Appraisal of the methodological quality and summary of the findings of systematic reviews on the relationship between SSRIs and suicidality.
Appraisal of the methodological quality and summary of the findings of systematic reviews on the relationship between SSRIs and suicidality.
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DOI：
10.11919/j.issn.1002-0829.214080
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发表时间：
2014-10
期刊：
影响因子：
--
通讯作者：
Li C
中科院分区：
文献类型：
--
作者：
Li W;Li W;Wan Y;Ren J;Li T;Li C
关于选择性5-羟色胺再摄取抑制剂（SSRIs）的使用与自杀意念或行为风险的关系，已发表了几篇系统性综述，但尚未对这些报告的质量进行正式评估。评估关于SSRI使用与自杀意念和行为关系的系统评价的方法学质量;并基于此评估提供总体结论。通过检索Pubmed、Embase、The科克伦图书馆、EBSCO、PsycINFO、中国知网、重庆维普中文科技期刊数据库、万方数据库和中国生物医学文献数据库，确定比较SSRI与安慰剂并将自杀意念或行为作为关键结局变量的RCT的系统评价。由两名专家评估员使用11项多系统评价（AMSTAR）量表独立评估纳入综述的方法学质量。确定了12项系统综述和荟萃分析。总体AMSTAR质量评分的评分者间信度为优（ICC=0.86），但11个AMSTAR项目中有5个的评分者间信度较差（Kappa <0.60）。根据AMSTAR的总评分，有一个高质量的评论，八个中等质量的评论，和三个低质量的评论。高质量的评论和三个中等质量的评论报告了SSRI组与安慰剂组相比自杀意念或行为的风险显着增加。仅限于儿童和青少年的四项综述中有三项发现使用SSRI的自杀意念或行为的风险显着增加，这在服用帕罗西汀的青少年和患有抑郁症的青少年中最为明显。现有的证据表明，青少年可能会经历增加自杀意念和行为与SSRI的使用，特别是那些谁有抑郁症和帕罗西汀治疗。然而，在这个问题上几乎没有高质量的评论，因此对证据的一些怀疑仍然存在。AMSTAR量表可能有助于提高系统评价质量的持续努力，但还需要进一步加强量表中某些项目的操作标准。
Several systematic reviews have been published about the relationship of the use of selective serotonin reuptake inhibitors (SSRIs) and risk of suicidal ideation or behavior but there has been no formal assessment of the quality of these reports. Assess the methodological quality of systematic reviews about the relationship of SSRI use and suicidal ideation and behavior; and provide overall conclusions based on this assessment. Systematic reviews of RCTs that compared SSRIs to placebo and used suicidal ideation or behavior as a key outcome variable were identified by searching Pubmed, Embase, The Cochrane Library, EBSCO, PsycINFO, Chinese National Knowledge Infrastructure, Chongqing VIP database for Chinese Technical Periodicals, WANFANG DATA, and the Chinese Biological Medical Literature Database. The methodological quality of included reviews was independently assessed by two expert raters using the 11-item Assessment of Multiple Systematic Reviews (AMSTAR) scale. Twelve systematic reviews and meta-analyses were identified. The inter-rater reliability of the overall AMSTAR quality score was excellent (ICC=0.86) but the inter-rater reliability of 5 of the 11 AMSTAR items was poor (Kappa <0.60). Based on the AMSTAR total score, there was one high-quality review, eight moderate-quality reviews, and three low-quality reviews. The high-quality review and three of the moderate-quality reviews reported a significantly increased risk of suicidal ideation or behavior in the SSRI group compared to the placebo group. Three of the four reviews limited to children and adolescents found a significantly increased risk of suicidal ideation or behavior with SSRI use which was most evident in teenagers taking paroxetine and in teenagers with depressive disorders. The available evidence suggests that adolescents may experience an increase in suicidal ideation and behavior with SSRI use, particularly those who have a depressive disorder and those treated with paroxetine. However, there are few high-quality reviews on this issue, so some doubt about the evidence remains. The AMSTAR scale may be useful in the ongoing efforts to improve the quality of systematic reviews, but further work is needed on tightening the operational criteria for some of the items in the scale.