Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA.
Psychol Med. 2022 May;52(7):1208-1221. doi: 10.1017/S0033291722000903. Epub 2022 May 13.
Psychomotor slowing is a key feature of depressive disorders. Despite its great clinical importance, the pathophysiology and prevalence across different diagnoses and mood states are still poorly understood. Actigraphy allows unbiased, objective, and naturalistic assessment of physical activity as a marker of psychomotor slowing. Yet, the true effect-sizes remain unclear as recent, large systematic reviews are missing. We conducted a novel meta-analysis on actigraphically measured slowing in depression with strict inclusion and exclusion criteria for diagnosis ascertainment and sample duplications. Medline/PubMed and Web-of-Science were searched with terms combining mood-keywords and actigraphy-keywords until September 2021. Original research measuring actigraphy for ⩾24 h in at least two groups of depressed, remitted, or healthy participants and applying operationalized diagnosis was included. Studies in somatically ill patients, N < 10 participants/group, and studies using consumer-devices were excluded. Activity-levels between groups were compared using random-effects models with standardized-mean-differences and several moderators were examined. In total, 34 studies (n = 1804 patients) were included. Patients had lower activity than controls [standardized mean difference (s.m.d.) = -0.78, 95% confidence interval (CI) -0.99 to -0.57]. Compared to controls, patients with unipolar and bipolar disorder had lower activity than controls whether in depressed (unipolar: s.m.d. = -0.82, 95% CI -1.07 to -0.56; bipolar: s.m.d. = -0.94, 95% CI -1.41 to -0.46), or remitted/euthymic mood (unipolar: s.m.d. = -0.28, 95% CI -0.56 to 0.0; bipolar: s.m.d. = -0.92, 95% CI -1.36 to -0.47). None of the examined moderators had any significant effect. To date, this is the largest meta-analysis on actigraphically measured slowing in mood disorders. They are associated with lower activity, even in the remitted/euthymic mood-state. Studying objective motor behavior via actigraphy holds promise for informing screening and staging of affective disorders.
精神运动迟缓是抑郁障碍的一个主要特征。尽管它具有重要的临床意义，但在不同的诊断和情绪状态下，其病理生理学和流行程度仍了解甚少。活动记录仪可以客观、无偏地评估身体活动，作为精神运动迟缓的标志物。然而，由于最近的大型系统综述缺失，真实的效果大小仍不清楚。我们根据诊断确定和样本重复的严格纳入和排除标准，对抑郁患者的活动记录仪测量的精神运动迟缓进行了新的荟萃分析。使用结合了心境关键词和活动记录仪关键词的术语，对 Medline/PubMed 和 Web-of-Science 进行了搜索，截至 2021 年 9 月。纳入了至少两组抑郁、缓解或健康参与者，且应用操作性诊断的使用活动记录仪测量 ⩾24 小时的原始研究。排除了患有躯体疾病的患者（N < 10 名参与者/组）和使用消费类设备的研究。使用随机效应模型比较组间的活动水平，并检验了几个调节因素。共有 34 项研究（n = 1804 名患者）被纳入。与对照组相比，患者的活动水平较低[标准化均数差（s.m.d.）=-0.78，95%置信区间（CI）-0.99 至 -0.57]。与对照组相比，无论是在抑郁期（单相障碍：s.m.d.=-0.82，95%CI-1.07 至 -0.56；双相障碍：s.m.d.=-0.94，95%CI-1.41 至 -0.46）还是缓解/良好心境期（单相障碍：s.m.d.=-0.28，95%CI-0.56 至 0.0；双相障碍：s.m.d.=-0.92，95%CI-1.36 至 -0.47），单相和双相障碍患者的活动水平均较低。检验的调节因素均无显著影响。到目前为止，这是对心境障碍患者活动记录仪测量的精神运动迟缓进行的最大荟萃分析。即使在缓解/良好心境期，它们也与较低的活动水平相关。通过活动记录仪研究客观运动行为有望为筛查和分期情感障碍提供信息。
