Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.
Department of Psychology, Chinese University of Hong Kong, Shatin, Hong Kong.
Fam Pract. 2024 Oct 8;41(5):662-679. doi: 10.1093/fampra/cmae036.
Self-help interventions may offer a scalable adjunct to traditional care, but their effectiveness in relapse prevention is not well-established. Objectives: This review aimed to assess their effectiveness in preventing relapses among individuals with mood disorders.
We systematically reviewed the pertinent trial literature in Web of Science, EMBASE, PubMed, PsycINFO, and Cochrane databases until May 2024. Randomized controlled trials that examined the self-help interventions among individuals diagnosed with major depressive disorder (MDD) or bipolar disorder (BD) were included. The random-effects model computed the pooled risk ratios of relapse, with subgroup analyses and meta-regression analyses to explore heterogeneity sources.
Fifteen papers and 16 comparisons of randomized trials involving 2735 patients with mood disorders were eligible for this meta-analysis. Adjunct self-help interventions had a small but significant effect on reducing the relapse rates of major depressive disorder (pooled risk ratio: 0.78, 95% confidence interval (CI): 0.66-0.92, P = 0.0032, NNT = 11), and were marginally better in bipolar disorder (pooled risk ratio: 0.62, 95% CI: 0.40-0.97, P = .0344, NNT = 12), as compared to treatment as usual (TAU). No subgroup difference was found based on intervention components, settings, delivery method, or guidance levels. The average dropout rate for self-help interventions (18.9%) did not significantly differ from TAU dropout rates. The examination of treatment adherence was highly variable, precluding definitive conclusions.
Self-help interventions demonstrate a modest preventative effect on relapse in mood disorders, despite low to very low certainty. Future research is essential to identify which elements of self-help interventions are most effective.
自助干预措施可能为传统治疗提供一种可扩展的辅助手段，但它们在预防复发方面的效果尚未得到充分证实。目的：本综述旨在评估其在预防心境障碍患者复发方面的有效性。
我们系统地检索了 Web of Science、EMBASE、PubMed、PsycINFO 和 Cochrane 数据库中截至 2024 年 5 月的相关试验文献。纳入了评估诊断为重度抑郁症（MDD）或双相情感障碍（BD）患者自助干预措施的随机对照试验。采用随机效应模型计算复发的合并风险比，并进行亚组分析和meta 回归分析以探索异质性来源。
共有 15 篇论文和 16 项随机试验比较纳入了 2735 名心境障碍患者，符合本 meta 分析的纳入标准。辅助自助干预措施对降低 MDD 的复发率有较小但显著的影响（合并风险比：0.78，95%置信区间（CI）：0.66-0.92，P=0.0032，NNH=11），在双相障碍方面效果略优（合并风险比：0.62，95%CI：0.40-0.97，P=0.0344，NNH=12），与常规治疗（TAU）相比。基于干预措施的组成部分、设置、传递方法或指导水平，未发现亚组差异。自助干预措施的平均脱落率（18.9%）与 TAU 的脱落率无显著差异。对治疗依从性的检查差异很大，无法得出明确的结论。
尽管证据质量为低至极低，但自助干预措施对心境障碍的复发有适度的预防作用。未来的研究对于确定自助干预措施中哪些元素最有效至关重要。
