Meta-Research Innovation Center at Stanford (METRICS),Stanford University,Palo Alto,USA.
Epidemiol Psychiatr Sci. 2018 Jun;27(3):230-239. doi: 10.1017/S2045796017000750. Epub 2017 Nov 29.
Leucht et al. in 2012 described an overview of meta-analyses of the efficacy of medication in psychiatry and general medicine, concluding that psychiatric drugs were not less efficacious than other drugs. Our goal was to explore the dissemination of this highly cited paper, which combined a thought provoking message with a series of caveats.
We conducted a prospectively registered citation content analysis. All papers published before June 1st citing the target paper were independently rated by two investigators. The primary outcome coded dichotomously was whether the citation was used to justify a small or modest effect observed for a given treatment. Secondary outcomes regarded mentioning any caveats when citing the target paper, the point the citation was making (treatment effectiveness in psychiatry closely resembles that in general medicine, others), the type of condition (psychiatric, medical or both), specific disease, treatment category and specific type. We also extracted information about the type of citing paper, financial conflict of interest (COI) declared and any industry support. The primary analysis was descriptive by tabulating the extracted variables, with numbers and percentages where appropriate. Co-authorship networks were constructed to identify possible clusters of citing authors. An exploratory univariate logistic regression was used to explore the relationship between each of a subset of pre-specified secondary outcomes and the primary outcome.
We identified 135 records and retrieved and analysed 120. Sixty-three (53%) quoted Leucht et al.'s paper to justify a small or modest effect observed for a given therapy, and 113 (94%) did not mention any caveats. Seventy-two (60%) used the citation to claim that treatment effectiveness in psychiatry closely resembles that in general medicine; 110 (91%) paper were about psychiatric conditions. Forty-one (34%) papers quoted it without pointing towards any specific treatment category, 28 (23%) were about antidepressants, 18 (15%) about antipsychotics. Forty (33%) of the citing papers included data. COIs were reported in 55 papers (46%). Univariate and multivariate regressions showed an association between a quote justifying small or modest effects and the point that treatment effectiveness in psychiatry closely resembles that in general medicine.
Our evaluation revealed an overwhelmingly uncritical reception and seemed to indicate that beyond defending psychiatry as a discipline, the paper by Leucht et al. served to lend support and credibility to a therapeutic myth: trivial effects of mental health interventions, most often drugs, are to be expected and therefore accepted.Protocol registration: https://osf.io/9dqat/.
Leucht 等人在 2012 年描述了精神医学和一般医学药物疗效的荟萃分析概述，得出结论认为精神药物的疗效并不逊于其他药物。我们的目标是探讨这篇高度引用的论文的传播情况，该论文将发人深省的信息与一系列警告结合在一起。
我们进行了前瞻性注册的引文内容分析。所有在 6 月 1 日之前引用目标论文的论文均由两名研究者独立进行评估。主要结果以二分法编码，判断引文是否用于证明特定治疗的观察到的小或适度效果。次要结果涉及在引用目标论文时提及任何警告、引文的要点（精神医学中的治疗效果与一般医学中的治疗效果非常相似，其他）、条件类型（精神科、医学或两者兼有）、特定疾病、治疗类别和特定类型。我们还提取了有关引用论文类型、财务利益冲突（COI）声明和任何行业支持的信息。主要分析是通过表格列出提取的变量进行描述，适当情况下使用数字和百分比。构建合著者网络以确定引用作者的可能聚类。使用探索性单变量逻辑回归分析了一组预先指定的次要结果中的每一个与主要结果之间的关系。
我们确定了 135 条记录，并检索和分析了 120 条。63 条（53%）引用 Leucht 等人的论文来证明特定治疗的观察到的小或适度效果，113 条（94%）未提及任何警告。72 条（60%）引用该论文声称精神医学中的治疗效果与一般医学中的治疗效果非常相似；110 条（91%）论文是关于精神科疾病的。41 条（34%）论文引用时没有指出任何特定的治疗类别，28 条（23%）是关于抗抑郁药，18 条（15%）是关于抗精神病药。40 条（33%）引用论文包含数据。55 篇论文（46%）报告了利益冲突。单变量和多变量回归显示，引用支持小或适度效果的引文与精神医学中的治疗效果与一般医学中的治疗效果非常相似的观点之间存在关联。
我们的评估显示出一种压倒性的非批判性接受，似乎表明，除了捍卫精神病学作为一门学科之外，Leucht 等人的论文还支持并为一个治疗神话提供了可信度：精神健康干预措施（通常是药物）的微小效果是可以预料到的，因此是可以接受的。
