School of Health and Social Care, University of Essex, Colchester, CO4 3SQ, UK.
BMC Psychiatry. 2020 Jun 18;20(1):313. doi: 10.1186/s12888-020-02682-1.
Globally, national guidelines for depression have prioritised evidence from randomised controlled trials and quantitative meta-analyses, omitting qualitative research concerning patient experience of treatments. A review of patient experience research can provide a comprehensive overview of this important form of evidence and thus enable the voices and subjectivities of those affected by depression to have an impact on the treatments and services they are offered. This review aims to seek a comprehensive understanding of patient experiences of psychological therapies for depression using a systematic and rigorous approach to review and synthesis of qualitative research.
PsychINFO, PsychARTICLES, MEDLINE, and CINAHL were searched for published articles using a qualitative approach to examine experiences of psychological therapies for depression. All types of psychological therapy were included irrespective of model or modes of delivery (e.g. remote or in person; group or individual). Each article was assessed following guidance provided by the Critical Appraisal Skill Programme tool. Articles were entered in full into NVIVO and themes were extracted and synthesized following inductive thematic analysis.
Thirty-seven studies, representing 671 patients were included. Three main themes are described; the role of therapy features and setting; therapy processes and how they impact on outcomes; and therapy outcomes (benefits and limitations). Subthemes are described within these themes and include discussion of what works and what's unhelpful; issues integrating therapy with real life; patient preferences and individual difference; challenges of undertaking therapy; influence of the therapist; benefits of therapy; limits of therapy and what happens when therapy ends.
Findings point to the importance of common factors in psychotherapies; highlight the need to assess negative outcomes; and indicate the need for patients to be more involved in discussions and decisions about therapy, including tailoring therapy to individual needs and taking social and cultural contexts into account.
在全球范围内，针对抑郁症的国家指南优先考虑了随机对照试验和定量荟萃分析的证据，而忽略了关于患者治疗体验的定性研究。对患者体验研究的回顾可以全面了解这种重要形式的证据，从而使受抑郁症影响的患者的声音和主观性能够对他们所接受的治疗和服务产生影响。本综述旨在通过系统和严格的方法来审查和综合定性研究，以寻求对抑郁症心理治疗患者体验的全面理解。
使用定性方法搜索了 PsychINFO、PsychARTICLES、MEDLINE 和 CINAHL 中的已发表文章，以检查抑郁症心理治疗的体验。无论模型或交付方式如何（例如远程或面对面、小组或个人），都包括所有类型的心理治疗。按照批判性评估技能计划工具提供的指导，对每篇文章进行评估。将文章全文输入 NVIVO 中，并根据归纳主题分析提取和综合主题。
纳入了 37 项研究，代表了 671 名患者。描述了三个主要主题；治疗特征和环境的作用；治疗过程以及它们如何影响结果；以及治疗结果（益处和局限性）。这些主题内描述了子主题，包括讨论什么有效，什么无效；将治疗与现实生活结合的问题；患者偏好和个体差异；进行治疗的挑战；治疗师的影响；治疗的益处；治疗的局限性以及治疗结束时会发生什么。
研究结果表明心理治疗中共同因素的重要性；强调需要评估负面结果；并表明需要患者更多地参与有关治疗的讨论和决策，包括根据个人需求定制治疗，并考虑社会和文化背景。
