Yisma Engida, Walsh Sandra, Hillier Susan, Gillam Marianne, Gray Richard, Jones Martin
Department of Rural Health, University of South Australia, Allied Health & Human Performance, Australia; and IIMPACT in Health, University of South Australia, Australia.
IIMPACT in Health, University of South Australia, Australia.
BJPsych Open. 2024 Jul 30;10(5):e134. doi: 10.1192/bjo.2024.721.
Previous research showed that behavioural activation is as effective as cognitive-behavioural therapy for general depression. However, it remains unclear if it leads to greater improvement in depressive symptoms when compared with standard treatment for post-stroke depression.
To compare the effectiveness of behavioural activation against control conditions in reducing depression symptoms in individuals with post-stroke depression.
This review searched five databases from inception until 13 July 2021 (updated 15 September 2023) for randomised controlled trials comparing behavioural activation and any control conditions for post-stroke depression. Risk of bias was assessed with the Cochrane Collaboration's Risk-of-Bias 2 tool. The primary outcome was improvement in depressive symptoms in individuals with post-stroke depression. We calculated a random-effects, inverse variance weighting meta-analysis.
Of 922 initial studies, five randomised controlled trials with 425 participants met the inclusion criteria. Meta-analysis showed that behavioural activation was associated with reduced depressive symptoms in individuals with post-stroke depression at 6-month follow-up (Hedges' -0.39; 95% CI -0.64 to -0.14). The risk of bias was low for two (40%) of five trials, and the remaining three (60%) trials were rated as having a high risk of bias. Heterogeneity was low, with no indication of inconsistency.
Evidence from this review was too little to confirm the effectiveness of behavioural activation as a useful treatment for post-stroke depression when compared with control conditions. Further high-quality studies are needed to conclusively establish the efficacy of behavioural activation as a treatment option for post-stroke depression.
先前的研究表明，行为激活疗法在治疗一般性抑郁症方面与认知行为疗法效果相当。然而，与中风后抑郁症的标准治疗方法相比，行为激活疗法是否能更有效地改善抑郁症状仍不明确。
比较行为激活疗法与对照疗法在减轻中风后抑郁症患者抑郁症状方面的有效性。
本综述检索了五个数据库，检索时间从数据库建立至2021年7月13日（2023年9月15日更新），以查找比较行为激活疗法与中风后抑郁症任何对照疗法的随机对照试验。使用Cochrane协作网的偏倚风险2工具评估偏倚风险。主要结局是中风后抑郁症患者抑郁症状的改善情况。我们进行了随机效应、逆方差加权荟萃分析。
在922项初始研究中，五项随机对照试验（共425名参与者）符合纳入标准。荟萃分析表明，在6个月的随访中，行为激活疗法与中风后抑郁症患者抑郁症状的减轻相关（Hedges' -0.39；95%置信区间 -0.64至 -0.14）。五项试验中有两项（40%）偏倚风险较低，其余三项（60%）试验被评为具有高偏倚风险。异质性较低，没有不一致的迹象。
本综述的证据太少，无法证实与对照疗法相比，行为激活疗法作为中风后抑郁症的有效治疗方法的有效性。需要进一步的高质量研究来最终确定行为激活疗法作为中风后抑郁症治疗选择的疗效。
