Gandy Milena, Woldhuis Thomas, Wu Wendy, Youssef Marette, Bisby Madelyne A, Dear Blake F, Heriseanu Andreea I, Scott Amelia J
School of Psychological Sciences, Macquarie University, Sydney, Australia.
Psychol Med. 2024 Sep 25;54(12):1-14. doi: 10.1017/S0033291724001995.
We examined the efficacy of cognitive and behavioral interventions for improving symptoms of depression and anxiety in adults with neurological disorders. A pre-registered systematic search of Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, Embase, and Neurobite was performed from inception to May 2024. Randomized controlled trials (RCTs) which examined the efficacy of cognitive and behavioral interventions in treating depression and/or anxiety among adults with neurological disorders were included. Estimates were pooled using a random-effects meta-analysis. Subgroup analyses and meta-regression were performed on categorical and continuous moderators, respectively. Main outcomes were pre- and post-intervention depression and anxiety symptom scores, as reported using standardized measures. Fifty-four RCTs involving 5372 participants with 11 neurological disorders (including multiple sclerosis, epilepsy, stroke) were included. The overall effect of interventions yielded significant improvements in both depression (57 arms, Hedges' = 0.45, 95% confidence interval [CI] 0.35-0.54) and anxiety symptoms (29 arms, = 0.38, 95% CI 0.29-0.48), compared to controls. Efficacy was greater in studies which employed a minimum baseline symptom severity inclusion criterion for both outcomes, and greater in trials using inactive controls for depression only. There was also evidence of differential efficacy of interventions across the neurological disorder types and the outcome measure used. Risk of bias, intervention delivery mode, intervention tailoring for neurological disorders, sample size, and study year did not moderate effects. Cognitive and behavioral interventions yield small-to-moderate improvements in symptoms of both depression and anxiety in adults with a range of neurological disorders.
我们研究了认知和行为干预对改善患有神经系统疾病的成年人抑郁和焦虑症状的疗效。从创刊至2024年5月，我们对Cochrane对照试验中央注册库、MEDLINE、PsycINFO、Embase和Neurobite进行了预先注册的系统检索。纳入了检验认知和行为干预对患有神经系统疾病的成年人治疗抑郁和/或焦虑疗效的随机对照试验（RCT）。使用随机效应荟萃分析汇总估计值。分别对分类和连续调节因素进行亚组分析和荟萃回归。主要结局是干预前后使用标准化测量方法报告的抑郁和焦虑症状评分。纳入了54项RCT，涉及5372名患有11种神经系统疾病（包括多发性硬化症、癫痫、中风）的参与者。与对照组相比，干预的总体效果在抑郁（57个研究组，Hedges' = 0.45，95%置信区间[CI] 0.35 - 0.54）和焦虑症状（29个研究组， = 0.38，95% CI 0.29 - 0.48）方面均产生了显著改善。在对两种结局均采用最低基线症状严重程度纳入标准的研究中，疗效更佳；在仅针对抑郁使用无活性对照的试验中，疗效也更佳。也有证据表明，干预在不同神经系统疾病类型和所使用的结局测量方法上存在疗效差异。偏倚风险、干预实施模式、针对神经系统疾病的干预调整、样本量和研究年份并未调节效应。认知和行为干预对患有一系列神经系统疾病的成年人的抑郁和焦虑症状均产生了小到中等程度的改善。
