裸盖菇素疗法对患有精神疾病诊断的人群自杀意念、自杀未遂及自杀死亡的影响：一项系统评价与荟萃分析。
Effect of psilocybin therapy on suicidal ideation, attempts, and deaths in people with psychiatric diagnoses: a systematic review and meta-analysis.
作者信息
Wong Stanley, Meckling Gray, Fabiano Nicholas, Lee Sanghun, Jones Brett D M, Shorr Risa, Dargel Aroldo, Davis Alan K, Fiedorowicz Jess G, Solmi Marco, Rosenblat Joshua D, Mulsant Benoit H, Blumberger Daniel M, Husain Muhammad Ishrat
机构信息
Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada.
Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
出版信息
Ther Adv Psychopharmacol. 2025 Sep 7;15:20451253251372449. doi: 10.1177/20451253251372449. eCollection 2025.
BACKGROUND
Suicidal ideation, attempts, and deaths present a major and tragic public health concern. Recent trials of psilocybin therapy (PT) have shown promise in treating treatment-resistant depression and have found a reduction in suicidal ideation. Given the growth of PT research, there is a need to further understand its effect on suicidal ideation, attempts, and deaths.
OBJECTIVE
To assess and synthesize evidence on the effects of PT on suicidal ideation, attempts, and deaths in psychiatric patients.
DESIGN
PRISMA-compliant systematic review and meta-analysis.
DATA SOURCE
MEDLINE, EMBASE, Cochrane, and PsychINFO.
METHOD
Databases were searched for randomized controlled trials of PT in adults with psychiatric diagnoses that reported suicide outcomes (ideation, attempts, and deaths). Abstract and full-text screening were conducted, and suicide outcomes were extracted. Meta-analysis was performed with a random effects model to assess changes in suicide outcomes compared to control through the standardized mean difference (SMD). Assessment of heterogeneity, risk of bias, and subgroup analysis was completed.
RESULTS
Nine studies were included ( = 593; 335 psilocybin & 258 control). Two studies were excluded from meta-analysis because suicide-related outcomes data were not available. Participants with PT experienced a small and significant decrease in suicidal ideation compared to control ( = 7, SMD = -0.24, 95% CI -0.42 to -0.06, = 0.008, = 0%). There was no publication bias found. Subgroup analysis found no significant differences between groups. No study reported suicide attempts or suicide deaths. Two studies had a high risk of bias.
CONCLUSION
Psilocybin therapy may reduce suicidal ideation in adults with psychiatric diagnoses. Current studies are limited by small sample size, lack of follow-up data, and assessment of blinding.
TRIAL REGISTRATION
CRD42023445706.
背景
自杀意念、自杀未遂及自杀死亡是重大且悲惨的公共卫生问题。近期的裸盖菇素疗法（PT）试验显示，该疗法在治疗难治性抑郁症方面颇具前景，且发现可减少自杀意念。鉴于PT研究的不断发展，有必要进一步了解其对自杀意念、自杀未遂及自杀死亡的影响。
目的
评估并综合关于PT对精神科患者自杀意念、自杀未遂及自杀死亡影响的证据。
设计
遵循PRISMA的系统评价和荟萃分析。
数据来源
MEDLINE、EMBASE、Cochrane和PsychINFO。
方法
在数据库中检索针对患有精神疾病诊断的成年人进行的PT随机对照试验，这些试验报告了自杀结局（意念、未遂及死亡）。进行摘要和全文筛选，并提取自杀结局。采用随机效应模型进行荟萃分析，通过标准化均值差（SMD）评估与对照组相比自杀结局的变化。完成异质性评估、偏倚风险评估及亚组分析。
结果
纳入9项研究（n = 593；335例接受裸盖菇素治疗，258例为对照组）。两项研究因无法获取与自杀相关的结局数据而被排除在荟萃分析之外。与对照组相比，接受PT治疗的参与者自杀意念有小幅但显著的下降（n = 7，SMD = -0.24，95% CI -0.42至-0.06，p = 0.008，I² = 0%）。未发现发表偏倚。亚组分析未发现组间存在显著差异。没有研究报告自杀未遂或自杀死亡情况。两项研究存在高偏倚风险。
结论
裸盖菇素疗法可能会降低患有精神疾病诊断的成年人的自杀意念。当前研究受样本量小、缺乏随访数据及盲法评估的限制。
试验注册号
CRD42023445706。
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