Different Types and Acceptability of Psychotherapies for Acute Anxiety Disorders in Children and Adolescents: A Network Meta-analysis.
Different Types and Acceptability of Psychotherapies for Acute Anxiety Disorders in Children and Adolescents: A Network Meta-analysis.
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儿童和青少年急性焦虑症心理治疗的不同类型和可接受性网络荟萃分析
DOI：
10.1001/jamapsychiatry.2018.3070
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发表时间：
2019-01-01
期刊：
影响因子：
25.8
通讯作者：
Xie P
中科院分区：
文献类型：
--
作者：
Zhou X;Zhang Y;Furukawa TA;Cuijpers P;Pu J;Weisz JR;Yang L;Hetrick SE;Del Giovane C;Cohen D;James AC;Yuan S;Whittington C;Jiang X;Teng T;Cipriani A;Xie P
就疗效和可接受性而言，儿童和青少年焦虑症的最佳心理治疗方法是什么？该网络荟萃分析包括101项独特的试验，6625名独特的参与者接受了11种不同的心理治疗和4种对照条件。在治疗后和短期随访中，只有群体认知行为疗法在减轻焦虑症状方面明显比其他心理疗法和所有对照条件更有效。团体认知行为治疗可能是儿童和青少年焦虑症的首选心理治疗方法，在未来的研究中，将重点放在疾病特异性心理治疗和治疗效果调节因子的确定上。这个网络荟萃分析比较和排名不同类型的心理治疗和不同的方式提供心理治疗焦虑症的儿童和青少年。焦虑症在儿童和青少年中很常见，对于这一人群的最佳心理治疗策略仍然存在不确定性。比较不同类型的心理治疗方法和不同的心理治疗方式对儿童和青少年焦虑症的治疗效果。检索了PubMed、Cochrane中央对照试验注册库、EMBASE、PsycINFO、Web of Science、CINAHL（护理和相关健康文献累积索引）、ProQuest博士论文、LILACS （Literatura Latino Americana em Ciências da Saúde）、国际试验注册库和美国食品和药物管理局的报告，检索时间为2017年11月30日。选择随机临床试验，将任何结构化心理治疗与另一种心理治疗或儿童和青少年焦虑症的对照条件进行比较。四名研究人员独立进行数据提取和质量评估。采用随机效应模型中的两两元分析和贝叶斯网络元分析进行数据综合。测量治疗后和随访时的疗效（焦虑症状的改变）、可接受性（全因停药）、生活质量和功能改善。使用建议分级评估、发展和评估框架评估证据的确定性。共有101项独特的试验，包括6625名独特的参与者，比较了11种不同的心理疗法和4种特定的对照条件。在大多数比较中，证据的确定性被评为低或非常低。就疗效而言，大多数心理疗法显著优于治疗后的等候名单条件（标准化平均差异[SMD]， - 1.43至- 0.61）和最长随访时间（SMD, - 1.84至- 1.64）。然而，只有群体认知行为疗法（CBT）显著优于其他心理疗法和治疗后的所有对照条件。在可接受性方面，阅读治疗CBT比一些心理治疗和对照条件有更多的全因中断（优势比范围，2.48-9.32）。在生活质量和功能改善方面，CBT（以不同方式提供）与心理安慰剂和等候名单条件相比显着有益（SMDs， 0.73至1.99）。基于这些发现，团体CBT将是治疗儿童和青少年焦虑症的更合适的选择。其他类型的心理治疗和提供心理治疗的不同方式可以作为替代选择。特异性焦虑障碍、障碍特异性心理治疗和治疗效果调节因子有待进一步研究。普洛斯彼罗标识符：CRD42015016283
What is the best psychotherapeutic approach for anxiety disorders in children and adolescents in terms of efficacy and acceptability? This network meta-analysis included 101 unique trials with 6625 unique participants who received 11 different psychotherapies and 4 control conditions. Only group cognitive behavioral therapy was significantly more effective in reducing anxiety symptoms than other psychotherapies and all control conditions posttreatment and at short-term follow-up. Group cognitive behavioral therapy may be the initial choice of psychotherapy for anxiety disorders in children and adolescents, after replication in future research with focus on disorder-specific psychotherapies and identification of moderators of treatment effect. This network meta-analysis compares and ranks the different types of psychotherapies and the different ways of delivering psychological treatments for anxiety disorders in children and adolescents. Anxiety disorders are common in children and adolescents, and uncertainty remains regarding the optimal strategy of psychotherapies in this population. To compare and rank the different types of psychotherapies and the different ways of delivering psychological treatments for anxiety disorders in children and adolescents. PubMed, Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ProQuest Dissertations, LILACS (Literatura Latino Americana em Ciências da Saúde), international trial registers, and US Food and Drug Administration reports were searched from inception to November 30, 2017. Randomized clinical trials that compared any structured psychotherapy with another psychotherapy or a control condition for anxiety disorders in children and adolescents were selected. Four researchers independently performed data extraction and quality assessment. Pairwise meta-analyses and Bayesian network meta-analysis within the random-effects model were used to synthesize data. Efficacy (change in anxiety symptoms) posttreatment and at follow-up, acceptability (all-cause discontinuation), and quality of life and functional improvement were measured. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. A total of 101 unique trials including 6625 unique participants compared 11 different psychotherapies with 4 specific control conditions. The certainty of evidence was rated as low or very low for most comparisons. For efficacy, most psychotherapies were significantly more effective than the wait list condition posttreatment (standardized mean difference [SMD], −1.43 to −0.61) and at the longest follow-up (SMD, −1.84 to −1.64). However, only group cognitive behavioral therapy (CBT) was significantly more effective than the other psychotherapies and all control conditions posttreatment. For acceptability, bibliotherapy CBT had significantly more all-cause discontinuations than some psychotherapies and control conditions (range of odds ratios, 2.48-9.32). In terms of quality of life and functional improvement, CBT (delivered in different ways) was significantly beneficial compared with psychological placebo and the wait list condition (SMDs, 0.73 to 1.99). Group CBT would be the more appropriate choice of psychotherapy for anxiety disorders in children and adolescents, based on these findings. Other types of psychotherapies and different ways of delivering psychological treatment can be alternative options. Further research is needed to explore specific anxiety disorders, disorder-specific psychotherapy, and moderators of treatment effect. PROSPERO Identifier: CRD42015016283
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DSM-5 的青少年焦虑测量 (YAM-5)：用于评估儿童和青少年焦虑症症状的新量表的开发和第一个心理测量证据。
影响因子：
2.9
作者：
Muris P;Simon E;Lijphart H;Bos A;Hale W 3rd;Schmeitz K;International Child and Adolescent Anxiety Assessment Expert Group (ICAAAEG)
通讯作者：
International Child and Adolescent Anxiety Assessment Expert Group (ICAAAEG)
影响因子：
3.7
作者：
Ebert DD;Zarski AC;Christensen H;Stikkelbroek Y;Cuijpers P;Berking M;Riper H
通讯作者：
Riper H
影响因子：
1.7
作者：
Beesdo, Katja;Knappe, Susanne;Pine, Daniel S.
通讯作者：
Pine, Daniel S.
影响因子：
10.3
作者：
Herbert, James D.;Gaudiano, Brandon A.;Brandsma, Lynn L.
通讯作者：
Brandsma, Lynn L.
DOI：
10.1176/appi.focus.16407
发表时间：
2018-10-01
期刊：
Focus (American Psychiatric Publishing)
影响因子：
--
作者：
Cipriani, Andrea;Furukawa, Toshi A;Geddes, John R
通讯作者：
Geddes, John R