School of Health and Social Care, Edinburgh Napier University, UK.
Rivers Centre for Traumatic Stress, Fountainbridge Library, NHS Lothian, Edinburgh, UK.
Br J Clin Psychol. 2018 Nov;57(4):453-472. doi: 10.1111/bjc.12182. Epub 2018 Apr 16.
The effectiveness of psychological therapies for those receiving acute adult mental health inpatient care remains unclear, partly because of the difficulty in conducting randomized controlled trials (RCTs) in this setting. The aim of this meta-analysis was to synthesize evidence from all controlled trials of psychological therapy carried out with this group, to estimate its effects on a number of important outcomes and examine whether the presence of randomization and rater blinding moderated these estimates.
A systematic review and meta-analysis of all controlled trials of psychological therapy delivered in acute inpatient settings was conducted, with a focus on psychotic symptoms, readmissions or emotional distress (anxiety and depression). Studies were identified through ASSIA, EMBASE, CINAHL, Cochrane, MEDLINE, and PsycINFO using a combination of the key terms 'inpatient', 'psychological therapy', and 'acute'. No restriction was placed on diagnosis. The moderating effect of the use of assessor-blind RCT methodology was examined via subgroup and sensitivity analyses.
Overall, psychological therapy was associated with small-to-moderate improvements in psychotic symptoms at end of therapy but the effect was smaller and not significant at follow-up. Psychological therapy was also associated with reduced readmissions, depression, and anxiety. The use of single-blind randomized controlled trial methodology was associated with significantly reduced benefits on psychotic symptoms and was also associated with reduced benefits on readmission and depression; however, these reductions were not statistically significant.
The provision of psychological therapy to acute psychiatric inpatients is associated with improvements; however, the use of single-blind RCT methodology was associated with reduced therapy-attributable improvements. Whether this is a consequence of increased internal validity or reduced external validity is unclear. Trials with both high internal and external validity are now required to establish what type, format, and intensity of brief psychological therapy is required to achieve sustained benefits.
Clinical implications: This review provides the first meta-analytical synthesis of brief psychological therapy delivered in acute psychiatric inpatient settings. This review suggests that brief psychological therapy may be associated with reduced emotional distress and readmissions.
The evidence in this review is of limited quality. The type, format, and intensity of brief psychological therapy required to achieve sustained benefits are yet to be established.
对于接受急性成人心理健康住院治疗的患者，心理治疗的有效性仍不清楚，部分原因是在这种环境中进行随机对照试验（RCT）具有一定难度。本荟萃分析的目的是综合该人群进行的所有心理治疗对照试验的证据，以评估其对许多重要结局的影响，并检验随机分组和评估者设盲是否会调节这些评估结果。
系统地检索了 ASSIA、EMBASE、CINAHL、Cochrane、MEDLINE 和 PsycINFO 中的所有急性住院环境中进行的心理治疗对照试验，使用“住院”、“心理治疗”和“急性”等关键词的组合进行了搜索。本研究没有对诊断进行限制。通过亚组分析和敏感性分析，检验评估者设盲 RCT 方法的调节作用。
总体而言，心理治疗与治疗结束时精神病症状的小到中等程度的改善相关，但在随访时效果较小且不显著。心理治疗也与减少再入院、抑郁和焦虑相关。使用单盲随机对照试验方法与精神病症状的显著较小的获益相关，也与再入院和抑郁的获益减少相关；然而，这些减少没有统计学意义。
为急性精神病住院患者提供心理治疗与改善相关；然而，使用单盲 RCT 方法与减少治疗归因改善相关。这是由于内部有效性增加还是外部有效性降低尚不清楚。现在需要进行具有高内部和外部有效性的试验，以确定实现持续获益所需的简短心理治疗的类型、格式和强度。
本综述提供了首个在急性精神病住院环境中进行的简短心理治疗的荟萃分析综合。本综述表明，简短心理治疗可能与减少情绪困扰和再入院相关。
本综述中的证据质量有限。实现持续获益所需的简短心理治疗的类型、格式和强度尚待确定。
