Center for Innovation in Mental Health, Academic Unit of Psychology and Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; the Solent NHS Trust, Southampton; the New York University Child Study Center, New York, NY; and the Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, UK.
University of Oxford, UK.
J Am Acad Child Adolesc Psychiatry. 2019 Feb;58(2):167-179. doi: 10.1016/j.jaac.2018.07.891. Epub 2018 Oct 16.
Network meta-analyses (NMAs) are gaining traction as the preferred method for evidence synthesis of intervention studies. This review aimed to summarize the basics of NMAs and conduct a meta-review of available NMAs on the treatment of child and adolescent psychiatric disorders by appraising their quality.
PubMed (Medline), PsycInfo, Embase, Ovid Medline, and Web of Knowledge were systematically searched (last update January 9, 2018). The quality of each included NMA was appraised using the AMSTAR-2 tool and the PRISMA-NMA checklist, which includes specific items for NMAs.
Eighteen NMAs (6 on attention-deficit/hyperactivity disorder; 4 on psychotic disorders; 2 on depression; 2 on anxiety disorders; 1 on obsessive-compulsive disorder; 1 on disruptive behavior disorder, 1 on bipolar disorder, and 1 on antipsychotics across disorders) were retrieved. Results from the AMSTAR-2 assessment showed that only 27% of appraised NMAs were rated as moderate quality; most were rated as low (33%) or critically low (40%) quality. Only 3 of the appraised NMAs reported on all PRISMA-NMA items specific for NMAs; the network structure was graphically presented in most NMAs (80%), and inconsistency was described in only 47%.
Given the paucity of head-to-head trials in child and adolescent psychiatry, NMAs have the potential to contribute to the field, because they provide evidence-based hierarchies for treatment decision making, even in the absence of trials directly comparing at least 2 treatments. However, because of important limitations in the included NMAs, additional methodologically sound NMAs are needed to inform future guidelines and clinical practice in child and adolescent psychiatry.
网络荟萃分析（NMAs）作为干预研究证据综合的首选方法越来越受到关注。本综述旨在总结 NMAs 的基础知识，并通过评估其质量对儿童和青少年精神障碍治疗的现有 NMAs 进行荟萃评价。
系统检索了 PubMed（Medline）、PsycInfo、Embase、Ovid Medline 和 Web of Knowledge（最后更新日期为 2018 年 1 月 9 日）。使用 AMSTAR-2 工具和 PRISMA-NMA 清单（其中包括 NMAs 的特定项目）评估每个纳入的 NMA 的质量。
检索到 18 项 NMAs（6 项关于注意力缺陷/多动障碍；4 项关于精神病性障碍；2 项关于抑郁；2 项关于焦虑障碍；1 项关于强迫症；1 项关于破坏性行为障碍；1 项关于双相障碍；1 项关于抗精神病药）。AMSTAR-2 评估结果表明，只有 27%的评估 NMAs 被评为中等质量；大多数被评为低（33%）或极低（40%）质量。只有 3 项评估的 NMAs 报告了所有针对 NMAs 的 PRISMA-NMA 特定项目；大多数 NMAs（80%）都以图形方式呈现了网络结构，只有 47%描述了不一致性。
鉴于儿童和青少年精神病学中头对头试验的缺乏，NMAs 有可能为该领域做出贡献，因为它们为治疗决策提供了基于证据的层次结构，即使在没有直接比较至少 2 种治疗方法的试验的情况下也是如此。然而，由于纳入的 NMAs 存在重要限制，需要更多方法学上合理的 NMAs 为儿童和青少年精神病学的未来指南和临床实践提供信息。
