Yuan Shuai, Zhou Xinyu, Zhang Yuqing, Zhang Hanpin, Pu Juncai, Yang Lining, Liu Lanxiang, Jiang Xiaofeng, Xie Peng
Institute of Neuroscience and the Collaborative Innovation Center for Brain Science, Chongqing Medical University.
Department of Psychiatry.
Neuropsychiatr Dis Treat. 2018 Jan 24;14:353-365. doi: 10.2147/NDT.S152747. eCollection 2018.
Depression and anxiety are the most common mental disorders in children and adolescents. Bibliotherapy is a treatment using written materials for mental health problems. Its main advantages are ease of use, low cost, low staffing demands, and greater privacy. Yet few meta-analyses have focused on the effect of bibliotherapy on depression and anxiety disorders in children and adolescents.
We included randomized controlled trials comparing bibliotherapy with control conditions for depression and anxiety in children and adolescents (aged ≤18 years). Five electronic databases (PubMed, Embase, Cochrane, Web of Science, and PsycINFO) were searched from inception to January 2017. Efficacy was defined as mean change scores in depression and anxiety symptoms. Acceptability was defined as the proportion of participants who discontinued the treatment. Random effects model was used. An intention-to-treat analysis was conducted.
Eight studies with 979 participants were selected. At posttreatment, bibliotherapy was significantly more effective than the control conditions in reducing the symptoms of depression or anxiety (standardized mean difference, -0.52; 95% confidence interval [CI], -0.89 to -0.15). Bibliotherapy did not have statistically significantly more all-cause discontinuations than controls (risk ratios, 1.66; 95% CI, 0.93 to 2.95). We also performed subgroup analyses for efficacy outcomes in different categories (types of disorder, mean age, control conditions, and parental involvement) of studies and found that bibliotherapy has been more effective in depressive adolescents.
Limited studies were eligible in this review and hence there was potential publication bias.
According to the findings in this review, bibliotherapy may be more beneficial in treating depression in adolescents, but shows less robust effects for anxiety in children. Further well-defined clinical studies should be performed to confirm these outcomes.
抑郁和焦虑是儿童及青少年中最常见的精神障碍。阅读疗法是一种使用书面材料来解决心理健康问题的治疗方法。其主要优点包括使用方便、成本低、对人员配备要求低以及隐私性更强。然而，很少有荟萃分析关注阅读疗法对儿童及青少年抑郁和焦虑障碍的影响。
我们纳入了比较阅读疗法与对照条件对儿童及青少年（年龄≤18岁）抑郁和焦虑影响的随机对照试验。检索了五个电子数据库（PubMed、Embase、Cochrane、科学引文索引和心理学文摘数据库），检索时间从建库至2017年1月。疗效定义为抑郁和焦虑症状的平均变化分数。可接受性定义为中断治疗的参与者比例。采用随机效应模型。进行了意向性分析。
选取了八项研究，共979名参与者。治疗后，阅读疗法在减轻抑郁或焦虑症状方面显著优于对照条件（标准化均数差，-0.52；95%置信区间[CI]，-0.89至-0.15）。阅读疗法在全因停药方面与对照组相比无统计学显著差异（风险比，1.66；95%CI，0.93至2.95）。我们还对不同类别（障碍类型、平均年龄、对照条件和父母参与情况）研究的疗效结果进行了亚组分析，发现阅读疗法对抑郁青少年更有效。
本综述中符合条件的研究有限，因此存在潜在的发表偏倚。
根据本综述的结果，阅读疗法可能对治疗青少年抑郁更有益，但对儿童焦虑的效果不太显著。应开展进一步明确的临床研究来证实这些结果。
