团体心理辅导对中国女性围产期抑郁症防治效果的Meta分析

Group psychotherapy for perinatal depression in Chinese women:a meta-analysis

目的系统评价在中国开展的团体心理辅导对围产期抑郁症的防治效果,为促进孕产妇人群心理健康的措施筛选和保障母婴安全的政策制定提供依据。方法在中国知网、万方数据资源系统、维普中文科技期刊数据库、PubMed中检索自建库至2021年11月6日止在中国女性中采用团体心理辅导防治围产期抑郁症的干预研究。由两位研究者独立筛选文献、提取资料和评价质量。采用Stata 15.1软件进行Meta分析,并探讨合并效应的异质性来源和亚组间的差异。结果共纳入12篇文献,研究对象共2022例。合并效应结果显示,团体心理辅导能减轻孕产妇抑郁症状(SMD=-0.54,95%CI:-0.73~-0.36),提升人际关系(SMD=-1.42,95%CI:-1.72~-1.12),改善焦虑症状(SMD=-3.01,95%CI:-5.36~-0.66)。其中,对围产期抑郁症的防治效果,相较于干预结束时(SMD=-0.48,95%CI:-0.84~-0.12)和干预后2个月内(SMD=-0.60,95%CI:-0.89~-0.32),在干预后3个月达到最优(SMD=-0.77,95%CI:-1.07~-0.47),并持续至干预后6个月(SMD=-0.23,95%CI:-0.45~-0.01)。亚组分析发现,高质量研究、线下实施干预、与常规护理为对照的干预效应更好;而不同研究设计、研究对象、干预人员在亚组间的干预效应没有差异。结论团体心理辅导能有效缓解孕产妇的抑郁症状,干预效果至少持续6个月;同时,团体心理辅导对孕产妇的焦虑症状、人际关系也有明显改善,但团体心理辅导对围产期抑郁症的长期防治效果仍待进一步研究。

Objective To systematically evaluate the effect of group psychotherapy in China on the prevention and treatment of perinatal depression,and provide a basis for strategy formulation to promote the mental health of pregnant women and ensure the safety of mothers and children.Methods Intervention studies on group psychotherapy for perinatal depression in Chinese women from Chinese Databases(the China National Knowledge Infrastructure,the Wan Fang,and the VIP)and English Database(PubMed)were systematically searched until November 6,2021.2 researchers independently selected articles,extracted information,and evaluated the quality of the studies.Meta-analyses were performed by using Stata 15.1 software.Sub-group analyses were conducted to explore the sources of heterogeneity and differences.Results 12 studies were included,involving 2022 samples of Meta-analyses showed that group psychotherapy relieved perinatal depressive symptoms(SMD=-0.54,95%CI:-0.73 to-0.36),improved interpersonal relationships(SMD=-1.42,95%CI:-1.72 to-1.12),and released anxiety symptoms(SMD=-3.01,95%CI:-5.36 to-0.66).The pooled effect on perinatal depression at three months after group psychotherapy(SMD=-0.77,95%CI:-1.07 to-0.47)was better than those at the end(SMD=-0.48,95%CI:-0.84 to-0.12)or within two months(SMD=-0.60,95%CI:-0.89 to-0.32)after the intervention.The effect of group psychotherapy lasted for at least six months(SMD=-0.23,95%CI:-0.45 to-0.01).Sub-group analysis found that high-quality studies,offline implementation of interventions,and interventions controlled with routine care were better.However,there were no differences in the intervention effects between subgroups between different study designs,study subjects,and intervention applicators.Conclusion Group psychotherapy effectively relieved perinatal depressive symptoms and lasted for at least 6 months.Meanwhile,it was also influential in releasing anxiety symptoms and improving interpersonal relationships.However,the long-term effect of group psychotherapy on perinatal depression should be studied in future.