认知行为疗法对自杀倾向患者心理状态的meta分析

doi:10.3969/j.issn.1004-583X.2024.12.002

摘要/Abstract

摘要：

目的通过meta分析评价认知行为疗法在自杀倾向患者中的应用效果。方法计算机检索PubMed、Ovid、Embase、Cochrane Library、Web of Science、中国知网(CNKI)、万方、维普(VIP)、中国生物医学文献数据库(CBM)有关认知行为疗法对自杀倾向患者干预效果的随机对照试验,检索时限为建库至2023年4月26日。由2名研究者独立筛查文献、提取资料并进行质量评价,使用RevMan 5.2软件进行meta分析。结果最终纳入13篇文献,共1 660例患者。Meta分析结果显示,与常规护理相比,认知行为疗法可以降低患者的自杀意念[SMD=-0.35, 95%CI(-0.51,-0.18),P<0.0001],能显著改善患者的抑郁[SMD=-0.34, 95%CI(-0.46,-0.21),P<0.00001]、焦虑[SMD=-0.22, 95%CI(-0.38,-0.06),P=0.007]、绝望[SMD=-0.23, 95%CI(-0.38,-0.08),P=0.003]和生活质量[SMD=0.32, 95%CI(0.07, 0.57),P=0.01],且干预组优于对照组。结论认知行为疗法能够降低自杀倾向患者的自杀意念,显著改善患者的抑郁、焦虑和绝望等负性情绪,但对提升患者的生活质量的证据不足,还需开展更多高质量的研究进行验证。

关键词: 认知行为疗法, 自杀意念, 自杀行为, 负性情绪, Meta分析

Abstract:

Objective To evaluate the effectiveness of cognitive behavioral therapy for suicidal tendencies by meta-analysis. Methods Randomized controlled trials reporting cognitive behavioral therapy for suicidal tendencies published until April 26,2023 were searched in the PubMed, Ovid, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, and China Biology Medicine(CBM).Two investigators independently screened the literatures, extracted data and performed quality evaluation. Meta-analysis was conducted using RevMan 5.2 software. Results A total of 13 articles involving 1,660 patients with suicidal tendencies were included. The results of the meta-analysis showed that in contrast to the usual care and routine care, cognitive behavioral therapy more significantly reduced suicidal ideation (SMD=-0.35, 95%CI -0.51, -0.18,P<0.0001), and improved the depression (SMD=-0.34, 95%CI -0.46, -0.21,P<0.00001), anxiety (SMD=-0.22, 95%CI -0.38, -0.06,P=0.007), despair (SMD=-0.23, 95%CI -0.38, -0.08,P=0.003) and quality of life (SMD=0.32, 95%CI 0.07, 0.57,P=0.01). Conclusion Cognitive behavioral therapy can reduce suicidal ideation in suicidal tendency patients and significantly improve negative emotions such as depression, anxiety and despair, but the improvement of quality of life lacks sufficient evidence, and more studies should be conducted.

Key words: cognitive behaviortherapy, suicidal ideation, suicidal behavior, negative emotions, meta-analysis

中图分类号:

R493

张雪梅, 张先, 董雪, 郭燕杰. 认知行为疗法对自杀倾向患者心理状态的meta分析[J]. 临床荟萃, 2024, 39(12): 1073-1080.

Zhang Xuemei, Zhang Xian, Dong Xue, Guo Yanjie. Cognitive-behavioral therapy on the psychological state of patients with suicidal tendencies:a meta-analysis[J]. Clinical Focus, 2024, 39(12): 1073-1080.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.12.002

