Does Pretreatment Severity Moderate the Efficacy of Psychological Treatment of Adult Outpatient Depression? A Meta-Analysis
Does Pretreatment Severity Moderate the Efficacy of Psychological Treatment of Adult Outpatient Depression? A Meta-Analysis
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DOI：
10.1037/a0020570
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发表时间：
2010-10-01
影响因子：
5.9
通讯作者：
Dekker, Jack J. M.
中科院分区：
文献类型：
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作者：
Driessen, Ellen;Cuijpers, Pim;Dekker, Jack J. M.
目的：目前普遍认为，心理治疗对较重度抑郁症患者的疗效甚微。本研究通过荟萃分析评估了相对于对照组，预处理严重程度是否会调节心理治疗结果。方法：我们纳入了来自研究数据库（www.evidencebasedpsychotherapies.org）的132项研究（10，134名参与者），其中心理治疗对患有抑郁症或抑郁症状水平升高的成年门诊患者的影响与随机对照试验中的对照条件进行了比较。两名评分员独立提取结果数据并对研究特征进行评分。我们进行了荟萃回归分析，评估平均治疗前抑郁评分是否预测心理治疗与对照条件治疗后的效果大小和亚组分析，总结了研究报告的研究内分析抑郁症的严重程度和心理治疗结果的结果。结果：心理治疗组的疗效明显上级对照组（d = 0.40-0.88）。我们没有发现任何迹象表明，预处理平均抑郁评分预测心理治疗与控制条件治疗后的效果大小，即使在调整相关的研究特征。然而，在报告研究内严重程度分析的较小研究子集中，当心理治疗相对于更严格的对照有效时，高严重程度患者（d = 0.63）的治疗后效应量高于低严重程度患者（d = 0.22）。结论：与传统观点相反，我们的研究结果表明，与对照组相比，心理治疗对高严重度患者可能比低严重度患者更有效。由于报告研究内严重程度分析的研究数量很少，我们建议未来的研究定期报告严重程度x治疗相互作用的测试。
Objective: It is widely believed that psychological treatment has little effect on more severely depressed patients. This study assessed whether pretreatment severity moderates psychological treatment outcome relative to controls by means of meta-analyses. Method: We included 132 studies (10,134 participants) from a database of studies (www.evidencebasedpsychotherapies.org) in which the effects of psychological treatment on adult outpatients with a depressive disorder or an elevated level of depressive symptoms were compared with a control condition in a randomized controlled trial. Two raters independently extracted outcome data and rated study characteristics. We conducted metaregression analyses assessing whether mean pretreatment depression scores predicted psychological treatment versus control condition posttreatment effect size and subgroup analyses summarizing the results of studies reporting within-study analyses of depression severity and psychological treatment outcome. Results: Psychological treatment was found to be consistently superior to control conditions (d = 0.40-0.88). We found no indication that pretreatment mean depression scores predicted psychological treatment versus control condition posttreatment effect size, even after adjusting for relevant study characteristics. However, among the smaller subset of studies that reported within-study severity analyses, posttreatment effect sizes were higher for high-severity patients (d = 0.63) than for low-severity patients (d = 0.22) when psychological treatment was efficacious relative to a more stringent control. Conclusion: Contrary to conventional wisdom, our findings suggest that when compared with control conditions, psychological treatment might be more efficacious for high-severity than for low-severity patients. Because the number of studies reporting within-study severity analyses is small, we recommend that future studies routinely report tests for Severity x Treatment interactions.