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首页> 外文期刊>The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry >A Systematic Review and Meta-analysis of Psychotherapy for Late-Life Depression
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A Systematic Review and Meta-analysis of Psychotherapy for Late-Life Depression

机译：晚期抑郁症心理治疗的系统评价和荟萃分析

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Objectives: To determine the efficacy of psychotherapy in late-life depression and to determine the effect of the type of control group on the magnitude of psychotherapy effects. Design: A systematic review and meta-analysis of randomized controlled psychotherapy trials for late-life depression. Setting: Outpatient clinics or in subjects' home. Participants: Subjects aged 55 years or older with acute-phase depressive disorder. Measurements: Change in depressive symptoms was measured with validated scales. Standardized mean differences (SMD) were calculated for each therapy-control contrast, as meta-analytic summaries for contrasts using a similar control, and for all contrasts combined. Results: The search identified 27 trials with 37 therapy-control contrasts and 2,245 subjects. Trials utilized five types of control groups (waitlist, treatment-as-usual, attention, supportive therapy, placebo). In the combined contrasts, psychotherapy was effective (SMD: 0.73; 95% confidence interval [CI]: 0.51, 0.95; z = 6.42, p < 0.00001). The SMD varied widely (from 0.05 to 1.36) and significantly (chi(2) = 35.67, df = 4, p < 0.00001) between subgroups by type of control. In five trials that compared psychotherapy with supportive therapy, the SMD was 0.39 (95% CI: 0.16, 0.61; z = 3.37, p < 0.0007; I-2 = 0%). The SMD was 0.11 within the waitlist controls and 1.10 within the supportive therapy subgroup. Conclusions: Psychotherapy is effective for late-life depression, but the magnitude of the effect varies widely with the type of control group. Supportive therapy appears to best control for the nonspecific elements of psychotherapy and is associated with considerable change itself, but few trials have utilized it as a control.
机译：目的：确定心理疗法在晚期抑郁症中的疗效，并确定对照组类型对心理疗法效果的影响。设计：针对晚期抑郁症的随机对照心理治疗试验的系统评价和荟萃分析。地点：门诊诊所或对象家中。参与者：55岁或以上的急性期抑郁症患者。测量：用经过验证的量表测量抑郁症状的变化。计算每个治疗-对照对比的标准平均差异（SMD），作为使用相似对照的对比的荟萃分析摘要，以及所有对比的总和。结果：搜索确定了27个试验，其中有37个治疗对照对比和2,245名受试者。试验使用了五种类型的对照组（候补，常规治疗，注意力，支持疗法，安慰剂）。在综合对比中，心理治疗是有效的（SMD：0.73; 95％置信区间[CI]：0.51、0.95; z = 6.42，p <0.00001）。根据控制类型，各亚组之间的SMD差异很大（从0.05到1.36），并且差异很大（chi（2）= 35.67，df = 4，p <0.00001）。在将心理疗法与支持疗法进行比较的五项试验中，SMD为0.39（95％CI：0.16，0.61; z = 3.37，p <0.0007; I-2 = 0％）。在等待清单对照中，SMD为0.11;在支持疗法亚组中，SMD为1.10。结论：心理治疗对晚年抑郁症有效，但影响程度因对照组而异。支持治疗似乎可以最好地控制心理治疗的非特异性因素，并且与自身的巨大变化相关，但是很少有试验将其用作控制手段。

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