Kremer Stefanie, Wiesinger Teresa, Bschor Tom, Baethge Christopher
Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Cologne, Cologne, Germany.
Department of Psychiatry and Psychotherapy, Technical University of Dresden, Dresden, Germany.
Psychother Psychosom. 2023;92(5):304-314. doi: 10.1159/000533494. Epub 2023 Sep 19.
Social functioning (SF) is the ability to fulfil one's social obligations and a key outcome in treatment.
The aim of the study was to estimate the effects of antidepressants on SF in patients with major depressive disorder (MDD).
This meta-analysis and its reporting are based on Cochrane Collaboration's Handbook of Systematic Reviews and Meta-Analyses and PRISMA guidelines (protocol registration at OSF). We systematically searched CENTRAL, Medline, PubMed Central, and PsycINFO for double-blind RCTs comparing antidepressants with placebo and reporting on SF. We computed standardized mean differences (SMDs) with 95% CIs and prediction intervals.
We selected 40 RCTs out of 1,188 records screened, including 16,586 patients (mean age 46.8 years, 64.2% women). In 27 studies investigating patients with MDD (primary depression), antidepressants resulted in a SMD of 0.25 compared to placebo ([95% CI: 0.21; 0.30] I2: 39%). In 13 trials with patients suffering from MDD comorbid with physical conditions or disorders, the summary estimate was 0.24 ([0.10; 0.37] I2: 75%). In comorbid depression, studies with high/uncertain risk of bias had higher SMDs than low-risk studies: 0.29 [0.13; 0.44] versus 0.04 [-0.16; 0.24]; no such effect was evident in primary depression. There was no indication of sizeable reporting bias. SF efficacy correlated with efficacy on depression scores, Spearman's rho 0.67 (p < 0.001), and QoL, 0.63 (p < 0.001).
The effect of antidepressants on SF is small, similar to its effect on depressive symptoms in primary MDD, and doubtful in comorbid depression. Strong correlations with both antidepressive and QoL effects suggest overlap among domains.
社会功能（SF）是履行社会义务的能力，也是治疗的关键结果。
本研究旨在评估抗抑郁药对重度抑郁症（MDD）患者社会功能的影响。
本荟萃分析及其报告基于Cochrane协作网的系统评价与荟萃分析手册以及PRISMA指南（在开放科学框架（OSF）进行方案注册）。我们系统检索了Cochrane系统评价数据库（CENTRAL）、医学索引数据库（Medline）、美国国立医学图书馆（NLM）的生物医学期刊文献数据库（PubMed Central）和心理学文摘数据库（PsycINFO），以查找比较抗抑郁药与安慰剂并报告社会功能的双盲随机对照试验（RCT）。我们计算了标准化均数差（SMD）及其95%置信区间（CI）和预测区间。
在筛选的1188条记录中，我们选择了40项RCT，包括16586名患者（平均年龄46.8岁，64.2%为女性）。在27项针对MDD（原发性抑郁症）患者的研究中，与安慰剂相比，抗抑郁药的标准化均数差为0.25（[95%CI：0.21；0.30]，I²：39%）。在13项针对合并身体疾病或障碍的MDD患者的试验中，汇总估计值为0.24（[0.10；0.37]，I²：75%）。在合并抑郁症中，偏倚风险高/不确定的研究的标准化均数差高于低风险研究：分别为0.29[0.13；0.44]和0.04[-0.16；0.24]；在原发性抑郁症中未观察到这种效应。没有明显的发表偏倚迹象。社会功能疗效与抑郁评分疗效相关，Spearman相关系数为0.67（p<0.001），与生活质量（QoL）疗效相关，Spearman相关系数为0.63（p<0.001）。
抗抑郁药对社会功能的影响较小，与对原发性MDD抑郁症状的影响相似，而对合并抑郁症的影响存疑。与抗抑郁和生活质量疗效的强相关性表明各领域之间存在重叠。
