Department of Psychology, University of Sheffield, Sheffield, UK.
School of Health and Related Research, University of Sheffield, Sheffield, UKxs.
Behav Cogn Psychother. 2019 Sep;47(5):514-529. doi: 10.1017/S1352465819000080. Epub 2019 Mar 21.
Cognitive behavioural therapy (CBT) is an effective psychological treatment for major depressive disorder, although some patients experience a return of symptoms after finishing therapy. The ability to predict which individuals are more vulnerable to deterioration would allow for targeted interventions to prevent short-term relapse and longer-term recurrence.
This systematic review and meta-analysis aimed to identify factors associated with an increased risk of relapse and/or recurrence (RR) after CBT for depression.
We reviewed 13 relevant papers, of which a small set of unique samples were eligible for meta-analysis (k = 5, N = 369). Twenty-six predictor variables were identified and grouped into seven categories: residual depressive symptoms; prior episodes of depression; cognitive reactivity; stressful life events; personality factors; clinical and diagnostic factors; demographics.
Meta-analyses indicated that residual depressive symptoms (r = 0.34 [0.10, 0.54], p = .01) and prior episodes (r = 0.19 [0.07, 0.30], p = .002) were statistically significant predictors of RR, but cognitive reactivity was not (r = 0.18 [-0.02, 0.36], p = .08). Other variables lacked replicated findings. On average, 33.4% of patients experienced RR after CBT.
Patients with the above risk factors could be offered evidence-based continuation-phase interventions to enhance the longer-term effectiveness of CBT.
认知行为疗法（CBT）是一种有效的治疗重度抑郁症的心理疗法，但有些患者在完成治疗后会出现症状复发。能够预测哪些个体更容易恶化，将有助于进行有针对性的干预，以预防短期复发和长期复发。
本系统回顾和荟萃分析旨在确定与 CBT 治疗抑郁症后复发和/或复发（RR）风险增加相关的因素。
我们回顾了 13 篇相关文献，其中一小部分独特的样本符合荟萃分析的条件（k=5，N=369）。确定了 26 个预测变量，并分为七类：残留抑郁症状；既往抑郁发作；认知反应性；生活应激事件；人格因素；临床和诊断因素；人口统计学。
荟萃分析表明，残留抑郁症状（r=0.34[0.10,0.54]，p=0.01）和既往发作（r=0.19[0.07,0.30]，p=0.002）是 RR 的统计学显著预测因素，但认知反应性不是（r=0.18[-0.02,0.36]，p=0.08）。其他变量缺乏重复的发现。平均而言，33.4%的患者在 CBT 后经历了 RR。
有上述风险因素的患者可以提供基于证据的延续性干预措施，以增强 CBT 的长期效果。
