Unit for Quality of Care and Rights Promotion in Mental Health, Istituto di Ricerche Farmacologiche Mario Negri Sede di Milano, Milano, Italy.
Unit for Quality of Care and Rights Promotion in Mental Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
Fam Process. 2020 Jun;59(2):361-375. doi: 10.1111/famp.12540. Epub 2020 Apr 15.
The association between depressive symptoms and distressed intimate relationships supported the assumption that couple therapy, by focusing on the interpersonal context of depression, might be more effective as a treatment for depression than individual psychotherapy or drug therapy. This issue was addressed by a Cochrane meta-analysis assessing the evidence from clinical trials of couple therapy for depression in comparison with individual psychotherapy, drug therapy, and no/minimal intervention, including fourteen studies with 651 participants. No study was found free of bias and the quality of the evidence was low, with major problems of small sample sizes, missing outcome data, selective reporting, lack of information on random sequence generation and allocation concealment, recruitment of people not representative of clinical practice, and allegiance bias. The meta-analysis showed that both couple therapy and individual psychotherapy improved depressive symptoms at end of treatment and after 6 months or longer, with moderate effect sizes, without any difference between the two treatments. Couple therapy was more effective in reducing couple distress. This effect was larger in studies with distressed couples only and should be considered as relevant in its own right. Couple therapy is a viable option for the treatment of a depressed partner, especially in discordant couples. Future research should address several issues left open to provide a sound empirical foundation for clinical practice.
抑郁症状与痛苦的亲密关系之间的关联支持了这样一种假设，即夫妻治疗通过关注抑郁的人际背景，可能比个体心理治疗或药物治疗更有效地治疗抑郁症。这一问题通过一项 Cochrane 荟萃分析得到了探讨，该分析评估了夫妻治疗抑郁症与个体心理治疗、药物治疗和无/最小干预的临床试验证据，包括 14 项涉及 651 名参与者的研究。没有发现无偏见的研究，证据质量低，主要存在样本量小、缺失结局数据、选择性报告、缺乏关于随机序列生成和分配隐藏的信息、招募的人不具有代表性、以及忠诚度偏见等问题。荟萃分析表明，夫妻治疗和个体心理治疗都能在治疗结束时和 6 个月或更长时间后改善抑郁症状，疗效中等，两种治疗方法之间没有差异。夫妻治疗在减轻夫妻痛苦方面更有效。仅在关系紧张的夫妻研究中，这种效果更大，应被视为具有独立的相关性。夫妻治疗是治疗抑郁伴侣的一种可行选择，尤其是在不和谐的夫妻中。未来的研究应解决一些遗留问题，为临床实践提供可靠的实证基础。
