Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom.
Division of Nursing, Midwifery & Social Work, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, United Kingdom.
PLoS One. 2020 Sep 10;15(9):e0238457. doi: 10.1371/journal.pone.0238457. eCollection 2020.
Anxiety and depression are common among patients with chronic physical illnesses and have a significant impact on morbidity, quality of life, and health service utilisation. Psychological treatment of anxiety and depression has small to moderate efficacy in this group and is not commonly based on a model of causal mechanisms. A novel approach to understanding and improving mental health outcomes in physical illnesses is needed. One approach may be to explore the role of metacognitive beliefs which are reliably associated with anxiety and depression in individuals with mental health difficulties. The current systematic review aimed to evaluate the contribution of metacognitive beliefs to anxiety and depression across physical illnesses. Systematic searches were conducted on Web of Science, PsychINFO, MEDLINE, Embase, and CINAHL of studies published between 1997 and January 2019. 13 eligible studies were identified that in sum comprised 2851 participants. Metacognitive beliefs were found to have reliable, moderate, positive and significant associations with anxiety and depression symptoms across a range of physical illnesses. There appeared to be commonality and some specificity in the relationships. Negative metacognitive beliefs concerned with uncontrollability and danger of worry were associated with both anxiety and depression across all physical illnesses assessed, whilst more specific associations emerged for individual medical conditions where positive beliefs about worry, cognitive confidence and cognitive self-consciousness were unique correlates. Negative metacognitive beliefs of uncontrollability and danger significantly and positively predicted symptoms of anxiety and depression after controlling for factors including age, gender, disease factors and cognition (illness perceptions and intolerance of uncertainty). The results suggest that the metacognitive model of psychological disorder is applicable to psychological symptoms of anxiety and depression across a range of chronic medical conditions, implying that metacognitive therapy might be helpful in improving outcomes in multiple morbidities that involve poor mental and medical health.
焦虑和抑郁在患有慢性躯体疾病的患者中很常见，对发病率、生活质量和卫生服务利用有重大影响。对这组患者进行心理治疗，疗效较小到中等，且通常不是基于因果机制模型。需要一种新的方法来了解和改善躯体疾病患者的心理健康结果。一种方法可能是探索元认知信念的作用，元认知信念与有心理健康问题的个体的焦虑和抑郁密切相关。本系统综述旨在评估元认知信念对各种躯体疾病中焦虑和抑郁的作用。在 1997 年至 2019 年 1 月期间，对 Web of Science、PsychINFO、MEDLINE、Embase 和 CINAHL 进行了系统检索，以查找发表的研究。确定了 13 项符合条件的研究，共纳入 2851 名参与者。元认知信念与各种躯体疾病的焦虑和抑郁症状存在可靠、中度、正相关和显著相关。在这些关系中似乎存在共性和一些特异性。与担忧的不可控性和危险性相关的负性元认知信念与所有评估的躯体疾病中的焦虑和抑郁都有关，而对于个别医疗状况，出现了更为特定的关联，即对担忧的积极信念、认知信心和认知自我意识是独特的相关因素。在控制了年龄、性别、疾病因素和认知（疾病感知和不确定性容忍度）等因素后，不可控性和危险性的负性元认知信念显著且正向预测了焦虑和抑郁症状。研究结果表明，心理障碍的元认知模型适用于多种慢性疾病中焦虑和抑郁的心理症状，这意味着元认知疗法可能有助于改善涉及心理健康和身体健康不佳的多种合并症的结局。
