应对技能训练对癌症患者抑郁和焦虑症状的影响及其调节因素：汇总数据分析和个体患者数据分析的荟萃分析。

Effects and moderators of coping skills training on symptoms of depression and anxiety in patients with cancer: Aggregate data and individual patient data meta-analyses.

机构信息

Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands; Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.

Department of Medical Oncology, Family Cancer Clinic, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.

出版信息

Clin Psychol Rev. 2020 Aug;80:101882. doi: 10.1016/j.cpr.2020.101882. Epub 2020 Jun 25.

DOI:10.1016/j.cpr.2020.101882

PMID:32640368

Abstract

PURPOSE

This study evaluated the effects of coping skills training (CST) on symptoms of depression and anxiety in cancer patients, and investigated moderators of the effects.

METHODS

Overall effects and intervention-related moderators were studied in meta-analyses of pooled aggregate data from 38 randomized controlled trials (RCTs). Patient-related moderators were examined using linear mixed-effect models with interaction tests on pooled individual patient data (n = 1953) from 15 of the RCTs.

RESULTS

CST had a statistically significant but small effect on depression (g = -0.31,95% confidence interval (CI) = -0.40;-0.22) and anxiety (g = -0.32,95%CI = -0.41;-0.24) symptoms. Effects on depression symptoms were significantly larger for interventions delivered face-to-face (p = .003), led by a psychologist (p = .02) and targeted to patients with psychological distress (p = .002). Significantly larger reductions in anxiety symptoms were found in younger patients (p < 0.025), with the largest reductions in patients <50 years (β = -0.31,95%CI = -0.44;-0.18) and no significant effects in patients ≥70 years. Effects of CST on depression (β = -0.16,95%CI = -0.25;-0.07) and anxiety (β = -0.24,95%CI = -0.33;-0.14) symptoms were significant in patients who received chemotherapy but not in patients who did not (p < 0.05).

CONCLUSIONS

CST significantly reduced symptoms of depression and anxiety in cancer patients, and particularly when delivered face-to-face, provided by a psychologist, targeted to patients with psychological distress, and given to patients who were younger and received chemotherapy.

摘要

目的

本研究评估了应对技能训练（CST）对癌症患者抑郁和焦虑症状的影响，并探讨了影响的调节因素。

方法

通过对 38 项随机对照试验（RCT）的汇总数据进行荟萃分析，研究了总体效果和与干预相关的调节因素。使用线性混合效应模型，对来自 15 项 RCT 的 1953 名个体患者数据（n=1953）进行了个体患者数据的汇总分析，并进行了交互检验，以研究患者相关的调节因素。

结果

CST 对抑郁（g=-0.31，95%置信区间[CI]：-0.40；-0.22）和焦虑（g=-0.32，95%CI：-0.41；-0.24）症状有统计学意义的但较小的影响。面对面干预（p=0.003）、由心理学家领导（p=0.02）和针对心理困扰患者（p=0.002）的干预效果显著更大。在年轻患者中（p<0.025），焦虑症状的减轻更为显著，其中<50 岁患者的降幅最大（β=-0.31，95%CI：-0.44；-0.18），而≥70 岁患者则没有显著效果。CST 对抑郁（β=-0.16，95%CI：-0.25；-0.07）和焦虑（β=-0.24，95%CI：-0.33；-0.14）症状的影响在接受化疗的患者中是显著的，但在未接受化疗的患者中则不显著（p<0.05）。