The Efficacy and Cost-Effectiveness of Stepped Care Prevention and Treatment for Depressive and/or Anxiety Disorders: A Systematic Review and Meta-Analysis
The Efficacy and Cost-Effectiveness of Stepped Care Prevention and Treatment for Depressive and/or Anxiety Disorders: A Systematic Review and Meta-Analysis
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DOI：
10.1038/srep29281
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发表时间：
2016-07-05
影响因子：
4.6
通讯作者：
Chan, Christian S.
中科院分区：
文献类型：
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作者：
Ho, Fiona Yan-Yee;Yeung, Wing-Fai;Chan, Christian S.
鉴于现有医疗服务的供需之间存在巨大差异，阶梯式护理是一种越来越受欢迎的常见精神健康障碍治疗模式。在这篇综述中，我们的目的是比较分级护理预防和治疗与常规护理（CAU）或等待名单控制抑郁症和/或焦虑症的疗效和成本效益。从最早的可用记录到2015年4月，使用了5个数据库。本综述纳入了10项随机对照试验，其中6项研究了阶梯式护理预防，4项研究了阶梯式护理治疗，特别是关于抑郁症和/或焦虑症的研究。仅纳入了将自助作为治疗组成部分的试验。结果显示，阶梯式护理治疗组在降低焦虑症状方面明显优于CAU组，阶梯式护理治疗组焦虑障碍的治疗有效率明显高于CAU组。阶梯式护理预防/治疗与CAU在预防焦虑和/或抑郁障碍及改善抑郁症状方面无显著差异。因此，阶梯式照护模式在治疗焦虑症上优于CAU。该模式有可能减轻心理健康现有资源的负担，并增加服务的覆盖面和可用性。
Stepped care is an increasingly popular treatment model for common mental health disorders, given the large discrepancy between the demand and supply of healthcare service available. In this review, we aim to compare the efficacy and cost-effectiveness of stepped care prevention and treatment with care-as-usual (CAU) or waiting-list control for depressive and/or anxiety disorders. 5 databases were utilized from its earliest available records up until April 2015. 10 randomized controlled trials were included in this review, of which 6 examined stepped care prevention and 4 examined stepped care treatment, specifically including ones regarding depressive and/or anxiety disorders. Only trials with self-help as a treatment component were included. Results showed stepped care treatment revealed a significantly better performance than CAU in reducing anxiety symptoms, and the treatment response rate of anxiety disorders was significantly higher in stepped care treatment than in CAU. No significant difference was found between stepped care prevention/treatment and CAU in preventing anxiety and/or depressive disorders and improving depressive symptoms. In conclusion, stepped care model appeared to be better than CAU in treating anxiety disorders. The model has the potential to reduce the burden on existing resources in mental health and increase the reach and availability of service.