Vogel Marie, Ebert Christopher, Gensichen Jochen, Applis Hanna, Hasan Alkomiet, Lochbühler Kirsten
Institute of General Practice and Family Medicine, LMU University Hospital, LMU, Munich, Germany; POKAL - Predictors and Outcomes in Primary Care Depression Care, (DFG - GrK 2621), Munich, Germany; DZPG (German Center for Mental Health), Partner site Munich/Augsburg, Augsburg, Germany.
Institute of General Practice and Family Medicine, LMU University Hospital, LMU, Munich, Germany; POKAL - Predictors and Outcomes in Primary Care Depression Care, (DFG - GrK 2621), Munich, Germany; DZPG (German Center for Mental Health), Partner site Munich/Augsburg, Augsburg, Germany.
Gen Hosp Psychiatry. 2024 Nov-Dec;91:167-179. doi: 10.1016/j.genhosppsych.2024.11.003. Epub 2024 Nov 8.
In primary care, treating common mental disorders according to the ICD or DSM is challenging. A transdiagnostic approach may facilitate the management of mental health problems by treating across psychiatric diagnoses. This meta-analysis aims to identify and compare transdiagnostic interventions delivered in primary care and to determine the effectiveness of these interventions, focusing on common mental disorders.
A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted by searching the databases Medline, Embase, Web of Science, and PsycINFO. Standardized mean differences (SMD) were calculated for the outcomes, and additional subgroup analyses were performed.
From an initial set of 10,618 RCTs, 38 studies were included and retained for data extraction. Transdiagnostic interventions led to a significant reduction in symptoms of depression (SMD: -0.38) and anxiety (SMD: - 0.47). Treatment outcomes for somatoform disorders were not significant (SMD: - 0.22). About half of the interventions were provided by health professionals not specifically trained in psychotherapy; these interventions also proved to be effective (depression: SMD: -0.47; anxiety: -0.39).
This meta-analysis supports the use of transdiagnostic interventions for common mental disorders in primary care. Transdiagnostic interventions carried out by medical and health professionals not specifically trained in psychotherapy are feasible in PC, but emphasis should be placed on adequate training for them.
The protocol for this study is registered with PROSPERO: CRD42024459073, Date of registration: 2024/01/03.
在初级保健中,依据国际疾病分类(ICD)或精神疾病诊断与统计手册(DSM)来治疗常见精神障碍具有挑战性。一种跨诊断方法或许能通过跨越精神疾病诊断来促进心理健康问题的管理。本荟萃分析旨在识别和比较在初级保健中实施的跨诊断干预措施,并确定这些干预措施的有效性,重点关注常见精神障碍。
通过检索Medline、Embase、科学引文索引(Web of Science)和心理学文摘数据库(PsycINFO),对随机对照试验(RCT)进行了系统评价和荟萃分析。计算结局指标的标准化均数差(SMD),并进行额外的亚组分析。
从最初的10618项随机对照试验中,纳入了38项研究并保留用于数据提取。跨诊断干预导致抑郁症状(SMD:-0.38)和焦虑症状(SMD:-0.47)显著减轻。躯体形式障碍的治疗结局不显著(SMD:-0.22)。约一半的干预措施由未接受过心理治疗专门培训的卫生专业人员提供;这些干预措施也被证明是有效的(抑郁:SMD:-0.47;焦虑:-0.39)。
本荟萃分析支持在初级保健中对常见精神障碍使用跨诊断干预措施。由未接受过心理治疗专门培训的医疗卫生专业人员实施的跨诊断干预在初级保健中是可行的,但应强调对他们进行充分培训。
本研究方案已在国际前瞻性系统评价注册库(PROSPERO)注册:CRD42024459073,注册日期:2024年1月3日。