认知行为治疗对自杀症状疗效的系统评价和meta分析
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摘要
目的:采用系统评价和meta分析的方法评估认知行为治疗(CBT)对自杀意念和自杀行为的疗效。方法:计算机检索Pub Med、PsycINFO、Cochrane图书馆、万方数据库、CNKI发表的CBT用于自杀意念和自杀行为者疗效比较的随机对照研究,主要结局为自杀意念的变化或消除,次要结局为自杀和自伤行为、抑郁症状。用Cochrane协作网研究偏倚风险评价工具评估研究质量,采用随机效应模型,使用RevM an 5. 3软件进行数据合并和分析。结果:共纳入19篇文献2707名患者。CBT可短期降低自杀意念(SMD=-0. 30,95%CI=-0. 42～-0. 19); CBT对自杀意念的中期和长期疗效和对照组无差异(SMD=-0. 27、-0. 18,95%CI:-0. 61～0. 07、-0. 41～0. 05)。CBT对自杀和自伤行为的短期、中期和长期疗效均优于对照组(OR=0. 68、0. 73、0. 50,95%CI=0. 48～0. 97、0. 54～0. 98、0. 31～0. 80)。CBT对抑郁症状短期、中期和长期疗效均优于对照组(SMD=-0. 35、-0. 28、-0. 35,95%CI=-0. 51～-0. 19、-0. 51～-0. 05、-0. 55～-0. 15)。结论:短期内认知行为治疗可以降低自杀意念;认知行为治疗也能减少自杀和自伤行为风险,改善与自杀相关的抑郁情绪。
Objective: To evaluate the effect of cognitive behavioral therapy( CBT) on suicidal ideation and suicidal behavior in a systematic review and meta-analysis. Methods: PubMed,PsycINFO,Cochrane library,Wanfang Data,CNKI were searched for randomized controlled trials( RCT) of CBT treatment suicidal ideation and behavior.The primary outcome was changes and elimination in suicidal ideation and the second outcomes were suicidal behavior and self-harm behavior,depressive symptoms. The risk of bias was assessed with the Cochrane risk of bias tool. Random-effects models were used to calculate pooled mean difference estimates by RevMan 5. 3. Results:Nineteen RCT( 2707 participants) were included. For suicidal ideation,CBT was significantly effective than control group in the short-term( SMD =-0. 30,95% CI =-0. 42--0. 19),but not in medium-term or in long-term( SMD =-0. 27,-0. 18; 95% CI =-0. 61-0. 07,-0. 41-0. 05). In terms of suicidal behavior and self-harm,CBT was better than control group in short-term,medium-term and long-term( OR = 0. 68,0. 73,0. 50; 95% CI =0. 48-0. 97,0. 54-0. 98,0. 31-0. 80). In terms of depressive symptoms,CBT was better than control group in short,medium and long-term( SMD =-0. 35,-0. 28,-0. 35; 95% CI =-0. 51--0. 19,-0. 51--0. 05,-0. 55--0. 15). Conclusion: Cognitive behavioral therapy( CBT) may be effective in suicidal ideation in shortterm.CBT could decrease the risk of suicidal behavior and self-harm,and improve depressive symptoms.
Objective: To evaluate the effect of cognitive behavioral therapy( CBT) on suicidal ideation and suicidal behavior in a systematic review and meta-analysis. Methods: PubMed,PsycINFO,Cochrane library,Wanfang Data,CNKI were searched for randomized controlled trials( RCT) of CBT treatment suicidal ideation and behavior.The primary outcome was changes and elimination in suicidal ideation and the second outcomes were suicidal behavior and self-harm behavior,depressive symptoms. The risk of bias was assessed with the Cochrane risk of bias tool. Random-effects models were used to calculate pooled mean difference estimates by RevMan 5. 3. Results:Nineteen RCT( 2707 participants) were included. For suicidal ideation,CBT was significantly effective than control group in the short-term( SMD =-0. 30,95% CI =-0. 42--0. 19),but not in medium-term or in long-term( SMD =-0. 27,-0. 18; 95% CI =-0. 61-0. 07,-0. 41-0. 05). In terms of suicidal behavior and self-harm,CBT was better than control group in short-term,medium-term and long-term( OR = 0. 68,0. 73,0. 50; 95% CI =0. 48-0. 97,0. 54-0. 98,0. 31-0. 80). In terms of depressive symptoms,CBT was better than control group in short,medium and long-term( SMD =-0. 35,-0. 28,-0. 35; 95% CI =-0. 51--0. 19,-0. 51--0. 05,-0. 55--0. 15). Conclusion: Cognitive behavioral therapy( CBT) may be effective in suicidal ideation in shortterm.CBT could decrease the risk of suicidal behavior and self-harm,and improve depressive symptoms.
