Chan Raffy C F, Chen Ming, Chan Jacqueline L M, Shum David H K, Cao Yuan
Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China.
Department of Social Work and Social Administration, University of Hong Kong, Pokfulam, Hong Kong SAR, China.
Depress Anxiety. 2025 Aug 15;2025:1610909. doi: 10.1155/da/1610909. eCollection 2025.
Recent research has emphasized the continuum of depression, highlighting the significance of early intervention for subclinical depression. However, previous studies often focused on specific populations or lacked comparisons across participants and intervention characteristics in the effectiveness of cognitive behavioral therapy (CBT). This systematic review and meta-analysis (CRD42024498284) aimed to address these gaps by examining the effectiveness of CBT in managing subclinical depression and its potential for preventing the transition to major depression. A comprehensive search across seven databases from inception to March 2025, identified 23 randomized controlled trials (RCTs) involving 5877 participants. Meta-regression, sensitivity analysis, and funnel plots were utilized to assess heterogeneity, publication bias, and study quality. CBT significantly improved subclinical depressive symptoms (at postassessment: = -0.89; 95% confidence interval (CI) = -1.57 to -0.20 and follow-up: = -0.56; 95% CI: -0.93 to -0.18) and anxiety symptoms (at postassessment: = -0.92; 95% CI: -1.84 to -0.00 and follow-up: = -0.70; 95% CI: -1.15 to -0.25), but had no notable impact on quality of life. Meta-regression analysis identified the number of CBT sessions as factors influencing CBT effectiveness in managing depressive symptoms. While there are statistically significant results (RR = 0.62; 95% CI = 0.50-0.77) indicating CBT's preventive efficacy in transitioning from subclinical to major depression, evidences were limited by the self-reporting data. The majority of included studies came from Europe which limited generalizability, and comparisons between different types of CBT, education levels, and CBT components were limited. In general, CBT has been demonstrated to be effective in managing depressive symptoms over time. Additional research, particularly from diverse regions and comparative studies between CBT and alternative treatments, is imperative to overcome the current study's limitations.
近期研究强调了抑郁症的连续性，突出了对亚临床抑郁症进行早期干预的重要性。然而，以往研究往往聚焦于特定人群，或者在认知行为疗法（CBT）有效性方面缺乏对参与者及干预特征的比较。本系统评价和荟萃分析（CRD42024498284）旨在通过研究CBT在管理亚临床抑郁症方面的有效性及其预防向重度抑郁症转变的潜力来填补这些空白。对从起始到2025年3月的七个数据库进行全面检索，识别出23项随机对照试验（RCT），涉及5877名参与者。采用荟萃回归、敏感性分析和漏斗图来评估异质性、发表偏倚和研究质量。CBT显著改善了亚临床抑郁症状（评估后： = -0.89；95%置信区间（CI）= -1.57至-0.20，随访时： = -0.56；95% CI：-0.93至-0.18）和焦虑症状（评估后： = -0.92；95% CI：-1.84至-0.00，随访时： = -0.70；95% CI：-1.15至-0.25），但对生活质量没有显著影响。荟萃回归分析确定CBT疗程数是影响CBT管理抑郁症状有效性的因素。虽然有统计学显著结果（RR = 0.62；95% CI = 0.50 - 0.77）表明CBT在预防从亚临床向重度抑郁症转变方面的疗效，但证据受到自我报告数据的限制。大多数纳入研究来自欧洲，这限制了普遍性，并且不同类型CBT、教育水平和CBT组成部分之间的比较有限。总体而言，随着时间推移，CBT已被证明在管理抑郁症状方面有效。需要更多研究，特别是来自不同地区的研究以及CBT与替代疗法之间的比较研究，以克服当前研究的局限性。
