DPH, Instituto Nacional de Salud Pública, Av. Universidad 655, Sta. Ma. Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico.
DPH, Instituto Nacional de Salud Pública, Av. Universidad 655, Sta. Ma. Ahuacatitlán, C.P. 62100, Cuernavaca, Morelos, Mexico.
Breast. 2019 Apr;44:135-143. doi: 10.1016/j.breast.2019.01.006. Epub 2019 Jan 31.
Depressive symptoms are common comorbidities among breast cancer (BC) patients. Non-pharmacological therapies (NPTs) such as exercise and psychotherapy may reduce depressive symptoms; however, the evidence is inconclusive. The objective of this study is to evaluate if NPTs reduce depressive symptoms among BC patients.
A systematic review and meta-analysis of randomized clinical trials (RCTs) of NPTs for BC patients were performed. A literature search was conducted from eight databases in English, Portuguese and Spanish from 2006 to 2017. Inclusion criteria were: RCTs that evaluated depressive symptoms as a primary or secondary outcome that did not include pharmacological interventions and did include a non-intervened control group, with at least 30 participants in non-terminal BC stage with no current psychiatric illness. A meta-analysis for each NPT was performed with DerSimonian and Laird's method for the random effects model. Sensitivity analyses were conducted. Heterogeneity and publication bias were assessed.
A total of 41 eligible RCTs were identified. Overall, NPTs significantly reduced depressive symptoms (Summary standardized mean difference (SMD) = -0.516; 95%CI: -0.814, -0.218; I = 96.2). Of the types of NPTs, psychotherapy significantly reduced depressive symptoms (Summary SMD = -0.819; 95% CI: -1.608, -0.030; I = 91.53). A significant difference emerged for Mindfulness (Summary SMD = -0.241; 95% CI: -0.412, -0.070; I = 28.6%) and yoga (Summary SMD = -0.305; 95% CI: -0.602, -0.007; I = 41.0%) when the heterogeneity was reduced. No evidence of publication bias was observed.
Psychotherapy and mind-body therapies may reduce depressive symptoms in women with BC. Laughter and couples therapy warrant attention in future studies.
抑郁症状是乳腺癌（BC）患者常见的合并症。非药物疗法（NPT），如运动和心理疗法，可能会降低抑郁症状；然而，证据并不明确。本研究的目的是评估 NPT 是否会降低 BC 患者的抑郁症状。
对 2006 年至 2017 年期间发表在英文、葡萄牙文和西班牙文的八种数据库中关于 NPT 治疗 BC 患者的随机临床试验（RCT）进行了系统评价和荟萃分析。纳入标准为：评估抑郁症状为主要或次要结局且不包括药物干预、包括未干预对照组、至少 30 名处于非晚期 BC 阶段且无当前精神疾病的参与者的 RCT。对每种 NPT 进行荟萃分析，采用 DerSimonian 和 Laird 方法进行随机效应模型。进行了敏感性分析。评估了异质性和发表偏倚。
共确定了 41 项符合条件的 RCT。总体而言，NPT 显著降低了抑郁症状（综合标准化均数差（SMD）=-0.516；95%CI：-0.814，-0.218；I²=96.2）。在 NPT 类型中，心理疗法显著降低了抑郁症状（综合 SMD=-0.819；95%CI：-1.608，-0.030；I²=91.53）。当异质性降低时，正念（综合 SMD=-0.241；95%CI：-0.412，-0.070；I²=28.6%）和瑜伽（综合 SMD=-0.305；95%CI：-0.602，-0.007；I²=41.0%）出现了显著差异。未发现发表偏倚的证据。
心理疗法和身心疗法可能会降低 BC 女性的抑郁症状。笑和夫妻疗法值得在未来的研究中关注。
