亚阈抑郁个体的心理干预：治疗效果及调节因素的个体参与者数据荟萃分析

Psychological intervention in individuals with subthreshold depression: individual participant data meta-analysis of treatment effects and moderators.

作者信息

Harrer Mathias, Sprenger Antonia A, Illing Susan, Adriaanse Marcel C, Albert Steven M, Allart Esther, Almeida Osvaldo P, Basanovic Julian, van Bastelaar Kim M P, Batterham Philip J, Baumeister Harald, Berger Thomas, Blanco Vanessa, Bø Ragnhild, Casten Robin J, Chan Dicken, Christensen Helen, Ciharova Marketa, Cook Lorna, Cornell John, Davis Elysia P, Dobson Keith S, Dozeman Elsien, Gilbody Simon, Hankin Benjamin L, Haringsma Rimke, Hoorelbeke Kristof, Irwin Michael R, Jansen Femke, Jonassen Rune, Karyotaki Eirini, Kawakami Norito, Klein J Philipp, Konnert Candace, Imamura Kotaro, Landrø Nils Inge, Lara María Asunción, Le Huynh-Nhu, Lehr Dirk, Luciano Juan V, Moritz Steffen, Mossey Jana M, Muñoz Ricardo F, Muntingh Anna, Nobis Stephanie, Olmstead Richard, Otero Patricia, Pibernik-Okanović Mirjana, Pot Anne Margriet, Reynolds Charles F, Rovner Barry W, Sanabria-Mazo Juan P, Sander Lasse B, Smit Filip, Snoek Frank J, Spek Viola, Spinhoven Philip, Stelmach Liza, Terhorst Yannik, Vázquez Fernando L, Leeuw Irma Verdonck-de, Watkins Ed, Yang Wenhui, Wong Samuel Yeung Shan, Zimmermann Johannes, Sakata Masatsugu, Furukawa Toshi A, Leucht Stefan, Cuijpers Pim, Buntrock Claudia, Ebert David Daniel

机构信息

Section for Evidence-Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of Medicine and Health, Technical University of Munich, Munich, Germany; and Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.

出版信息

Br J Psychiatry. 2025 May 14:1-14. doi: 10.1192/bjp.2025.56.

DOI:10.1192/bjp.2025.56

PMID:40365980

Abstract

BACKGROUND

It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.

AIMS

To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.

METHOD

Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment-covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.

RESULTS

IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = -0.48 to -0.27). Effects could not be ascertained up to 24 months (s.m.d. = -0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27-2.79), reliable improvement (relative risk = 1.38-3.17), deterioration (relative risk = 0.67-0.54) and close-to-symptom-free status (relative risk = 1.41-2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible ( > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = -0.33 for PHQ-9 = 5).

CONCLUSIONS

Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.

摘要

背景

尚不清楚哪些亚阈值抑郁症患者从心理干预中获益最大，以及这对症状恶化、反应和缓解有何长期影响。

目的

综合心理干预对亚阈值抑郁症成年人长达2年的益处，并探索个体水平的效应修饰因素。

方法

通过系统检索确定将心理干预与无活性对照进行比较的随机试验。联系作者以获取个体参与者数据（IPD），使用贝叶斯单阶段荟萃分析进行分析。添加治疗-协变量相互作用以检查调节因素。使用分层加法模型探索以基线患者健康问卷9（PHQ-9）值为条件的治疗益处。

结果

可纳入10671名个体（50项研究）的IPD。我们发现长达12个月对抑郁症状严重程度有显著影响（标准化均差[s.m.d.] = -0.48至-0.27）。长达24个月时无法确定影响（s.m.d. = -0.18）。对于症状减轻50%（相对风险 = 1.27 - 2.79）、可靠改善（相对风险 = 1.38 - 3.17）、恶化（相对风险 = 0.67 - 0.54）和接近无症状状态（相对风险 = 1.41 - 2.80）也出现了类似的结果。在个体水平的调节因素中，只有初始抑郁和焦虑严重程度具有高度可信度（> 0.99）。预测的治疗益处随着症状严重程度降低而减少，但即使对于非常轻微的症状仍然具有最小的重要性（PHQ-9 = 5时s.m.d. = -0.33）。