Zamiri-Miandoab Nasrin, Hassanzade Robab, Mirghafourvand Mojgan
Student Research Committee, School of Nursing and Midwifery, Tabriz University of Medical Science, Tabriz, Iran.
Department of Midwifery, Bonab Branch, Islamic Azad University, Bonab, Iran.
Ann Gen Psychiatry. 2022 Oct 9;21(1):40. doi: 10.1186/s12991-022-00417-y.
The global spread of coronavirus has caused many physical and mental health problems throughout the world. Depression and anxiety are among the issues that people are experiencing abundantly, along with other mental health disorders, during this period. Cognitive behavior therapy (CBT) is one of the approaches that is effective on improving most of the psychological issues including depression and anxiety. The objective of this systematic review and meta-analysis was to assess the effects of CBT on depression and anxiety during COVID-19 pandemic period.
English databases such as Cochrane, PubMed, Google Scholar, Web of Science and Persian databases such as SID, MagIran and IranDoc were searched with a time limit of 2019 to 2022. Two researchers independently evaluated the quality of the entered studies based on Cochrane handbook. Subgroup analysis was conducted separately on the basis of being infected with coronavirus, not being infected with coronavirus, and having a history of depression or anxiety before the intervention and internet-based CBT for depression and anxiety. Meta-analysis results were reported using standardized mean difference (SMD) and 95% confidence interval (95% CI). Heterogeneity of studies was analyzed by means of I index; and in the case of heterogeneity presence, random effects model was used instead of fixed effects model. Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used for evaluating the quality of evidence.
Totally, 2015 articles were analyzed of which 11 articles entered meta-analysis. The overall results of meta-analysis showed that mean score of anxiety in the group receiving CBT was significantly lower than the control group (SMD: - 0.95, 95% CI - 1.29 to - 0.62; P < 0.00001, I = 94%). In addition, mean score of depression in the intervention group was significantly lower than the control group (SMD: - 0.58; 95% CI - 1.00 to - 0.16, P < 0.00001, I = 94%). In addition, the results of subgroup meta-analysis showed that internet-based CBT was effective in reducing of depression (SMD - 0.35; 95% CI - 0.50 to - 0.20; P < 0.00001; I = 0%) and anxiety (SMD - 0.90; 95%CI - 1.47 to - 0.33; P = 0.002; I = 94%). The evidence about the effectiveness of CBT on depression and anxiety compared with control group on the basis of GRADE approach had low quality.
Meta-analysis results showed that CBT reduced the mean scores of anxiety and depression significantly during COVID-19 pandemic period. Due to the low quality of evidence, conducting more randomized controlled trials with rigorous design is suggested. Prospero registration This systematic review has been registered in Prospero (ID: CRD42021277213).
冠状病毒在全球的传播在全世界引发了诸多身心健康问题。在此期间，抑郁和焦虑是人们大量经历的问题，同时还伴有其他心理健康障碍。认知行为疗法（CBT）是对改善包括抑郁和焦虑在内的大多数心理问题有效的方法之一。本系统评价和荟萃分析的目的是评估CBT在新冠疫情期间对抑郁和焦虑的影响。
检索了Cochrane、PubMed、谷歌学术、科学网等英文数据库以及SID、MagIran和IranDoc等波斯文数据库，时间范围为2019年至2022年。两名研究人员根据Cochrane手册独立评估纳入研究的质量。基于是否感染冠状病毒、未感染冠状病毒以及干预前是否有抑郁或焦虑病史和基于互联网的抑郁与焦虑CBT进行了亚组分析。荟萃分析结果采用标准化均数差（SMD）和95%置信区间（95%CI）报告。通过I指数分析研究的异质性；若存在异质性，则使用随机效应模型而非固定效应模型。采用推荐分级评估、制定与评价（GRADE）来评估证据质量。
共分析了2015篇文章，其中11篇纳入荟萃分析。荟萃分析的总体结果显示，接受CBT组的焦虑平均得分显著低于对照组（SMD：-0.95，95%CI -1.29至-0.62；P＜0.00001，I = 94%）。此外，干预组的抑郁平均得分显著低于对照组（SMD：-0.58；95%CI -1.00至-0.16，P＜0.00001，I = 94%）。此外，亚组荟萃分析结果显示，基于互联网的CBT在减轻抑郁（SMD -0.35；95%CI -0.50至-0.20；P＜0.00001；I = 0%）和焦虑（SMD -0.90；95%CI -1.47至-0.33；P = 0.002；I = 94%）方面有效。基于GRADE方法，与对照组相比，CBT对抑郁和焦虑有效性的证据质量较低。
荟萃分析结果表明，在新冠疫情期间，CBT显著降低了焦虑和抑郁的平均得分。由于证据质量较低，建议开展更多设计严谨的随机对照试验。Prospero注册 本系统评价已在Prospero注册（ID：CRD42021277213）。
