Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany; Psychologische Hochschule Berlin, Berlin, Germany.
Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.
J Affect Disord. 2021 Jan 1;278:614-626. doi: 10.1016/j.jad.2020.09.092. Epub 2020 Sep 30.
By understanding specific differences between responders to a treatment and non-responders, treatment modalities may be fitted to the individual in order to increase effectiveness, a concept known as "precision medicine". This systematic review and meta-analysis investigated which pretreatment patient and family characteristics may predict the outcome of cognitive-behavioral therapy (CBT) in clinically anxious and/or depressed youth. In particular, higher symptom severity, more severe co-occurring anxiety or depression and more severe parental psychopathology were hypothesized to predict a worse CBT outcome.
The databases PubMed, PsycINFO and Cochrane Library were searched; 73 publications were included in the review from which 23 studies were used for the meta-analysis.
Higher symptom severity represented a clinically relevant predictor of a worse CBT outcome, with large effects estimated by meta-analysis. Further, parental psychopathology was significant and detrimental for CBT outcome in anxious but not depressed youth, while the effects for co-occurring anxiety and depression remained unclear. The additional results of the review show that only few characteristics seemed to be clearly associated with a worse CBT outcome, namely worse coping skills and, restricted to depressed patients, more non-suicidal self-injury.
The available evidence was of only moderate quality in general, further high-quality research with more transparent reporting is needed.
The patient characteristics identified as being relevant for CBT outcome may represent important candidates for use in single patient prediction models for precision medicine in the field of child and adolescent psychotherapy. The review was preregistered on PROSPERO (ID: CRD42018116881).
通过了解治疗反应者和非反应者之间的特定差异，治疗方法可以根据个体进行调整，以提高疗效，这一概念被称为“精准医学”。本系统评价和荟萃分析研究了哪些治疗前患者和家庭特征可能预测临床焦虑和/或抑郁青少年认知行为疗法（CBT）的结果。特别是，较高的症状严重程度、更严重的共病焦虑或抑郁以及更严重的父母精神病理学被假设为预测 CBT 结果更差。
检索了 PubMed、PsycINFO 和 Cochrane Library 数据库；从该综述中纳入了 73 篇出版物，其中 23 项研究用于荟萃分析。
较高的症状严重程度代表 CBT 结果较差的临床相关预测因素，荟萃分析估计其影响较大。此外，父母精神病理学对焦虑青少年的 CBT 结果有显著影响且不利，但共病焦虑和抑郁的影响仍不清楚。综述的其他结果表明，只有少数特征似乎与 CBT 结果较差明显相关，即较差的应对技能，以及仅在抑郁患者中，更多的非自杀性自伤。
一般来说，可用证据的质量仅为中等，需要进一步进行高质量、更透明报告的研究。
确定与 CBT 结果相关的患者特征可能代表儿童和青少年心理治疗领域精准医学中用于单患者预测模型的重要候选者。该综述已在 PROSPERO（ID：CRD42018116881）上预先注册。
