Graf Daniel, Sigrist Christine, Boege Isabel, Cavelti Marialuisa, Koenig Julian, Kaess Michael
University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
BMC Med. 2024 Jun 13;22(1):241. doi: 10.1186/s12916-024-03448-2.
BACKGROUND: Home treatment in child and adolescent psychiatry offers an alternative to conventional inpatient treatment by involving the patient's family, school, and peers more directly in therapy. Although several reviews have summarised existing home treatment programmes, evidence of their effectiveness remains limited and data synthesis is lacking. METHODS: We conducted a meta-analysis on the effectiveness of home treatment compared with inpatient treatment in child and adolescent psychiatry, based on a systematic search of four databases (PubMed, CINAHL, PsychINFO, Embase). Primary outcomes were psychosocial functioning and psychopathology. Additional outcomes included treatment satisfaction, duration, costs, and readmission rates. Group differences were expressed as standardised mean differences (SMD) in change scores. We used three-level random-effects meta-analysis and meta-regression and conducted both superiority and non-inferiority testing. RESULTS: We included 30 studies from 13 non-overlapping samples, providing data from 1795 individuals (mean age: 11.95 ± 2.33 years; 42.5% female). We found no significant differences between home and inpatient treatment for postline psychosocial functioning (SMD = 0.05 [- 0.18; 0.30], p = 0.68, I = 98.0%) and psychopathology (SMD = 0.10 [- 0.17; 0.37], p = 0.44, I = 98.3%). Similar results were observed from follow-up data and non-inferiority testing. Meta-regression showed better outcomes for patient groups with higher levels of psychopathology at baseline and favoured home treatment over inpatient treatment when only randomised controlled trials were considered. CONCLUSIONS: This meta-analysis found no evidence that home treatment is less effective than conventional inpatient treatment, highlighting its potential as an effective alternative in child and adolescent psychiatry. The generalisability of these findings is reduced by limitations in the existing literature, and further research is needed to better understand which patients benefit most from home treatment. TRIAL REGISTRATION: Registered at PROSPERO (CRD42020177558), July 5, 2020.
背景：儿童和青少年精神病学中的家庭治疗通过让患者的家庭、学校和同龄人更直接地参与治疗，为传统住院治疗提供了一种替代方案。尽管已有几项综述总结了现有的家庭治疗项目，但其有效性的证据仍然有限，且缺乏数据综合分析。 方法：我们基于对四个数据库（PubMed、CINAHL、PsychINFO、Embase）的系统检索，对儿童和青少年精神病学中家庭治疗与住院治疗的有效性进行了荟萃分析。主要结局是心理社会功能和精神病理学。其他结局包括治疗满意度、持续时间、成本和再入院率。组间差异以变化分数的标准化平均差异（SMD）表示。我们使用三级随机效应荟萃分析和荟萃回归，并进行了优效性和非劣效性检验。 结果：我们纳入了来自13个不重叠样本的30项研究，提供了1795名个体的数据（平均年龄：11.95±2.33岁；42.5%为女性）。我们发现，家庭治疗和住院治疗在治疗后心理社会功能（SMD = 0.05[-0.18；0.30]，p = 0.68，I = 98.0%）和精神病理学方面没有显著差异（SMD = 0.10[-0.17；0.37]，p = 0.44，I = 98.3%）。随访数据和非劣效性检验也得出了类似结果。荟萃回归显示，基线精神病理学水平较高的患者组结局更好，并且在仅考虑随机对照试验时，家庭治疗优于住院治疗。 结论：这项荟萃分析没有发现证据表明家庭治疗比传统住院治疗效果差，这突出了其作为儿童和青少年精神病学中一种有效替代方案的潜力。现有文献的局限性降低了这些发现的普遍性，需要进一步研究以更好地了解哪些患者从家庭治疗中获益最大。 试验注册：于2020年7月5日在PROSPERO（CRD42020177558）注册。
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