Liew Tau Ming, Lee Cia Sin
Department of Geriatric Psychiatry, Institute of Mental Health, Singapore.
Psychotherapy Unit, Institute of Mental Health, Singapore.
BMJ Open. 2018 Jan 21;8(1):e019819. doi: 10.1136/bmjopen-2017-019819.
Major depression is a leading cause of disability and has been associated with adverse effects in older persons. While many pharmacological and non-pharmacological interventions have been shown to be effective to address major depression in older persons, there has not been a meta-analysis that consolidates all the available interventions and compare the relative benefits of these available interventions. In this study, we aim to conduct a systematic review and network meta-analysis to compare the efficacy and acceptability of all the known pharmacological and non-pharmacological interventions for major depression in older persons.
We will search Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health, Cochrane Central Register of Controlled Trials and references of other review articles for articles related to the keywords of 'randomised trial', 'major depression', 'older persons' and 'treatments'. Two reviewers will independently select the eligible articles. For each included article, the two reviewers will independently extract the data and assess the risk of bias using the Cochrane revised tool for risk of bias. Bayesian network meta-analyses will be conducted to pool the depression scores (based on standardised mean difference) and the all-cause discontinuation across all included studies. The ranking probabilities for all interventions will be estimated and the hierarchy of each intervention will be summarised as surface under the cumulative ranking curve (SUCRA). Meta-regression and sub-group analyses will also be performed to evaluate the effect of study-level covariates. The quality of the evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.
The results will be disseminated through conference presentations and peer-reviewed publications. They will provide the consolidated evidence to inform clinicians on the best choice of intervention to address major depression in older persons.
CRD42017075756.
重度抑郁症是导致残疾的主要原因，并且与老年人的不良影响相关。虽然许多药物和非药物干预措施已被证明对治疗老年人的重度抑郁症有效，但尚未有荟萃分析整合所有可用干预措施并比较这些可用干预措施的相对益处。在本研究中，我们旨在进行一项系统评价和网状荟萃分析，以比较所有已知的药物和非药物干预措施治疗老年人重度抑郁症的疗效和可接受性。
我们将检索Medline、Embase、PsycINFO、护理及相关健康累积索引、Cochrane对照试验中央注册库以及其他综述文章的参考文献，查找与“随机试验”“重度抑郁症”“老年人”和“治疗”等关键词相关的文章。两名评审员将独立选择符合条件的文章。对于每篇纳入的文章，两名评审员将独立提取数据，并使用Cochrane修订的偏倚风险工具评估偏倚风险。将进行贝叶斯网状荟萃分析，汇总所有纳入研究中的抑郁评分（基于标准化均数差）和全因停药情况。将估计所有干预措施的排序概率，并将每种干预措施的等级总结为累积排序曲线下面积（SUCRA）。还将进行Meta回归和亚组分析，以评估研究水平协变量的影响。将使用推荐分级的评估、制定与评价方法评估证据质量。
研究结果将通过会议报告和同行评审出版物进行传播。它们将提供综合证据，为临床医生提供有关治疗老年人重度抑郁症最佳干预措施选择的信息。
PROSPERO注册号：CRD42017075756。