引文
[1] WHO. World Health Organization Suicide Prevention(SUPRE)[M]. Geneva:World Health Organization,2013.
[2]杨帆,王晓彦,童俊.边缘型人格障碍自杀死亡率的meta分析[J].中国心理卫生杂志,2016,30(7):513-518.
[3] Sinniah A,Oei TPS,Maniam T,et al. Positive effects of Individual cognitive behavior therapy for patients with unipolar mood disorders with suicidal ideation in Malaysia:a randomised controlled tri al[J]. Psychiatry Res,2017,254:179-189. doi:10. 1016/j. psychres.2017. 04. 026.
[4] Rees CS,Hasking P,Breen LJ,et al. Group mindfulness based cognitive therapy vs group support forself-injury among young people:study protocol for a randomised controlled trial[J]. BMC Psychiatry,2015,15:154. doi:10. 1186/s12888-015-0527-5.
[5] Tarrier N,Kelly J,Maqsood S,et al. The cognitive behavioural prevention of suicide in psychosis:a clinical trial[J]. Schizophr Res,2014,156(2-3):204-210.
[6] Weitz E,Hollon SD,Kerkhof A,et al. Do depression treatments reduce suicidal ideation? The effects of CBT,IPT,pharmacotherapy,and placebo on suicidality[J]. J Affect Disord,2014,167:98-103. doi:10. 1016/j. jad. 2014. 05. 036.
[7] Abdollahi A,LeBouthillier DM,Najafi M,et al. Effect of exercise augmentation of cognitive behavioural therapy for the treatment of suicidal ideation and depression[J]. J Affect Disord,2017,219:58-63. doi:10. 1016/j. jad. 2017. 05. 012.
[8] Guille C,Zhao Z,Krystal J,et al. Web-based cognitive behavioral therapy intervention for the prevention of suicidal ideation in medical interns:arandomized clinical trial[J]. JAMA Psychiatry,2015,72(12):1192-1198.
[9] Rudd MD,Bryan CJ,Wertenberger EG,et al. Brief cognitive-behavioral therapy effects on post-treatment suicide attempts in a military sample:results of a randomized clinical trial with 2-year followup[J]. Am J Psychiatry,2015,172(5):441-449.
[10]Mewton L,Andrews G. Cognitive behavioral therapy for suicidal behaviors:improving patient outcomes[J]. Psychol Res Behav Manag,2016,9:21-29. doi:10. 2147/PRBM. S84589.
[11]Moher D,Shamseer L,Clarke M,et al. Preferred reporting items for systematic review and meta-analysis protocols(PRISMA-P)2015statement[J]. Syst Rev,2015,4(1):1. doi. org/10. 1186/2046-4053-4-1.
[12]Higgins JP,Altman DG,Gtzsche PC,et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials[J].BMJ,2011,18:343:d5928. doi. org/10. 1136/bmj. d5928.
[13]Brown GK,Ten Have T,Henriques GR,et al. Cognitive therapy for the prevention of suicide attempts:a randomized controlled trial[J]. JAMA Psychiatry,2005,294(5):563-570.
[14]Cottraux J,Note ID,Boutitie F,et al. Cognitive therapy versus Rogerian supportive therapy in borderline personality disorder:twoyear follow-up of a controlled pilot study[J]. Psychother Psychosom,2009,78(5):307-316.
[15]Davidson KM,Tyrer P,Norrie J,et al. Cognitive therapy v. usual treatment for borderline personality disorder:prospective 6-year followup[J]. Br J Psychiatry,2010,197(6):456-462.
[16]Fischer A,Schroder J,Vettorazzi E,et al. An online programme to reduce depression in patients with multiple sclerosis:a randomised controlled trial[J]. Lancet Psychiatry,2015,2(3):217-223.
[17] Forkmann T, Brakemeier EL, Teismann T, et al. The effects of mindfulness-based cognitive therapy and cognitive behavioral analysis system of psychotherapy added to treatment as usual on suicidal ideation in chronic depression:results of a randomized-clinical trial[J]. J Affect Disord, 2016, 200:51-57. doi:10. 1016/j. jad. 2016. 01. 047.
