贝叶斯网络荟萃分析探讨随机对照试验中的调节因素：在养老院居民中减少抑郁，什么方法对谁有效？
A bayesian network meta-analysis to explore modifying factors in randomized controlled trials: what works for whom to reduce depression in nursing home residents?
机构信息
Department of Primary and Community Care, Radboud University Medical Center, Gelderland, 6500 HBNijmegen, The Netherlands.
Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands.
出版信息
BMC Geriatr. 2024 Jun 14;24(1):518. doi: 10.1186/s12877-024-05117-8.
BACKGROUND
Reviews of depression interventions in nursing home residents resulted in positive findings. However, because of the heterogeneity of the studies, it remains unclear what works for whom. Considering moderator effects may contribute to a comprehensive understanding of depression treatment in residents. Therefore, this study aims to review depression interventions, examining moderator effects of (1) residents' factors, and (2) components specific of interventions.
METHODS
A Bayesian network meta-analysis of randomized controlled trials primarily aimed at reducing depressive symptoms among residents was conducted. First, intervention types, e.g., exercise interventions, were compared to care as usual. Second, meta-regression analyses were conducted for moderator effects of residents' factors (i.e., severity of depressive symptoms, physical dependency, and cognitive impairment) and components identified as specific to an intervention (e.g., music, creativity, positivity).
RESULTS
Our search across six databases resulted in 118 eligible studies: 16 on neurobiological interventions, 102 on non-pharmacological interventions. Compared to care as usual, cognitive interventions, such as cognitive behavioral therapy and goal-oriented therapy, showed the strongest effects (MD = -1.00, 95% CrI [-1.40 to -0.66]). Furthermore, the severity of depressive symptoms moderated the effect of interventions (ƅ = -0.63, CrI 95% [-1.04 to -0.22]), while none of fifteen identified intervention-specific components did. In residents with a depression diagnosis, there were larger effect sizes for interventions including daily structure, psychoeducation, healthy food, creativity, positivity, and an activating/encouraging environment, whereas interventions focusing on distraction and relaxation had larger effect sizes in those residents without.
CONCLUSIONS
By examining the moderator effects, we provided an integrative perspective on the observed variations in effects across different target groups, and components of depression interventions. This approach underscores the complex nature of interventions, emphasizing the need for continued transdisciplinary research, and the exploration of potential moderators. Future investigations should carefully assess residents' factors and choose interventions and their components accordingly.
背景
对疗养院居民进行的抑郁干预措施的综述得出了积极的结果。然而，由于研究的异质性，仍然不清楚对谁有效。考虑到调节因素可能有助于全面了解居民的抑郁治疗。因此，本研究旨在综述抑郁干预措施，检查（1）居民因素和（2）干预措施特定组成部分的调节效应。
方法
对主要旨在降低居民抑郁症状的随机对照试验进行贝叶斯网络荟萃分析。首先，将干预类型（例如，运动干预）与常规护理进行比较。其次，对居民因素（即抑郁症状严重程度、身体依赖性和认知障碍）和被确定为干预措施特定的组成部分（例如音乐、创造力、积极性）的调节效应进行元回归分析。
结果
我们在六个数据库中搜索得到了 118 项合格研究：16 项神经生物学干预研究，102 项非药物干预研究。与常规护理相比，认知干预，如认知行为疗法和目标导向疗法，显示出最强的效果（MD=-1.00，95% CrI[-1.40 至-0.66]）。此外，抑郁症状的严重程度调节了干预措施的效果（ƅ=-0.63，95% CrI[-1.04 至-0.22]），而十五个确定的干预特定组成部分均没有。在有抑郁诊断的居民中，包括日常生活结构、心理教育、健康食品、创造力、积极性和激活/鼓励环境的干预措施的效果大小较大，而在没有抑郁诊断的居民中，注意力分散和放松的干预措施的效果大小较大。
结论
通过检查调节效应，我们对不同目标群体的观察到的效果变化提供了一个综合的视角，并对抑郁干预措施的组成部分进行了检查。这种方法强调了干预措施的复杂性，强调需要继续进行跨学科研究，并探索潜在的调节因素。未来的研究应仔细评估居民的因素，并相应地选择干预措施及其组成部分。
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