Research School of Psychology, Australian National University, Canberra, ACT, 2601, Australia.
Centre for Mental Health Research, Australian National University, Canberra, Australia.
BMC Fam Pract. 2021 May 15;22(1):92. doi: 10.1186/s12875-021-01445-5.
Anxiety disorders are highly prevalent mental health conditions and are managed predominantly in primary care. We conducted a systematic review and meta-analysis of psychological and pharmacological treatments in countries with universal healthcare, and investigated the influence of treatment provider on the efficacy of psychological treatment.
PubMed, Cochrane, PsycINFO, CINAHL, and Scopus were searched in April 2017 for controlled studies of evidence-based anxiety treatment in adults in primary care, published in English since 1997. Searches were repeated in April 2020. We synthesised results using a combination of meta-analysis and narrative methods. Meta-analysis was conducted using a random-effects multi-level model to account for intercorrelation between effects contributed different treatment arms of the same study. Moderator variables were explored using meta-regression analyses.
In total, 19 articles (from an initial 2,247) reporting 18 studies were included. Meta-analysis including ten studies (n = 1,308) found a pooled effect size of g = 1.16 (95%CI = 0.63 - 1.69) for psychological treatment compared to waitlist control, and no significant effect compared to care as usual (p = .225). Substantial heterogeneity was present (I = 81.25). Specialist treatment produced large effects compared to both waitlist control (g = 1.46, 95%CI = 0.96 - 1.96) and care as usual (g = 0.76, 95%CI = 0.27 - 1.25). Treatment provided by non-specialists was only superior to waitlist control (g = 0.80, 95%CI = 0.31 - 1.28). We identified relatively few studies (n = 4) of medications, which reported small to moderate effects for SSRI/SNRI medications and hydroxyzine. The quality of included studies was variable and most studies had at least "unclear" risk of bias in one or more key domains.
Psychological treatments for anxiety are effective in primary care and are more effective when provided by a specialist (psychologist or clinical psychologist) than a non-specialist (GP, nurse, trainee). However, non-specialists provide effective treatment compared with no care at all. Limited research into the efficacy of pharmacological treatments in primary care needs to be considered carefully by prescribers TRIAL REGISTRATION: PROSPERO registration number CRD42018050659.
焦虑症是一种高发的心理健康疾病，主要在初级保健机构进行管理。我们对全民医保国家的成人初级保健中基于证据的心理和药物治疗进行了系统评价和荟萃分析，并调查了治疗提供者对心理治疗效果的影响。
2017 年 4 月，我们在 PubMed、Cochrane、PsycINFO、CINAHL 和 Scopus 数据库中检索了自 1997 年以来以英语发表的关于成人初级保健中焦虑症的基于证据的心理治疗的对照研究。2020 年 4 月重复检索。我们使用荟萃分析和叙述性方法相结合的方法综合结果。荟萃分析使用随机效应多水平模型进行，以解释同一研究的不同治疗臂之间的效果相关性。使用元回归分析探索调节变量。
共纳入 19 篇文章（最初 2247 篇中的 18 篇），报道了 18 项研究。纳入 10 项研究（n=1308）的荟萃分析发现，与等待名单对照相比，心理治疗的总效应大小为 g=1.16（95%CI=0.63-1.69），与常规护理相比无显著差异（p=0.225）。存在显著的异质性（I=81.25）。与等待名单对照（g=1.46，95%CI=0.96-1.96）和常规护理（g=0.76，95%CI=0.27-1.25）相比，专科治疗的效果显著较大。非专科治疗仅优于等待名单对照（g=0.80，95%CI=0.31-1.28）。我们发现药物治疗的研究相对较少（n=4），报告了 SSRI/SNRI 药物和羟嗪的小至中等疗效。纳入研究的质量参差不齐，大多数研究在一个或多个关键领域至少存在“不清楚”的偏倚风险。
焦虑症的心理治疗在初级保健中是有效的，由专家（心理学家或临床心理学家）提供比由非专家（全科医生、护士、受训者）提供更有效。然而，非专家提供的治疗与完全不治疗相比也具有有效性。在初级保健中药物治疗疗效的有限研究需要由处方者谨慎考虑。
PROSPERO 注册号 CRD42018050659。
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