School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Caulfield Pain Management and Research Centre, Caulfield Hospital, VIC, Australia; Institute for Safety, Compensation and Recovery Research, Monash University, Melbourne, VIC, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Clin Psychol Rev. 2018 Jun;62:11-36. doi: 10.1016/j.cpr.2018.05.001. Epub 2018 May 5.
The psychological impacts of injury have significant long-term implications on injury recovery. This review examined the effectiveness of interventions delivered within three months of injury on reducing the severity of posttraumatic stress disorder (PTSD), anxiety and depression symptoms. A systematic search of seven databases (PsycINFO, Medline, Web of Science, CINAHL, Embase, Scopus and Cochrane Library) identified 15,224 records. 212 full-text articles were retrieved, 26 studies were included in narrative synthesis, and 12 studies with lower risk of bias were included in meta-analyses. Prolonged exposure, and cognitive and behavioural interventions elicited improvements in PTSD, anxiety and depression symptoms; multidisciplinary interventions improved PTSD and depression symptoms; and education-based interventions had little impact on any psychological symptoms. Studies comprising risk stratified or stepped care methods showed markedly greater population impact through better reach, implementation and adoption. Meta-analyses revealed small-medium reductions in PTSD symptoms over the first 12 months postinjury (SMD = 0.32 to 0.49) with clinically meaningful effects in 64% of studies; reduced depression symptoms at 0-3 (small effect; SMD = 0.34) and 6-12 months postinjury (medium effect; SMD = 0.60), with clinically meaningful effects in 40% of studies; but no pooled effects on anxiety symptoms at any time. Altogether, exposure- and CBT-based psychological interventions had the greatest impact on PTSD and depression symptoms postinjury when delivered within three months of injury, with risk-stratified, stepped care having the greatest population impact potential.
创伤后的心理影响对创伤恢复有重大的长期影响。本综述考察了在创伤后三个月内实施的干预措施对减少创伤后应激障碍（PTSD）、焦虑和抑郁症状严重程度的有效性。通过对七个数据库（PsycINFO、Medline、Web of Science、CINAHL、Embase、Scopus 和 Cochrane Library）的系统检索，共确定了 15224 条记录。检索到 212 篇全文文章，纳入了 26 项叙述性综合研究，12 项低偏倚风险的研究纳入了荟萃分析。延长暴露、认知和行为干预可改善 PTSD、焦虑和抑郁症状；多学科干预可改善 PTSD 和抑郁症状；基于教育的干预对任何心理症状影响不大。包含风险分层或阶梯式护理方法的研究通过更好的覆盖面、实施和采用，对人群产生了更大的影响。荟萃分析显示，创伤后 12 个月内 PTSD 症状的中等程度降低（SMD=0.32 至 0.49），64%的研究有临床意义；0-3 个月（小效应；SMD=0.34）和 6-12 个月（中效应；SMD=0.60）时抑郁症状降低，40%的研究有临床意义；但任何时间点焦虑症状均无聚集效应。总之，暴露和基于 CBT 的心理干预在创伤后三个月内实施时对 PTSD 和抑郁症状的影响最大，风险分层、阶梯式护理具有最大的人群影响潜力。