[18]Gandy M,Sharpe L,Nicholson Perry K,et al. Cognitive behavior therapy to improve mood in people with epilepsy:a randomised controlled trial[J]. Cogn Behav Ther,2014,43(2):153-166.
[19]de Groot M,de Keijser J,Neeleman J,et al. Cognitive behaviour therapy to prevent complicated grief among relatives and spouses bereaved by suicide:cluster randomised controlled trial[J]. BMJ,2007,334(7601):994-996.
[20]Gysin-Maillart A,Schwab S,Soravia L,et al. A novel brief therapy for patients who attempt suicide:a 24-months follow-up randomized controlled study of the Attempted Suicide Short Intervention Program(ASSIP)[J]. PLoS Med,2016,13(3):e1001968. doi:10. 1371/journal. pmed. 1001968.
[21]Morley KC,Sitharthan G,Haber PS,et al. The efficacy of an opportunistic cognitive behavioral intervention package(OCB)on substance use and comorbid suicide risk:a multisite randomized controlled trial[J]. J Consult Clinl Psychol,2014,82(1):130-140.
[22]Slee N,Garnefski N,Leeden RVD,et al. Cognitive-behavioural intervention for self-harm:randomised controlled trial[J]. Br J Psychiatry,2008,192(3):202-211
[23]van Spijker BA,van Straten A,Kerkhof AJ. Effectiveness of online self-help for suicidal thoughts:results of a randomised controlled trial[J]. PLoS One, 2014, 9(2):e90118. doi:10. 1371/journal. pone. 0090118.
[24]Tyrer P,Thompson S,Schmidt U,et al. Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm:the POPMACT study[J]. Psychol Med,2003,33(6):969-976.
[25]Weinberg I,Gunderson JG,Hennen J,et al. Manual assisted cognitive treatment for deliberate self-harm in borderline personality disorder patients[J]. J Pers Disord,2006,20(5):482-492.
[26]付佳林,李鸣.认知行为治疗对抑郁症患者外显、内隐自杀态度的影响[J].神经损伤与功能重建,2016,11(6):526-528.
[27]李桂林,陈炯华,张玉琦,等.认知行为干预对抑郁症患者自杀意念的影响[J].中华护理杂志,2014,49(10):1202-1206.
[28]Davidson K,Norrie J,Tyrer P,et al. The effectiveness of cognitive behavior therapy for borderline personality disorder:results from the borderline personality disorder study of cognitive therapy(BOSCOT)trial[J]. J Pers Disord,2006,20(5):450-465.
[29]张娟,杨帆,王晓彦,等.边缘型人格障碍患者自杀意念特征及危险因素分析[J].中华行为医学与脑科学杂志,2017,26(5):426-430.
[30]Asarnow JR,Hughes JL,Babeva KN, et al. Cognitive-behavioral family treatment for suicide attempt prevention:a randomized controlled trial[J]. J Am Acad Child Adolesc Psychiatry,2017,56(6):506-514.
[31]Goodyer IM,Reynolds S, Barrett B, et al. Cognitive-behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression(IMPACT):a multicentre,pragmatic,observer-blind,randomised controlled trial[J]. Health Technol Assess,2017,21(12):1-94.
[32]Gustavson KA,Alexopoulos GS,Niu GC, et al. Problem-solving therapy reduces suicidal ideation in depressed older adults with executive dysfunction[J]. Am J Geriatr Psychiatry,2016,24(1):11-17.
[2]杨帆,王晓彦,童俊.边缘型人格障碍自杀死亡率的meta分析[J].中国心理卫生杂志,2016,30(7):513-518.
[3] Sinniah A,Oei TPS,Maniam T,et al. Positive effects of Individual cognitive behavior therapy for patients with unipolar mood disorders with suicidal ideation in Malaysia:a randomised controlled tri al[J]. Psychiatry Res,2017,254:179-189. doi:10. 1016/j. psychres.2017. 04. 026.
[4] Rees CS,Hasking P,Breen LJ,et al. Group mindfulness based cognitive therapy vs group support forself-injury among young people:study protocol for a randomised controlled trial[J]. BMC Psychiatry,2015,15:154. doi:10. 1186/s12888-015-0527-5.
[5] Tarrier N,Kelly J,Maqsood S,et al. The cognitive behavioural prevention of suicide in psychosis:a clinical trial[J]. Schizophr Res,2014,156(2-3):204-210.
