for anxiety symptoms (SMD -0.36) and mental QOL (SMD 0.24). The timing of the intervention was a source of between-group heterogeneity for depression symptoms (between groups p=0.04, I(2)=76.5%).

CONCLUSIONS

Collaborative depression care did not lead to a sustained reduction in the primary MACE end point. Small effects were observed for depression, depression remission, anxiety and mental QOL.

TRIALS REGISTRATION NUMBER

PROSPERO CRD42014013653.

摘要

目的

系统评价协作式照护（CC）对合并抑郁症的冠心病（CHD）成年患者抑郁症的疗效。

设计

系统评价和荟萃分析。

数据来源

检索电子数据库（Cochrane对照试验中央注册库、MEDLINE、EMBASE、PsycINFO和CINAHL）至2014年4月。

纳入标准

研究对象为合并抑郁症的CHD患者；干预措施为CC的随机对照试验（RCT）；对照为常规护理、等待名单对照组或不进行进一步治疗；结局指标为（主要）重大不良心脏事件（MACE），（次要）抑郁症、焦虑症、生活质量（QOL）的标准化测量指标以及成本效益。

数据提取与分析

使用RevMan V.5.3将数据合成为随机效应模型中的风险比（RRs）、比值比（ORs）和标准化均数差（SMD）以及95%可信区间（CIs）。

结果

六项RCT符合纳入标准，共纳入1284名参与者，其中655名随机分配至CC组，629名随机分配至对照组。协作式抑郁症照护在短期内可显著降低MACE（三项试验，RR 0.54；95%CI 0.31至0.95，p = 0.03），但长期效果未持续。短期内抑郁症状有小幅减轻（六项试验，合并SMD -0.31；95%CI -0.43至-0.19，p < 0.00001），且CC更有可能实现抑郁症缓解（五项试验，OR 1.77；95%CI 1.28至2.44，p = 0.0005）。同样，观察到焦虑症状（SMD -0.36）和心理QOL（SMD 0.24）有显著效果。干预时机是抑郁症状组间异质性的一个来源（组间p = 0.04，I² = 76.5%）。