Cuijpers Pim, Miguel Clara, Ciharova Marketa, Harrer Mathias, Basic Djordje, Cristea Ioana A, de Ponti Nino, Driessen Ellen, Hamblen Jessica, Larsen Sadie E, Matbouriahi Minoo, Papola Davide, Pauley Darin, Plessen Constantin Y, Pfund Rory A, Setkowski Kim, Schnurr Paula P, van Ballegooijen Wouter, Wang Yingying, Riper Heleen, van Straten Annemieke, Sijbrandij Marit, Furukawa Toshi A, Karyotaki Eirini
Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands.
International Institute for Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania.
World Psychiatry. 2024 Jun;23(2):267-275. doi: 10.1002/wps.21203.
Psychotherapies are first-line treatments for most mental disorders, but their absolute outcomes (i.e., response and remission rates) are not well studied, despite the relevance of such information for health care users, providers and policy makers. We aimed to examine absolute and relative outcomes of psychotherapies across eight mental disorders: major depressive disorder (MDD), social anxiety disorder, panic disorder, generalized anxiety disorder (GAD), specific phobia, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and borderline personality disorder (BPD). We used a series of living systematic reviews included in the Metapsy initiative (www.metapsy.org), with a common strategy for literature search, inclusion of studies and extraction of data, and a common format for the analyses. Literature search was conducted in major bibliographical databases (PubMed, PsycINFO, Embase, and the Cochrane Register of Controlled Trials) up to January 1, 2023. We included randomized controlled trials comparing psychotherapies for any of the eight mental disorders, established by a diagnostic interview, with a control group (waitlist, care-as-usual, or pill placebo). We conducted random-effects model pairwise meta-analyses. The main outcome was the absolute rate of response (at least 50% symptom reduction between baseline and post-test) in the treatment and control conditions. Secondary outcomes included the relative risk (RR) of response, and the number needed to treat (NNT). Random-effects meta-analyses of the included 441 trials (33,881 patients) indicated modest response rates for psychotherapies: 0.42 (95% CI: 0.39-0.45) for MDD; 0.38 (95% CI: 0.33-0.43) for PTSD; 0.38 (95% CI: 0.30-0.47) for OCD; 0.38 (95% CI: 0.33-0.43) for panic disorder; 0.36 (95% CI: 0.30-0.42) for GAD; 0.32 (95% CI: 0.29-0.37) for social anxiety disorder; 0.32 (95% CI: 0.23-0.42) for specific phobia; and 0.24 (95% CI: 0.15-0.36) for BPD. Most sensitivity analyses broadly supported these findings. The RRs were significant for all disorders, except BPD. Our conclusion is that most psychotherapies for the eight mental disorders are effective compared with control conditions, but absolute response rates are modest. More effective treatments and interventions for those not responding to a first-line treatment are needed.
心理治疗是大多数精神障碍的一线治疗方法，但尽管此类信息对医疗保健使用者、提供者和政策制定者具有相关性，但其绝对疗效（即缓解率和治愈率）尚未得到充分研究。我们旨在研究针对八种精神障碍的心理治疗的绝对和相对疗效：重度抑郁症（MDD）、社交焦虑症、恐慌症、广泛性焦虑症（GAD）、特定恐惧症、创伤后应激障碍（PTSD）、强迫症（OCD）和边缘性人格障碍（BPD）。我们使用了一系列纳入Metapsy计划（www.metapsy.org）的实时系统评价，采用了共同的文献检索策略、研究纳入和数据提取方法，以及共同的分析格式。截至2023年1月1日，在主要文献数据库（PubMed、PsycINFO、Embase和Cochrane对照试验注册库）中进行了文献检索。我们纳入了通过诊断访谈确定的、将针对这八种精神障碍中任何一种的心理治疗与对照组（等候名单、常规护理或药物安慰剂）进行比较的随机对照试验。我们进行了随机效应模型的成对荟萃分析。主要结局是治疗组和对照组中达到缓解（基线至测试后症状减轻至少50%）的绝对比率。次要结局包括缓解的相对风险（RR）和治疗所需人数（NNT）。对纳入的441项试验（33881名患者）进行的随机效应荟萃分析表明，心理治疗的缓解率适中：MDD为0.42（95%CI：0.39 - 0.45）；PTSD为0.38（95%CI：0.33 - 0.43）；OCD为0.38（95%CI：0.30 - 0.47）；恐慌症为0.38（95%CI：0.33 - 0.43）；GAD为0.36（95%CI：0.30 - 0.42）；社交焦虑症为0.32（95%CI：0.29 - 0.37）；特定恐惧症为0.32（95%CI：0.23 - 0.42）；BPD为0.24（95%CI：0.15 - 0.36）。大多数敏感性分析广泛支持了这些结果。除BPD外，所有障碍的RR均具有统计学意义。我们的结论是，与对照情况相比，针对这八种精神障碍的大多数心理治疗是有效的，但绝对缓解率适中。需要针对那些对一线治疗无反应的患者开发更有效的治疗方法和干预措施。
