Unit for Bereavement Research, Aarhus University, Denmark; Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus University, Denmark.
Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus University, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
J Affect Disord. 2019 Jun 15;253:69-86. doi: 10.1016/j.jad.2019.04.065. Epub 2019 Apr 10.
The present meta-analysis evaluates the efficacy of psychological interventions for grief in bereaved adults and explores the possible moderating influence of various study characteristics.
A systematic literature search was conducted by two reviewers who independently searched electronic databases, reviewed and selected eligible studies, and evaluated their methodological quality.
A total of 31 randomized controlled trials (RCTs) were included in the meta-analysis. Statistically significant pooled effects of psychological intervention on grief symptoms were found for both post-intervention (Hedges's g = 0.41, p > .001, K = 31) and follow-up (g = 0.45, p > .001, K = 18). While generally robust, the effect was smaller at post-intervention when adjusting for possible publication bias (g = 0.31). Compared with the remaining studies, larger post-intervention effect sizes were found for studies with (1) individually delivered interventions (Beta = 0.49, p < .001), (2) the ICG-(R)/PG-13 questionnaire as the grief instrument (Beta = 0.46, p < .001), (3) participants who were ≥6 months post-loss (Beta = 0.58, p < .001), (4) participants included based on high baseline symptom levels (Beta = 0.40, p = .002) and (5) higher study quality (Beta = 0.06, p = .013).
The included studies were methodologically heterogeneous and their methodological quality varied considerably. Moreover, there were some indications of publication bias.
Given the recent introduction of Prolonged Grief Disorder in the ICD-11, the results of the present meta-analysis are timely and of clinical relevance. Based on our results, psychological intervention appears efficacious for alleviating grief symptoms in bereaved adults, with several study characteristics as possible moderators of the effect. The interpretability of the results, however, is challenged by some limitations of the available research, including possible publication bias.
本荟萃分析评估了心理干预对丧亲成年人悲伤的疗效，并探讨了各种研究特征的可能调节作用。
两位审查员进行了系统的文献搜索，他们独立搜索电子数据库，审查并选择合格的研究，并评估其方法学质量。
荟萃分析共纳入 31 项随机对照试验（RCT）。心理干预对悲伤症状的干预后（Hedges's g=0.41，p>.001，K=31）和随访（g=0.45，p>.001，K=18）均有统计学意义的汇总效应。虽然总体上稳健，但在调整可能的发表偏倚后，干预后效应较小（g=0.31）。与其余研究相比，以下研究的干预后效应较大：（1）单独提供的干预（Beta=0.49，p<.001），（2）ICG-（R）/PG-13 问卷作为悲伤工具（Beta=0.46，p<.001），（3）参与者≥6 个月丧亲（Beta=0.58，p<.001），（4）基于高基线症状水平纳入的参与者（Beta=0.40，p=0.002），（5）研究质量较高（Beta=0.06，p=0.013）。
纳入的研究方法学上存在异质性，方法学质量差异很大。此外，存在一些发表偏倚的迹象。
鉴于 ICD-11 最近引入了持续性悲伤障碍，本荟萃分析的结果具有及时性和临床相关性。基于我们的结果，心理干预似乎对缓解丧亲成年人的悲伤症状有效，而几个研究特征可能是该效果的调节因素。然而，由于现有研究的一些局限性，包括可能的发表偏倚，结果的可解释性受到挑战。
