Hubei University of Arts and Science, Xiangyang, Hubei, China.
School of Public Health Jilin University, Changchun, Jilin, China.
J Psychiatr Res. 2022 Apr;148:348-356. doi: 10.1016/j.jpsychires.2022.02.010. Epub 2022 Feb 16.
BACKGROUND & OBJECTIVES: Trials to assess the efficacy of psychological interventions for personal stigma in patients with schizophrenia are controversial, inconclusive, and limited. Using a systematic review and network meta-analysis, this study aimed to compare the effect of different psychological interventions for reducing personal stigma in patients with schizophrenia both direct and indirect.
Relevant randomized controlled trials (RCTs) were obtained from Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Web of Science, PsycINFO, Embase, Ovid Medline, CNKI, Wanfang, CBM, and Weipu. The focus of this network meta-analysis was on comparing the effects of various psychological interventions for reducing personal stigma in patients with schizophrenia. Standardized mean differences (SMDs) of personal stigma outcomes and 95% confidence intervals (CIs) were used to determine the efficacy. Inconsistency test, network map, surface under the cumulative rankings curve (SUCRA), comparison-adjusted funnel plot, and sensitivity analysis was performed.
Twenty-one RCTs involving 1,749 participants and nine psychological interventions were included. In terms of short-term efficacy, group self-assertiveness training ranked as most likely to reduce personal stigma (SUCRA: 97.0%, SMD: 2.15, 95% CI: 1.07 to 3.23), followed by group psychoeducation programs (SUCRA: 60.1%, SMD: 0.90, 95% CI: 0.24 to 1.55). These two interventions were significantly more effective than the treatment as usual.
Group self-assertiveness training and psychoeducation programs with higher ranks in short-term efficacy might be favorable to reduce personal stigma in patients with schizophrenia. However, the quality of evidence for pairwise comparison was rated as "very low" to "low" according to the Confidence in Network Meta-Analysis (CINeMA) approach. Further longitudinal studies with larger well-designed multicentric RCTs are needed to verify the efficacy of long-term outcomes.
评估心理干预对精神分裂症患者个体耻辱感疗效的试验存在争议、结果不确定且数量有限。本研究采用系统评价和网络荟萃分析，旨在直接和间接比较不同心理干预对降低精神分裂症患者个体耻辱感的效果。
从 Cochrane 对照试验中心注册库（CENTRAL）、PubMed、Web of Science、PsycINFO、Embase、Ovid Medline、中国知网（CNKI）、万方、中国生物医学文献数据库（CBM）和维普数据库中检索相关随机对照试验（RCT）。本网络荟萃分析的重点是比较各种心理干预降低精神分裂症患者个体耻辱感的效果。采用标准化均数差（SMD）和 95%置信区间（CI）表示个体耻辱感结局的效应量。采用不一致性检验、网络图、排序概率曲线下面积（SUCRA）、比较调整漏斗图和敏感性分析。
纳入 21 项 RCT 共计 1749 名参与者和 9 种心理干预措施。短期疗效方面，团体自强训练排名最高（SUCRA：97.0%，SMD：2.15，95%CI：1.07 至 3.23），其次是团体心理教育项目（SUCRA：60.1%，SMD：0.90，95%CI：0.24 至 1.55）。这两种干预措施与常规治疗相比，效果显著。
短期疗效排名较高的团体自强训练和心理教育项目可能有利于降低精神分裂症患者的个体耻辱感。然而，根据置信网络荟萃分析（CINeMA）方法，两两比较的证据质量被评为“极低”至“低”。需要进一步开展长期、高质量、大样本、多中心 RCT 以验证长期结局的疗效。
