School of Nursing, Peking University, Beijing, China.
School of Nursing, Peking University, Beijing, China.
J Affect Disord. 2022 Jul 1;308:181-187. doi: 10.1016/j.jad.2022.04.055. Epub 2022 Apr 13.
Cognitive behavioral therapy (CBT) has been shown to be effective to improve depressive symptoms by changing their cognitive processes and concepts for dementia caregivers (DCs). However, whether CBT can be effectively delivered in individual, group, telephone-administered, internet, combine formats remains unclear. We aimed to examine the most effective delivery format for CBT via a network meta-analysis (NMA).
An exhaustive literature search was conducted based on Pubmed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure database, Chinese Biomedical Literature Database, Wan Fang database, and unpublished data. RCTs were identified from their inception to January 15, 2022. We conducted pairwise and NMA to evaluate the relative effectiveness and rank probability (rank P-score) for different CBT delivery formats. A series of analyses and assessments, such as the risk of bias, and GRADE were performed concurrently. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used for abstracting data.
A total of 37 studies were included in our analysis based on a series of rigorous screenings, which comprised 4191 DCs. Compared with controls, internet (SMD = -1.33, confidence interval (CI): -2.18, -0.66, GRADE low), telephone (SMD = -1.29, CI: -1.89, -0.61, GRADE moderate), and individual (SMD = -1.04, CI: -2.01, -0.07, GRADE very low) showed the largest improvement on depressive symptoms, whereas the group and combine delivery formats were not effective. Notably, there were no statistically significant differences between these five delivery formats: internet, telephone, individual, group, and combine. Sensitivity analyses supported the overall findings.
Our results suggested that internet, telephone, individual CBT delivery formats were effective for reducing depressive symptoms in DCs. Given the limitations of the NMA approach and the number of included studies, the result should be cautiously interpreted. Further RCTs with respect to the CBT based on different delivery formats' effectiveness are needed.
认知行为疗法（CBT）已被证明可通过改变痴呆症照顾者（DC）的认知过程和概念来有效改善抑郁症状。然而，CBT 能否以个体、小组、电话管理、互联网、结合形式有效实施尚不清楚。我们旨在通过网络荟萃分析（NMA）来检查 CBT 最有效的实施形式。
根据 Pubmed、Embase、Web of Science、护理学和联合健康文献累积索引（CINAHL）、PsycINFO、Cochrane 对照试验中心注册库、中国国家知识基础设施数据库、中国生物医学文献数据库、万方数据库和未发表的数据，进行了全面的文献检索。从研究开始到 2022 年 1 月 15 日，确定了 RCT。我们进行了成对和 NMA，以评估不同 CBT 实施形式的相对有效性和等级概率（等级 P-评分）。同时进行了一系列分析和评估，例如偏倚风险和 GRADE。系统评价和荟萃分析的首选报告项目（PRISMA）用于提取数据。
基于一系列严格的筛选，共有 37 项研究被纳入我们的分析，其中包括 4191 名 DC。与对照组相比，互联网（SMD=-1.33，置信区间[CI]：-2.18，-0.66，GRADE 低）、电话（SMD=-1.29，CI：-1.89，-0.61，GRADE 中）和个体（SMD=-1.04，CI：-2.01，-0.07，GRADE 非常低）在改善抑郁症状方面表现出最大的改善，而小组和组合实施形式则没有效果。值得注意的是，这五种实施形式之间没有统计学上的显著差异：互联网、电话、个体、小组和组合。敏感性分析支持了总体发现。
我们的结果表明，互联网、电话、个体 CBT 实施形式对降低 DC 的抑郁症状有效。鉴于 NMA 方法和纳入研究数量的局限性，结果应谨慎解释。需要进一步进行基于不同实施形式效果的 CBT 随机对照试验。
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