Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG), Im Mediapark 8, Cologne, 50670, Germany.
Family Therapy Centre (Familientherapeutisches Zentrum gGmbH, FaTZ), Hermann-Walker-Straße 16, 69151, Neckargemünd, Germany.
BMC Psychiatry. 2024 Feb 14;24(1):125. doi: 10.1186/s12888-024-05556-y.
Systemic therapy (ST) is a psychotherapeutic intervention in complex human systems (both psychological and interpersonal). Cognitive behavioural therapy (CBT) is an established treatment for children and adolescents with mental disorders. As methodologically rigorous systematic reviews on ST in this population are lacking, we conducted a systematic review and meta-analysis to compare the benefit and harm of ST (and ST as an add-on to CBT) with CBT in children and adolescents with mental disorders.
We searched MEDLINE, Embase, PsycINFO and other sources for randomised controlled trials in 14 mental disorder classes for the above comparisons in respect of effects on patient-relevant outcomes (search date: 7/2022). Where possible, meta-analyses were performed and results were graded into 3 different evidence categories: "proof", "indication", or "hint" (or none of these categories). PRISMA standards were followed.
Fifteen studies in 5 mental disorder classes with usable data were identified. 2079 patients (mean age: 10 to 19 years) were analysed. 12/15 studies and 29/30 outcomes showed a high risk of bias. In 2 classes, statistically significant and clinically relevant effects in favour of ST were found, supporting the conclusion of a hint of greater benefit of ST for mental and behavioural disorders due to psychoactive substance use and of ST as an add-on to CBT for obsessive-compulsive disorders. In 2 other classes (eating disorders; hyperkinetic disorders), there was no evidence of greater benefit or harm of ST. For affective disorders, a statistically significant effect to the disadvantage of ST was found for 1 outcome, supporting the conclusion of a hint of lesser benefit of ST.
Our results show a hint of greater benefit of ST (or ST as an add-on to CBT) compared with CBT for 2 mental disorder classes in children and adolescents (mental and behavioural disorders due to psychoactive substance use, obsessive compulsive disorders). Given the importance of CBT as a control intervention, ST can therefore be considered a beneficial treatment option for children and adolescents with certain mental disorders. Limitations include an overall high risk of bias of studies and outcomes and a lack of data for several disorders.
系统治疗（ST）是一种针对复杂人类系统（心理和人际）的心理治疗干预措施。认知行为疗法（CBT）是一种针对儿童和青少年精神障碍的既定治疗方法。由于缺乏针对该人群 ST 的系统评价，我们进行了一项系统评价和荟萃分析，以比较 ST（以及 ST 作为 CBT 的附加治疗）与 CBT 对患有精神障碍的儿童和青少年的疗效和安全性。
我们在 14 种精神障碍类别中搜索了 MEDLINE、Embase、PsycINFO 和其他来源的随机对照试验，以比较这些类别中 ST 对患者相关结局的影响（搜索日期：2022 年 7 月）。在可能的情况下，我们进行了荟萃分析，并将结果分为 3 个不同的证据类别：“证据确凿”、“提示”或“无证据”（或不属于这些类别）。我们遵循了 PRISMA 标准。
确定了 15 项来自 5 种精神障碍类别的研究，其中有可用数据。共分析了 2079 名患者（平均年龄：10 至 19 岁）。12/15 项研究和 29/30 项结局显示存在高偏倚风险。在 2 个类别中，发现 ST 的治疗效果具有统计学意义且具有临床相关性，支持 ST 对精神和行为障碍（由于精神活性物质使用所致）和 CBT 附加治疗强迫症具有更大益处的提示性结论。在另外 2 个类别（饮食障碍；多动障碍）中，没有证据表明 ST 具有更大的益处或危害。对于情感障碍，发现 ST 治疗的 1 项结局具有统计学意义的不利影响，支持 ST 益处较小的提示性结论。
我们的结果表明，与 CBT 相比，ST 对儿童和青少年的 2 种精神障碍（由于精神活性物质使用所致的精神和行为障碍、强迫症）具有更大的益处（或 ST 作为 CBT 的附加治疗）。鉴于 CBT 作为对照干预的重要性，因此 ST 可以被视为某些精神障碍儿童和青少年的有益治疗选择。局限性包括研究和结局的总体高偏倚风险以及对多种疾病缺乏数据。
