认知行为疗法对老年抑郁症患者干预效果的Meta分析

Effects of cognitive behavioral therapy in elderly patients with depression:a Meta-analysis

目的系统评价认知行为疗法(CBT)对老年抑郁症患者的干预效果。方法检索PubMed、CINHAL、Cochrane Library、中国生物医学文献服务系统、中国知网、万方、维普数据库,收集建库至2022年12月15日发表的有关CBT对老年抑郁症患者影响的随机对照试验。由2名研究者独立筛选文献、提取资料并采用Cochrane随机对照试验偏倚风险工具(ROB 2.0)对纳入研究进行质量评价,采用Stata 16.0软件进行统计分析,采用GRADE profier软件对证据体进行证据质量评级。结果共纳入11篇随机对照试验,共计833例老年抑郁症患者,并对其抑郁水平、焦虑水平、生活质量等结局指标采用随机效应模型合并效应量进行分析。Meta分析及GRADE证据体质量结果显示,与对照组相比,中等质量证据表明CBT能够改善老年抑郁症患者的抑郁水平(SMD=-1.58,95%CI:-2.16~-0.99,P<0.05);低等质量证据表明CBT能够改善老年抑郁症患者的焦虑水平(SMD=-2.25,95%CI:-4.04~-0.47,P<0.05);但极低质量证据表明CBT较常规治疗或药物治疗,对老年抑郁症患者的生活质量改善不明显(SMD=-0.09,95%CI:-2.07~1.88,P>0.05)。结论当前证据表明,CBT能降低老年抑郁症患者抑郁、焦虑水平,但其对生活质量的提高尚不明显,CBT治疗反馈及形式可能成为近年对老年抑郁症患者干预的研究重点。

Objective To systematically evaluate the effect of cognitive behavioral therapy(CBT)in elderly patients with depression.Methods The randomized controlled trials on the effect of CBT in elderly patients with depression,published until December 15,2022,were searched in PubMed,CINHAL,Cochrane Library,China Biology Medicine,China National Knowledge Infrastructure,WanFang Data,and VIP.Two researchers independently screened the literature,extracted data,and used the revised Cochrane risk of bias tool for randomized trials(ROB 2.0)to evaluate the quality of the included studies.Statistical analysis was conducted using Stata 16.0,and the quality of evidence was rated using Appraisal of Guidelines for Research and Evaluation(GRADE)predictor software.Results A total of 11 randomized controlled trials were included,with a total of 833 elderly patients with depression.Randomized effect models were used to analyze outcome indicators such as depression,anxiety,and quality of life by combining effect quantities.Meta-analysis and GRADE evidence quality showed that compared to the control group,medium quality evidence showed that CBT could relieve depression in elderly depression patients with a statistical difference[SMD=-1.58,95%CI(-2.16,-0.99),P<0.05].Low quality evidence suggested that CBT could alleviate anxiety in elderly depression patients also with a statistical difference[SMD=-2.25,95%CI(-4.04,-0.47),P<0.05].Very low quality evidence indicated that CBT did not significantly improve the quality of life in elderly depression patients compared to conventional or pharmacological treatment[SMD=-0.09,95%CI(-2.07,1.88),P>0.05].Conclusions Existing evidence suggests that CBT can alleviate depression and anxiety in elderly depression patients,but its improvement in quality of life is not yet significant.Treatment feedback and forms of CBT may become a research focus in recent years on intervention for elderly depression patients.