Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands.
Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, The Netherlands.
J Affect Disord. 2018 Oct 15;239:138-145. doi: 10.1016/j.jad.2018.05.050. Epub 2018 Jul 3.
The risk for deterioration in patients receiving psychotherapy for adult depression has not been examined extensively and it is not clear whether psychotherapy reduces this risk or may even increase it in some patients. We conducted a meta-analysis of trials comparing these psychotherapies with control conditions that report deterioration rates.
We used an existing database of randomized trials on psychotherapies for adult depression which was updated up to 1/1/2017, through systematic searches in bibliographic databases. We included trials that reported clinically significant deterioration rates.
We included 18 studies with 23 comparisons between therapy and control groups. The pooled risk ratio of deterioration was 0.39 (95% CI: 0.27∼0.57), indicating that patients in the psychotherapy groups have a 61% lower chance to deteriorate than patients in the control groups. We found that 20 patients need to be treated with psychotherapy in order to avoid one case of deterioration, compared to the control conditions. The median deterioration rate in the therapy groups was 4%, and in some studies more than 10%, indicating that clinicians should always be aware of the risk of deterioration.
The results should be considered with caution because most studies had at least some risk of bias. Only 6% of all trials comparing psychotherapy with a control condition reported deterioration rates, using different ways to define deterioration which made pooling the prevalence rates across treatments and control groups impossible.
Psychological treatments of adult depression may reduce the risk for deterioration, compared to control groups, but this should be considered with caution because of the small proportion of studies reporting deterioration rates.
接受成人抑郁症心理治疗的患者病情恶化的风险尚未得到广泛研究，目前尚不清楚心理治疗是降低了这种风险，还是在某些患者中甚至增加了这种风险。我们对比较这些心理疗法与报告恶化率的对照条件的试验进行了荟萃分析。
我们使用了一个现有的成人抑郁症心理治疗随机试验数据库，该数据库通过对文献数据库的系统搜索进行了更新，截至 2017 年 1 月 1 日。我们纳入了报告有临床显著恶化率的试验。
我们纳入了 18 项研究，共有 23 项治疗组与对照组的比较。恶化的汇总风险比为 0.39（95%CI：0.27∼0.57），这表明治疗组患者恶化的可能性比对照组低 61%。我们发现，与对照组相比，需要对 20 名患者进行心理治疗，才能避免 1 例恶化。治疗组的恶化率中位数为 4%，在某些研究中超过 10%，这表明临床医生应始终意识到恶化的风险。
由于大多数研究都存在至少一定程度的偏倚，因此应谨慎考虑这些结果。在比较心理治疗与对照条件的所有试验中，只有 6%报告了恶化率，并使用不同的方法来定义恶化，这使得无法对治疗组和对照组的流行率进行汇总。
与对照组相比，成人抑郁症的心理治疗可能降低恶化的风险，但应谨慎考虑，因为报告恶化率的研究比例很小。
