心理治疗老年抑郁症疗效的系统评价

Psychotherapy for Depression in Older Patients:A Systematic Review

目的系统评价心理治疗对老年抑郁症的疗效。方法检索Cochrane图书馆临床对照试验资料库(1990～2007.8)、MEDLINE(1966～2007.8)、EMbase(1980～2007.8)、CBMdisc(1990～2007.8)中所有心理治疗老年抑郁症的随机对照试验(RCT),根据纳入和排除标准筛选文献、提取资料和进行质量评价,并用RevMan4.2软件对数据进行Meta分析。结果共纳入10个RCT。与空白对照比较,Meta分析显示心理治疗在减少抑郁评分方面有效[SMD=–0.63,95%CI(–0.84,–0.42)]。亚组分析显示认知行为治疗、怀旧治疗和一般心理治疗均优于空白对照[SMD=–0.70,95%CI(–1.12,–0.27);SMD=–0.54,95%CI(–0.81,–0.26),SMD=–0.84,95%CI(–1.34,–0.34)]。然而心理治疗作为一种辅助治疗并不能明显增加抗抑郁药物的疗效[SMD=–0.35,95%C(I–0.74,0.05)]。在改善抑郁症状方面认知行为治疗与怀旧治疗没有差别[SMD=0.13,95%CI(–0.30,0.56)]。使用心理治疗组与未使用心理治疗组的失访率差异无统计学意义[RR=1.03,95%CI(0.55,1.94)]。结论各种形式的心理治疗对老年抑郁症的治疗都有效。但是作为抗抑郁药物的一种辅助治疗,心理治疗并不能够增加抗抑郁药物的疗效。

Objective To assess the effectiveness of psychotherapy for depression in older patients. Methods We searched the Cochrane Central Register of Controlled Trials （1990 to August 2007）, MEDLINE （1966 to August 2007）, EMbase （1980 to August 2007）, and CMB-disk （1990 to August 2007） to collect randomized controlled trials （RCTs） in which psychotherapy was used to treat depression in older patients. We screened the retrieved studies according to the predefined inclusion and exclusion criteria, evaluated the quality of included studies, and performed meta-analyses by using The Cochrane Collaboration＇s RevMan 4.2 software. Results Ten RCTs were included. Compared with placebo, psychotherapy was more effective in decreasing depression score （SMD 0.63, 95%CI -0.84 to -0.42）. Subgroup analysis showed that cognitive-behavioral therapy, reminiscence therapy, and general psychological therapy were more effective than placebo （SMD -0.70, 95%CI -1.12 to -0.27; SMD -0.54, 95%CI -0.81 to -0.26; SMD -0.84, 95%CI -1.34 to -0.34, respectively）. However, psychotherapy as an adjunct treatment could not significantly improve the effectiveness of antidepressant medication （SMD -0.35, 95%CI -0.74 to 0.05）. There was no significant difference between cognitive-behavioral therapy and reminiscence therapy in improving depression symptoms （SMD 0.13, 95%CI -0.30 to 0.56）. The dropout rate was similar between patients treated with or without psychotherapy （RR 1.03, 95%CI 0.55 to 1.94）. Conclusion Various kinds of psychotherapy are effective for depression in older patients. But psychotherapy as an adjunct treatment could not significantly improve the effectiveness of antidepressant medication.