مقاله رایگان با موضوع رفتار درمانی برای افسردگی
عنوان مقاله:
سال انتشار: 2022
رشته: روانشناسی - پزشکی
گرایش: روانپزشکی - روانشناسی بالینی
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دانلود مقاله رفتار درمانی برای افسردگی
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3. Results
3.1. Study selection The flowchart of record inclusion/exclusion process is presented in Fig. 1. A total of 3348 records were identified from the databases, and 9 records were identified from the reference list of other reviews. After removal of 1595 duplicates, titles and abstracts of 1762 records were screened. After excluding 1615 irrelevant articles, full texts of 147 articles were assessed and 77 articles of these met criteria for inclusion. 3.2. Characteristics of included trials Characteristics of the 77 articles (79 trials, n = 11,221 women) included in the current systematic review are presented in Supplementary Table S4. Among these articles, 66 articles (68 trials) (see Supplementary S3) were included in the meta-analysis while 11 were excluded due to unavailable outcome data. Most trials were RCTs, and six were quasi-RCTs. Interventions can be divided into selective prevention (10 trials), indicated prevention (8 trials) and treatment (61 trials). Fortytwo trials examined CBT conducted during pregnancy only, 33 trials examined CBT conducted during the postnatal period only, and four trials examined CBT conducted during both pregnancy and the postnatal period. Intervention groups ranged from 1 to 15 sessions, and the interventions included CBT-only (59 trials) and CBT-CI (20 trials). For control groups, the most common comparator was TAU (52 trials), followed by waitlist (12 trials), attention control (5 trials), active control (4 trials), enhanced TAU (2 trials), informational booklet (3 trials) and no intervention control (1 trial). 3.3. Quality assessment Risks of bias of the 79 trials are presented in Supplementary Figs. S1 and S2.
4. Discussion
This is the first meta-analysis to comprehensively evaluate the shortand long-term efficacy of CBT-only and CBT-CI for perinatal depression, anxiety, stress and PTSD. Overall, there are three main findings. First, both CBT-only and CBT-CI were effective for perinatal maternal depression in the short and long term. Second, CBT-only had both shortand long-term efficacy for perinatal anxiety. Third, CBT-only was effective for women with perinatal stress in the short term and for women with perinatal PTSD in the long term. This is also the largest and the most comprehensive meta-analysis examining the efficacy of CBTonly specific to a wide variety of modalities in perinatal women. 4.1. Depression CBT-only outperformed control conditions in short and long terms across in-person group (women alone), in-person individual (women alone or women and partners), internet-based (women alone) and workbook-based (women alone) formats, and whether delivered by specialists or non-specialists. We found that internet-based (women alone) CBT-only showed greater improvement in perinatal depression compared to controls, which was consistent with a previous review (SMD = − 1.08, 95% CI: − 1.74 to − 0.41) (Huang et al., 2018). Another meta-analysis including 8 trials also found short-term efficacy of internet-based CBT for postnatal depression: SMD = − 0.63, 95% CI: − 0.77 to − 0.50 (Lau, Htun, Wong, Tam, & Klainin-Yobas, 2017). We found that both in-person group (women and partners) and inperson individual (women and partners) formats were effective to improve women’s perinatal depression in the short term, supporting the feasibility of partner-inclusive CBT that focuses on couple relationships and social support form partners (Epstein & Zheng, 2017). Partners involved in CBT sessions are thought to help provide support, avoid conflict or decrease distress for women (Baucom, Belus, Adelman, Fischer, & Paprocki, 2014). In addition, both women (23.8%) and men (10.4%) can suffer from perinatal depression between the first trimester and 1 year postpartum (Paulson & Bazemore, 2010), and thus it is important to develop couple interventions to meet the stressful demands of parenthood. The efficacy of in-person individual (women and partners) CBT-only, but not in-person group (women and partners) CBTonly, was maintained in the long term. This difference may be due to the fact that the in-person group format had fewer sessions (3 vs. 8 sessions) and longer follow-up (12 vs. 9 months) compared to the inperson individual format.
چکیده
رفتادرمانی شناختی (CBT) به شکل گسترده ای در افسردگی پیش از زایمان یا پس از زایمان مورد مطالعه قرار گرفته است اما پژوهش های بسیار کم تری در زمینه ی اضطراب و استرس انجام گرفته است. این فراتحلیل بر آن است تا به طور گسترده ای اثربخشی CBT برای افسردگی، اضطراب و استرس پیرازایشی را در کوتاه مدت (از خط مبنا تا بلافاصله پس از از مداخله) و در بلندمدت (از خط مبنا تا پایان پیگیری درمان) ارزیابی کند. پنج پایگاه داده مورد جست وجو قرار گرفتند. ما 79 کارآزمایی کنترل شده ی تصادفی (RCT) و شبه RCT را که اثربخشی CBT در طی بارداری و سال نخست پس از زایمان را ارزیابی می کنند، در مطالعه گنجاندیم. پیامد اصلی، میانگین تغییر نمره در افسردگی، اضطراب و استرس بود. CBT محض و CBT با دیگر مداخله ها برای افسردگی مادری پیرازایشی در کوتاه مدت (SMD -0.69، 95% CI: -0.83, -0.55) و بلندمدت (SMD -0.59, 95% -0.75, -0.42) اثربخش بودند. CBT محض هم دارای اثربخشی کوتاه مدت و بلندمدت برای اضطراب پیرازایشی (کوتاه مدت: SMD -0.63, 95% CI -0.85, -0.42؛ بلندمدت: SMD -0.71, 95% CI -1.02, -0.39) و هم دارای اثربخشی کوتاه مدت برای استرس پیرازایشی (SMD -0.96, 95% CI -1.40, -0.52) بود. به طور کلی، CBT برای افسردگی، اضطراب و استرس مادری پیرازایشی اثربخش بود. CBT محض اثربخشی کوتاه مدت برای افسردگی، اضطراب و استرس پیرازایشی، و اثربخشی بلندمدت برای افسردگی و اضطراب بلندمدت را بروز داد. تحلیل های زیرگروه دلالت بر آن داشت که CBT محض برای طیف گسترده ای از شرایط و وجوه اثربخش بود.