Xiao Feng, Song Xue, Chen Qianjun, Dai Yan, Xu Rui, Qiu Chang, Guo Qianqian
Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China.
Department of Breast Cancer, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, People's Republic of China.
Clin Breast Cancer. 2017 Jun;17(3):171-179. doi: 10.1016/j.clbc.2016.11.003. Epub 2016 Nov 23.
The present study assessed the effectiveness of individually delivered cognitive behavioral therapy (CBT) interventions in improving depression in patients with breast cancer. A systematic search of Medline (Ovid), PubMed, Cochrane Library, China National Knowledge Infrastructure database, WANFANG, and the VIP database. Quality assessment of included studies was conducted by 2 reviewers independently using the Jadad scale. The pooled effect of the mean difference in the baseline and post-treatment depressive scores was analyzed using different outcome measuring instruments (Self-rating Depression Scale, Hospital Anxiety and Depression Scale, and Hamilton Depression Rating Scale) separately. Thirteen studies involving 966 patients were included. The pooled standardized mean difference (SMD) comparing the intervention groups to the control groups was -0.87 (95% confidence interval [CI], -1.03 to -0.71; overall effect Z, 10.84; P < .0001) in the Self-rating Depression Scale subgroup, which indicated a large effect size based on Cohen's d value (Cohen's d, -0.87). The SMD was -0.50 (95% CI, -0.98 to -0.02; overall effect Z, 20.6; P = .04) in the Hospital Anxiety and Depression Scale subgroup, which indicated a moderate effect size (Cohen's d, -0.50). Finally, the SMD was -2.61 (95% CI, -4.07 to -1.14; overall effect Z, 3.49; P = .0005) in the Hamilton Depression Rating Scale subgroup, which indicated a very large effect size (Cohen's d, -2.61). The overall effect size of the individually delivered CBT in improving depression in breast cancer patients was large. Also, no evidence was found of statistical heterogeneity. The present meta-analysis showed significant efficacy for individually delivered CBT in the reduction of depression in patients after breast cancer surgery. However, further well-designed randomized controlled trials with large sample sizes are needed to provide more valid and reliable results on the long-term outcomes.
本研究评估了个体化认知行为疗法（CBT）干预对改善乳腺癌患者抑郁症状的有效性。对Medline（Ovid）、PubMed、Cochrane图书馆、中国知网数据库、万方数据库和维普数据库进行了系统检索。由2名评审员独立使用Jadad量表对纳入研究进行质量评估。分别使用不同的结局测量工具（自评抑郁量表、医院焦虑抑郁量表和汉密尔顿抑郁量表）分析基线和治疗后抑郁评分的平均差异的合并效应。纳入了13项涉及966例患者的研究。在自评抑郁量表亚组中，干预组与对照组比较的合并标准化均数差（SMD）为-0.87（95%置信区间[CI]，-1.03至-0.71；总体效应Z，10.84；P <.0001），根据Cohen's d值（Cohen's d，-0.87）表明效应量较大。在医院焦虑抑郁量表亚组中，SMD为-0.50（95%CI，-0.98至-0.02；总体效应Z，20.6；P =.04），表明效应量中等（Cohen's d，-0.50）。最后，在汉密尔顿抑郁量表亚组中，SMD为-2.61（95%CI，-4.07至-1.14；总体效应Z，3.49；P =.0005），表明效应量非常大（Cohen's d，-2.61）。个体化CBT改善乳腺癌患者抑郁症状的总体效应量较大。此外，未发现统计学异质性的证据。本荟萃分析显示个体化CBT对降低乳腺癌术后患者的抑郁症状具有显著疗效。然而，需要进一步进行设计良好、样本量较大的随机对照试验，以提供关于长期结局更有效和可靠的结果。
