Department of Psychology, University of Sheffield, Sheffield, United Kingdom.
Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, United Kingdom.
Depress Anxiety. 2019 Sep;36(9):866-878. doi: 10.1002/da.22931. Epub 2019 Jun 24.
Previous studies indicate that early symptomatic improvement, typically observed during the first 4 weeks of psychological therapy, is associated with positive treatment outcomes for a range of mental health problems. However, the replicability, statistical significance, and magnitude of this association remain unclear.
The current study reviewed the literature on early response to psychological interventions for adults with depression and anxiety symptoms.
A systematic review and random effects meta-analysis were conducted, including studies found in Medline, PsychINFO, SCOPUS, Web of Science, and through reference lists and reverse citations.
Twenty-five eligible studies including 11,091 patients measured early response and examined associations with posttreatment outcomes. It was possible to extract and/or calculate effect size data from 15 studies to conduct a meta-analysis. A large pooled effect size (g = 0.87 [95% confidence interval: 0.63-1.10], p < .0001) indicated that early responders had significantly better posttreatment outcomes compared to cases without early response, and this effect was larger in anxiety (g = 1.37) compared to depression (g = 0.76) measures. Most studies were of good quality and there was no evidence of publication bias. The main limitations concerned insufficient statistical reporting in some studies, which precluded their inclusion in meta-analysis, and it was not possible to examine effect sizes according to different outcome questionnaires.
There is robust and replicated evidence that early response to therapy is a reliable prognostic indicator for depression and anxiety treatment outcomes.
先前的研究表明，在心理治疗的前 4 周内通常观察到的早期症状改善与一系列心理健康问题的积极治疗结果相关。然而，这种关联的可重复性、统计学意义和幅度仍不清楚。
本研究综述了针对抑郁和焦虑症状的成年人的心理干预早期反应的文献。
进行了系统回顾和随机效应荟萃分析，包括在 Medline、PsychINFO、SCOPUS、Web of Science 以及参考文献和反向引用中找到的研究。
25 项符合条件的研究包括 11091 名患者，测量了早期反应并检查了与治疗后结果的关联。可以从 15 项研究中提取和/或计算效应量数据以进行荟萃分析。较大的 pooled 效应量（g = 0.87 [95%置信区间：0.63-1.10]，p < .0001）表明，与没有早期反应的病例相比，早期反应者的治疗后结果明显更好，并且在焦虑（g = 1.37）中比抑郁（g = 0.76）措施更大。大多数研究的质量都很好，并且没有发表偏倚的证据。主要的局限性在于一些研究的统计报告不足，这使得它们无法纳入荟萃分析，并且无法根据不同的结果问卷来检查效应量。
有可靠且可重复的证据表明，治疗的早期反应是抑郁和焦虑治疗结果的可靠预后指标。
