Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America.
Centre for Evidence and Implementation, London, United Kingdom.
PLoS One. 2023 Aug 29;18(8):e0285949. doi: 10.1371/journal.pone.0285949. eCollection 2023.
Problem-solving (PS) has been identified as a therapeutic technique found in multiple evidence-based treatments for depression. To further understand for whom and how this intervention works, we undertook a systematic review of the evidence for PS's effectiveness in preventing and treating depression among adolescents and young adults. We searched electronic databases (PsycINFO, Medline, and Cochrane Library) for studies published between 2000 and 2022. Studies meeting the following criteria were included: (a) the intervention was described by authors as a PS intervention or including PS; (b) the intervention was used to treat or prevent depression; (c) mean or median age between 13-25 years; (d) at least one depression outcome was reported. Risk of bias of included studies was assessed using the Cochrane Risk of Bias 2.0 tool. A narrative synthesis was undertaken given the high level of heterogeneity in study variables. Twenty-five out of 874 studies met inclusion criteria. The interventions studied were heterogeneous in population, intervention, modality, comparison condition, study design, and outcome. Twelve studies focused purely on PS; 13 used PS as part of a more comprehensive intervention. Eleven studies found positive effects in reducing depressive symptoms and two in reducing suicidality. There was little evidence that the intervention impacted PS skills or that PS skills acted as a mediator or moderator of effects on depression. There is mixed evidence about the effectiveness of PS as a prevention and treatment of depression among AYA. Our findings indicate that pure PS interventions to treat clinical depression have the strongest evidence, while pure PS interventions used to prevent or treat sub-clinical depression and PS as part of a more comprehensive intervention show mixed results. Possible explanations for limited effectiveness are discussed, including missing outcome bias, variability in quality, dosage, and fidelity monitoring; small sample sizes and short follow-up periods.
问题解决 (PS) 已被确定为多种基于证据的抑郁症治疗方法中的一种治疗技术。为了进一步了解该干预措施对哪些人有效以及如何发挥作用，我们对 PS 在预防和治疗青少年和年轻成年人抑郁症方面的有效性进行了系统评价。我们在电子数据库（PsycINFO、Medline 和 Cochrane Library）中搜索了 2000 年至 2022 年期间发表的研究。符合以下标准的研究被纳入：(a) 作者将干预描述为 PS 干预或包括 PS；(b) 干预用于治疗或预防抑郁症；(c) 平均或中位数年龄在 13-25 岁之间；(d) 报告了至少一个抑郁结果。使用 Cochrane 偏倚风险 2.0 工具评估纳入研究的偏倚风险。由于研究变量的高度异质性，进行了叙述性综合分析。25 项研究符合纳入标准。所研究的干预措施在人群、干预措施、方式、对照条件、研究设计和结果方面存在差异。12 项研究纯粹关注 PS；13 项研究将 PS 作为更全面干预的一部分。11 项研究发现 PS 可降低抑郁症状，两项研究发现 PS 可降低自杀意念。几乎没有证据表明干预措施会影响 PS 技能，或者 PS 技能是对抑郁影响的中介或调节因素。PS 作为 AYA 抑郁预防和治疗的有效性存在混合证据。我们的研究结果表明，治疗临床抑郁症的纯 PS 干预措施具有最强的证据，而用于预防或治疗亚临床抑郁症的纯 PS 干预措施以及 PS 作为更全面干预措施的一部分显示出混合结果。讨论了可能导致干预效果有限的原因，包括缺失结果偏差、质量、剂量和保真度监测的变异性；样本量小和随访时间短。
