ABSTRACT

Most people with a mental disorder meet criteria for multiple disorders. We conducted a systematic review and meta-analysis of randomized trials comparing psychotherapies for people with depression and comorbid other mental disorders with non-active control conditions. We identified studies through an existing database of randomized trials on psychotherapies for depression. Thirty-five trials (3,157 patients) met inclusion criteria. Twenty-seven of the 41 interventions in the 35 trials (66%) were based on CBT. The overall effect on depression was large (g = 0.65; 95% CI: 0.40 ~ 0.90), with high heterogeneity (I² = 78%; 95% CI: 70 ~ 83). The ten studies in comorbid anxiety showed large effects on depression (g = 0.90; 95% CI: 0.30 ~ 1.51) and anxiety (g = 1.01; 95% CI: 0.28 ~ 1.74). For comorbid insomnia (11 comparisons) a large and significant effect on depression (g = 0.99; 95% CI: 0.16 ~ 1.82) and insomnia (g = 1.38; 95% CI: 0.38 ~ 2.38) were found. For comorbid substance use problems (12 comparisons) effects on depression (g = 0.25; 95% CI: 0.06 ~ 0.43) and on substance use problems (g = 0.25; 95% CI: 0.01 ~ 0.50) were significant. Most effects were no longer significant after adjustment for publication bias and when limited to studies with low risk of bias. Therapies are probably effective in the treatment of depression with comorbid anxiety, insomnia, and substance use problems.

摘要

大多数精神障碍患者符合多种障碍的标准。我们对随机试验进行了系统回顾和荟萃分析，这些试验比较了抑郁症患者和其他精神障碍患者的心理治疗与非主动控制条件。我们通过现有的抑郁症心理治疗随机试验数据库确定了研究。三十五项试验（3,157 名患者）符合纳入标准。35 项试验的 41 项干预措施中有 27 项 (66%) 基于 CBT。对抑郁症的总体影响较大（g = 0.65；95% CI：0.40 ~ 0.90），异质性高（I ² = 78%；95% 置信区间：70 ~ 83)。共病焦虑的十项研究显示对抑郁症（g = 0.90；95% CI：0.30 ~ 1.51）和焦虑症（g = 1.01；95% CI：0.28 ~ 1.74）有很大影响。对于共病失眠（11 项比较），发现对抑郁症（g = 0.99；95% CI：0.16 ~ 1.82）和失眠（g = 1.38；95% CI：0.38 ~ 2.38）有很大且显着的影响。对于合并物质使用问题（12 项比较），对抑郁症（g = 0.25；95% CI：0.06 ~ 0.43）和物质使用问题（g = 0.25；95% CI：0.01 ~ 0.50）的影响是显着的。大多数影响在调整发表偏倚后不再显着，并且仅限于低偏倚风险的研究。疗法可能对治疗伴有焦虑、失眠和物质使用问题的抑郁症有效。