Deter Hans-Christian, Orth-Gomér Kristina
1Medical Clinic, Psychosomatics, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm, 30 12200 Berlin, Germany.
2Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Biopsychosoc Med. 2020 May 12;14:11. doi: 10.1186/s13030-020-00180-0. eCollection 2020.
Many intervention studies of coronary artery disease (CAD) have found health benefits for patients in the "treatment as usual" (TAU) group like in the specific psychotherapy group. In this pilot study, we wanted to examine and discuss the role and reasons for TAU effects.
By means of a systematic review, we examined the control conditions from psychotherapeutic RCTs with CAD patients related to depressive symptoms, mortality and recurrence rate of events. The review question was limited to factors influencing the TAU effectiveness in such psychotherapeutic outcome studies.
We found a decrease in depressive symptoms in TAU patients (mean ES: 0.65) and very differing mortality and recurrence rates of events. The effects were dependant on the year the study was published (1986-2016), the follow-up time of the study (0.25-7.8 years) and the treatment arms. A small dose of additional counselling, medical attention, and teaching of therapeutic techniques with clinical competence may reinforce the therapeutic alliance. These factors would be possible moderators of control group efficacy related to the reduction in depressive symptoms and a decrease in mortality and events.
In the reviewed studies, we found that the control condition was beneficial for CAD patients, but this benefit was highly variable. Specified psychotherapeutic interventions showed an additional independent effect of treatment on depression and effects on morbidity and mortality. There is a need to identify patients at risk of remaining depressed or under severe stress during usual care. These patients may require additional psychosocial intervention.
许多冠心病（CAD）干预研究发现，“常规治疗”（TAU）组患者与特定心理治疗组患者一样能从中获益。在这项初步研究中，我们想探讨并讨论TAU效应的作用及原因。
通过系统综述，我们研究了针对CAD患者的心理治疗随机对照试验（RCT）中与抑郁症状、死亡率和事件复发率相关的对照条件。综述问题仅限于影响此类心理治疗结果研究中TAU有效性的因素。
我们发现TAU组患者的抑郁症状有所减轻（平均效应量：0.65），且死亡率和事件复发率差异很大。这些效应取决于研究发表年份（1986 - 2016年）、研究的随访时间（0.25 - 7.8年）以及治疗组。少量额外的咨询、医疗关注以及具备临床能力的治疗技术教学可能会加强治疗联盟。这些因素可能是与抑郁症状减轻以及死亡率和事件减少相关的对照组疗效的调节因素。
在纳入综述的研究中，我们发现对照条件对CAD患者有益，但这种益处差异很大。特定的心理治疗干预显示出对抑郁症治疗的额外独立效应以及对发病率和死亡率的影响。有必要识别出在常规护理期间仍有抑郁风险或处于严重压力下的患者。这些患者可能需要额外的心理社会干预。