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I12/1073

图/表 13

参考文献 30

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作者	时间	国家	对照组		干预组		干预时间	测评时间	结局指标	测评工具	文献质量
作者	时间	国家	例数	措施	例数	措施	干预时间	测评时间	结局指标	测评工具	文献质量
Slesnick等^[10]	2020	美国	75	ATU	75	CTSP	3个月	干预后3个月、6个月和 9个月	②④	BDI、BHS	B
Brown等^[11]	2005	美国	60	ATU	60	CBT	3周	干预后1个月、3个月、 6个月、12个月和18个月	②④	HAMD、BHS	B
Ecker等^[12]	2019	美国	122	ATU	180	CBT	3周	在4个月、8个月和12个月	③⑤	BAI、PHQ-9	B
Hepburn等^[13]	2009	英国	35	ATU	33	MBCT	8周	干预结束后	②	BDI	A
Husain等^[14]	2014	巴基斯坦	113	ATU	108	问题解决疗法	3个月	干预结束后3个月和基线检查后6个月	①②④⑤	BSS、BDI、BHS、 EQ-5D	A
Rudd等^[15]	2015	美国	76	ATU	76	CBT	10周	干预后3个月、6个月、12个月、18个月和24个月	①②③④	BSS、BDI、BAI、BHS	B
Sinniah等^[16]	2017	马来西亚	36	ATU	33	个体CBT	8周	干预第1个月、干预后第2月、第3个月、第6个月	①②③④	BSS、BDI、BAI、BHS	B
Tarrier等^[17]	2014	英国	24	ATU	25	CBT	12周	干预后4个月和6个月	①②③④⑤	BSS、BDI、BAI、BHS、WHO-5	B
Ward-Ciesielski等^[18]	2017	美国	47	放松训练	46	CBT	12周	一周(T2)、四周(T3)和干预后12周(T4)	①②③	SSI-W、PHQ、BAI	A
丁晓晴等^[19]	2018	中国	50	ATU	50	CBT	4周	干预结束后	②③	HAMD、HAMA	B
李桂林等^[20]	2014	中国	113	ATU	113	CBT	8周	干预后第2/4/8周	②	HAMD	B
魏春燕等^[21]	2021	中国	29	ATU	31	团体CBT	6周	干预结束后	①②	BSI-CV、HAMD	B
胡颖颖等^[22]	2022	中国	25	ATU	25	团体CBT	未说明	干预结束后	③	SAS	B

作者	时间	国家	对照组		干预组		干预时间	测评时间	结局指标	测评工具	文献质量
作者	时间	国家	例数	措施	例数	措施	干预时间	测评时间	结局指标	测评工具	文献质量
Slesnick等^[10]	2020	美国	75	ATU	75	CTSP	3个月	干预后3个月、6个月和 9个月	②④	BDI、BHS	B
Brown等^[11]	2005	美国	60	ATU	60	CBT	3周	干预后1个月、3个月、 6个月、12个月和18个月	②④	HAMD、BHS	B
Ecker等^[12]	2019	美国	122	ATU	180	CBT	3周	在4个月、8个月和12个月	③⑤	BAI、PHQ-9	B
Hepburn等^[13]	2009	英国	35	ATU	33	MBCT	8周	干预结束后	②	BDI	A
Husain等^[14]	2014	巴基斯坦	113	ATU	108	问题解决疗法	3个月	干预结束后3个月和基线检查后6个月	①②④⑤	BSS、BDI、BHS、 EQ-5D	A
Rudd等^[15]	2015	美国	76	ATU	76	CBT	10周	干预后3个月、6个月、12个月、18个月和24个月	①②③④	BSS、BDI、BAI、BHS	B
Sinniah等^[16]	2017	马来西亚	36	ATU	33	个体CBT	8周	干预第1个月、干预后第2月、第3个月、第6个月	①②③④	BSS、BDI、BAI、BHS	B
Tarrier等^[17]	2014	英国	24	ATU	25	CBT	12周	干预后4个月和6个月	①②③④⑤	BSS、BDI、BAI、BHS、WHO-5	B
Ward-Ciesielski等^[18]	2017	美国	47	放松训练	46	CBT	12周	一周(T2)、四周(T3)和干预后12周(T4)	①②③	SSI-W、PHQ、BAI	A
丁晓晴等^[19]	2018	中国	50	ATU	50	CBT	4周	干预结束后	②③	HAMD、HAMA	B
李桂林等^[20]	2014	中国	113	ATU	113	CBT	8周	干预后第2/4/8周	②	HAMD	B
魏春燕等^[21]	2021	中国	29	ATU	31	团体CBT	6周	干预结束后	①②	BSI-CV、HAMD	B
胡颖颖等^[22]	2022	中国	25	ATU	25	团体CBT	未说明	干预结束后	③	SAS	B