1 Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.
2 Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.
Aust N Z J Psychiatry. 2018 Aug;52(8):737-750. doi: 10.1177/0004867418758922. Epub 2018 Feb 21.
Alcohol misuse and depression are commonly co-occurring conditions. To date, no review has examined the most efficacious treatment model for psychosocial treatment of co-occurring alcohol misuse and depression. This systematic review determined the: (i) methodological quality of publications examining psychosocial treatment of co-occurring alcohol misuse and depression using a sequential, parallel or integrated treatment model; and (ii) effectiveness of each dual treatment model compared to single treatment for those with co-occurring alcohol misuse and depression.
PubMed, Medline and PsycInfo databases were searched for studies which were included if they involved treatment for alcohol misuse and depression and could be classified into one of the three treatment models. Included studies were assessed using the Cochrane's Effective Practice and Organisation of Care risk of bias criteria. Relevant study characteristics and outcomes were extracted and are presented in a narrative review format.
Seven studies met inclusion criteria. None were categorised as low risk on the risk of bias criteria. No studies examined a sequential model of treatment, three examined a parallel model and four examined an integrated model of dual-focussed treatment. The studies examining the parallel model and two out of four studies examining the effectiveness of an integrated model demonstrated greater improvement for alcohol or depression outcomes compared to control conditions.
Evidence for the psychosocial treatment of co-occurring alcohol misuse and depression is limited to a handful of studies. The evidence has several methodological limitations, which impact the interpretation of the findings. Therefore, while international guidelines recommend integrated dual-focussed treatment for co-occurring conditions, there is little evidence supporting the superiority of this treatment format for co-occurring alcohol misuse and depression. High-quality research demonstrating improvements in patient outcomes is required to ensure recommendations for clinical practice are based on strong empirical evidence.
酒精滥用和抑郁通常是同时存在的情况。迄今为止，尚无研究审查过针对酒精滥用和抑郁共病的心理社会治疗最有效的治疗模式。本系统评价旨在确定：（i）使用序贯、并行或综合治疗模式检查共病酒精滥用和抑郁的心理社会治疗的出版物的方法学质量；以及（ii）与单一治疗相比，每种双重治疗模式对共病酒精滥用和抑郁患者的有效性。
检索 PubMed、Medline 和 PsycInfo 数据库，纳入涉及酒精滥用和抑郁治疗且可分为三种治疗模式之一的研究。纳入的研究使用 Cochrane 有效实践和护理组织风险偏倚标准进行评估。提取相关研究特征和结果，并以叙述性综述的形式呈现。
有 7 项研究符合纳入标准。没有一项研究在偏倚风险标准中被归类为低风险。没有研究检查序贯治疗模型，三项研究检查并行治疗模型，四项研究检查双重焦点治疗的综合模型。检查并行治疗模型的研究和检查综合模型有效性的四项研究中的两项，与对照条件相比，酒精或抑郁结局的改善更为显著。
针对共病酒精滥用和抑郁的心理社会治疗证据仅限于少数几项研究。这些证据存在若干方法学限制，影响了研究结果的解释。因此，尽管国际指南建议对共病情况进行综合双重焦点治疗，但几乎没有证据支持这种治疗模式对共病酒精滥用和抑郁的优越性。需要高质量的研究来证明改善患者结局，以确保针对临床实践的建议基于强有力的经验证据。
