Ko Woolim, Jeong Hyunsuk, Yim Hyeon Woo, Lee Seung-Yup
Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
J Affect Disord. 2025 Apr 1;374:141-149. doi: 10.1016/j.jad.2025.01.012. Epub 2025 Jan 7.
Suicide is a leading cause of preventable death worldwide. While Collaborative Care (CC) effectively treats depression in primary care led by general practitioners, its impact on reducing suicide behavior remains uncertain. Additionally, the optimal intensity and duration of CC interventions are unclear.
This systematic review and meta-analysis aimed to evaluate the effect of CC interventions on suicidal behavior in patients with depression or at risk of suicide in primary care settings.
We searched PubMed, Embase, and Cochrane databases from inception to April 2024. Two researchers independently performed data selection, extraction, and quality assessment. Data were pooled using the odds ratio (OR) and a random-effects model. The main outcome was suicidal behavior, including attempts and ideation. Subgroup analyses assessed the effectiveness of intensity and duration. A meta-analysis was conducted using the R "meta" package, and the protocol was registered with PROSPERO (CRD 42023477655).
From 3696 articles, 10 randomized controlled trials with 20,110 participants were included. CC interventions significantly reduced suicidal behavior compared to controls (pooled OR = 0.66; 95 % CI, 0.46-0.96). High-intensity interventions were particularly effective (pooled OR = 0.56; 95 % CI, 0.40-0.78). However, no significant relationship was found between intervention duration and suicidal behavior. There was no clear evidence of publication bias.
CC interventions can reduce suicidal behavior in primary care settings, especially with high-intensity interventions. However, caution is needed due to study heterogeneity and low quality.
自杀是全球可预防死亡的主要原因。虽然协作护理（CC）在全科医生主导的初级保健中能有效治疗抑郁症，但其对减少自杀行为的影响仍不确定。此外，CC干预的最佳强度和持续时间尚不清楚。
本系统评价和荟萃分析旨在评估CC干预对初级保健环境中抑郁症患者或有自杀风险患者自杀行为的影响。
我们检索了从数据库建立至2024年4月的PubMed、Embase和Cochrane数据库。两名研究人员独立进行数据选择、提取和质量评估。使用比值比（OR）和随机效应模型汇总数据。主要结局是自杀行为，包括自杀未遂和自杀意念。亚组分析评估了强度和持续时间的有效性。使用R语言“meta”包进行荟萃分析，研究方案已在国际前瞻性系统评价注册库（PROSPERO）注册（注册号CRD 42023477655）。
从3696篇文章中，纳入了10项随机对照试验，共20110名参与者。与对照组相比，CC干预显著降低了自杀行为（汇总OR = 0.66；95%CI，0.46 - 0.96）。高强度干预尤其有效（汇总OR = 0.56；95%CI，0.40 - 0.78）。然而，未发现干预持续时间与自杀行为之间存在显著关系。没有明显的发表偏倚证据。
CC干预可减少初级保健环境中的自杀行为，尤其是高强度干预。然而，由于研究的异质性和低质量，仍需谨慎。
