Cristea Ioana A, Gentili Claudio, Pietrini Pietro, Cuijpers Pim
Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania.
Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, United States of America.
PLoS One. 2017 Feb 3;12(2):e0171654. doi: 10.1371/journal.pone.0171654. eCollection 2017.
The influence of factors related to the background of investigators conducting trials comparing psychotherapy and pharmacotherapy has remained largely unstudied. Specializations emphasizing biological determinants of mental disorders, like psychiatry, might favor pharmacotherapy, while others stressing psychosocial factors, like psychology, could promote psychotherapy. Yet financial conflict of interest (COI) could be a confounding factor as authors with a medical specialization might receive more sponsoring from the pharmaceutical industry.
We conducted a meta-analysis with subgroup and meta-regression analysis examining whether the specialization and affiliation of trial authors were associated to outcomes in the direct comparison of psychotherapy and pharmacotherapy for the acute treatment of depression. Meta-regression analysis also included trial risk of bias and author conflict of interest in relationship to the pharmaceutical industry.
We included 45 trials. In half, the first author was psychologist. The last author was psychiatrist/MD in half of the trials, and a psychologist or statistician/other technical in the rest. Most lead authors had medical affiliations. Subgroup analysis indicated that studies with last authors statisticians favored pharmacotherapy. Univariate analysis showed a negative relationship between the presence of statisticians and outcomes favoring psychotherapy. Multivariate analysis showed that trials including authors with financial COI reported findings more favorable to pharmacotherapy.
We report the first detailed overview of the background of authors conducting head to head trials for depression. Trials co-authored by statisticians appear to subtly favor pharmacotherapy. Receiving funding from the industry is more closely related to finding better outcomes for the industry's elective treatment than are factors related to authors' background.
For a minority of authors we could not retrieve background information. The number of trials was insufficient to evidence subtler effects.
在比较心理治疗和药物治疗的试验中，与研究者背景相关的因素的影响在很大程度上尚未得到研究。强调精神障碍生物学决定因素的专业领域，如精神病学，可能更倾向于药物治疗，而其他强调心理社会因素的领域，如心理学，则可能促进心理治疗。然而，利益冲突（COI）可能是一个混杂因素，因为具有医学专业背景的作者可能会从制药行业获得更多赞助。
我们进行了一项荟萃分析，并进行了亚组分析和元回归分析，以检验在抑郁症急性治疗中，心理治疗和药物治疗的直接比较中，试验作者的专业和所属机构是否与结果相关。元回归分析还包括试验的偏倚风险以及作者与制药行业的利益冲突。
我们纳入了45项试验。其中一半试验的第一作者是心理学家。在一半的试验中，最后作者是精神病医生/医学博士，其余试验的最后作者是心理学家或统计学家/其他技术人员。大多数主要作者具有医学背景。亚组分析表明，最后作者为统计学家的研究更倾向于药物治疗。单变量分析显示，统计学家的参与与更有利于心理治疗的结果之间存在负相关。多变量分析表明，包括存在财务利益冲突作者的试验报告的结果更有利于药物治疗。
我们首次详细概述了进行抑郁症直接对比试验的作者背景。由统计学家共同撰写的试验似乎在微妙地倾向于药物治疗。与作者背景相关的因素相比，从行业获得资金与为该行业的选择性治疗找到更好的结果更密切相关。
对于少数作者，我们无法获取背景信息。试验数量不足以证明更细微的影响。
