Psychotherapies are first‐line treatments for most mental disorders, but their absolute outcomes (i.e., response and remission rates) are not well studied, despite the relevance of such information for health care users, providers and policy makers. We aimed to examine absolute and relative outcomes of psychotherapies across eight mental disorders: major depressive disorder (MDD), social anxiety disorder, panic disorder, generalized anxiety disorder (GAD), specific phobia, post‐traumatic stress disorder (PTSD), obsessive‐compulsive disorder (OCD), and borderline personality disorder (BPD). We used a series of living systematic reviews included in the Metapsy initiative (www.metapsy.org), with a common strategy for literature search, inclusion of studies and extraction of data, and a common format for the analyses. Literature search was conducted in major bibliographical databases (PubMed, PsycINFO, Embase, and the Cochrane Register of Controlled Trials) up to January 1, 2023. We included randomized controlled trials comparing psychotherapies for any of the eight mental disorders, established by a diagnostic interview, with a control group (waitlist, care‐as‐usual, or pill placebo). We conducted random‐effects model pairwise meta‐analyses. The main outcome was the absolute rate of response (at least 50% symptom reduction between baseline and post‐test) in the treatment and control conditions. Secondary outcomes included the relative risk (RR) of response, and the number needed to treat (NNT). Random‐effects meta‐analyses of the included 441 trials (33,881 patients) indicated modest response rates for psychotherapies: 0.42 (95% CI: 0.39‐0.45) for MDD; 0.38 (95% CI: 0.33‐0.43) for PTSD; 0.38 (95% CI: 0.30‐0.47) for OCD; 0.38 (95% CI: 0.33‐0.43) for panic disorder; 0.36 (95% CI: 0.30‐0.42) for GAD; 0.32 (95% CI: 0.29‐0.37) for social anxiety disorder; 0.32 (95% CI: 0.23‐0.42) for specific phobia; and 0.24 (95% CI: 0.15‐0.36) for BPD. Most sensitivity analyses broadly supported these findings. The RRs were significant for all disorders, except BPD. Our conclusion is that most psychotherapies for the eight mental disorders are effective compared with control conditions, but absolute response rates are modest. More effective treatments and interventions for those not responding to a first‐line treatment are needed.

中文翻译：

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八种精神障碍心理治疗的绝对和相对结果：系统评价和荟萃分析


心理治疗是大多数精神障碍的一线治疗方法，但其绝对结果（即缓解率和缓解率）尚未得到充分研究，尽管此类信息对于医疗保健使用者、提供者和政策制定者具有相关性。我们的目的是检查心理治疗在八种精神障碍中的绝对和相对结果：重度抑郁症（MDD）、社交焦虑症、恐慌症、广泛性焦虑症（GAD）、特定恐惧症、创伤后应激障碍（PTSD）、强迫症强迫症（OCD）和边缘性人格障碍（BPD）。我们使用了 Metapsy 计划中包含的一系列实时系统评价（ www.metapsy.org ），具有文献检索、研究纳入和数据提取的通用策略以及分析的通用格式。截至 2023 年 1 月 1 日，在主要书目数据库（PubMed、PsycINFO、Embase 和 Cochrane 对照试验注册库）中进行了文献检索。我们纳入了通过诊断访谈建立的比较针对八种精神障碍中任何一种的心理治疗的随机对照试验，与对照组（候补组、照常护理组或安慰剂安慰剂组）。我们进行了随机效应模型成对荟萃分析。主要结果是治疗和对照条件下的绝对缓解率（基线和测试后症状减少至少 50%）。次要结局包括缓解的相对风险（RR）和需要治疗的人数（NNT）。纳入的 441 项试验（33,881 名患者）的随机效应荟萃分析表明，心理治疗的缓解率适中：MDD 为 0.42（95% CI：0.39-0.45）； PTSD 为 0.38（95% CI：0.33-0.43）；强迫症为 0.38（95% CI：0.30-0.47）； 0.38（95% CI：0.33-0。43）恐慌症； GAD 为 0.36（95% CI：0.30-0.42）；社交焦虑障碍为 0.32 (95% CI: 0.29‐0.37)；特定恐惧症为 0.32 (95% CI: 0.23-0.42)； BPD 为 0.24（95% CI：0.15-0.36）。大多数敏感性分析广泛支持这些发现。除 BPD 外，所有疾病的 RR 均显着。我们的结论是，与对照条件相比，大多数针对八种精神障碍的心理治疗是有效的，但绝对缓解率较低。对于那些对一线治疗没有反应的人，需要更有效的治疗和干预措施。