[6] Weitz E,Hollon SD,Kerkhof A,et al. Do depression treatments reduce suicidal ideation? The effects of CBT,IPT,pharmacotherapy,and placebo on suicidality[J]. J Affect Disord,2014,167:98-103. doi:10. 1016/j. jad. 2014. 05. 036.
[7] Abdollahi A,LeBouthillier DM,Najafi M,et al. Effect of exercise augmentation of cognitive behavioural therapy for the treatment of suicidal ideation and depression[J]. J Affect Disord,2017,219:58-63. doi:10. 1016/j. jad. 2017. 05. 012.
[8] Guille C,Zhao Z,Krystal J,et al. Web-based cognitive behavioral therapy intervention for the prevention of suicidal ideation in medical interns:arandomized clinical trial[J]. JAMA Psychiatry,2015,72(12):1192-1198.
[9] Rudd MD,Bryan CJ,Wertenberger EG,et al. Brief cognitive-behavioral therapy effects on post-treatment suicide attempts in a military sample:results of a randomized clinical trial with 2-year followup[J]. Am J Psychiatry,2015,172(5):441-449.
[10]Mewton L,Andrews G. Cognitive behavioral therapy for suicidal behaviors:improving patient outcomes[J]. Psychol Res Behav Manag,2016,9:21-29. doi:10. 2147/PRBM. S84589.
[11]Moher D,Shamseer L,Clarke M,et al. Preferred reporting items for systematic review and meta-analysis protocols(PRISMA-P)2015statement[J]. Syst Rev,2015,4(1):1. doi. org/10. 1186/2046-4053-4-1.
[12]Higgins JP,Altman DG,Gtzsche PC,et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials[J].BMJ,2011,18:343:d5928. doi. org/10. 1136/bmj. d5928.
[13]Brown GK,Ten Have T,Henriques GR,et al. Cognitive therapy for the prevention of suicide attempts:a randomized controlled trial[J]. JAMA Psychiatry,2005,294(5):563-570.
[14]Cottraux J,Note ID,Boutitie F,et al. Cognitive therapy versus Rogerian supportive therapy in borderline personality disorder:twoyear follow-up of a controlled pilot study[J]. Psychother Psychosom,2009,78(5):307-316.
[15]Davidson KM,Tyrer P,Norrie J,et al. Cognitive therapy v. usual treatment for borderline personality disorder:prospective 6-year followup[J]. Br J Psychiatry,2010,197(6):456-462.
[16]Fischer A,Schroder J,Vettorazzi E,et al. An online programme to reduce depression in patients with multiple sclerosis:a randomised controlled trial[J]. Lancet Psychiatry,2015,2(3):217-223.
[17] Forkmann T, Brakemeier EL, Teismann T, et al. The effects of mindfulness-based cognitive therapy and cognitive behavioral analysis system of psychotherapy added to treatment as usual on suicidal ideation in chronic depression:results of a randomized-clinical trial[J]. J Affect Disord, 2016, 200:51-57. doi:10. 1016/j. jad. 2016. 01. 047.
[18]Gandy M,Sharpe L,Nicholson Perry K,et al. Cognitive behavior therapy to improve mood in people with epilepsy:a randomised controlled trial[J]. Cogn Behav Ther,2014,43(2):153-166.
[19]de Groot M,de Keijser J,Neeleman J,et al. Cognitive behaviour therapy to prevent complicated grief among relatives and spouses bereaved by suicide:cluster randomised controlled trial[J]. BMJ,2007,334(7601):994-996.
[20]Gysin-Maillart A,Schwab S,Soravia L,et al. A novel brief therapy for patients who attempt suicide:a 24-months follow-up randomized controlled study of the Attempted Suicide Short Intervention Program(ASSIP)[J]. PLoS Med,2016,13(3):e1001968. doi:10. 1371/journal. pmed. 1001968.
[21]Morley KC,Sitharthan G,Haber PS,et al. The efficacy of an opportunistic cognitive behavioral intervention package(OCB)on substance use and comorbid suicide risk:a multisite randomized controlled trial[J]. J Consult Clinl Psychol,2014,82(1):130-140.
[22]Slee N,Garnefski N,Leeden RVD,et al. Cognitive-behavioural intervention for self-harm:randomised controlled trial[J]. Br J Psychiatry,2008,192(3):202-211
[23]van Spijker BA,van Straten A,Kerkhof AJ. Effectiveness of online self-help for suicidal thoughts:results of a randomised controlled trial[J]. PLoS One, 2014, 9(2):e90118. doi:10. 1371/journal. pone. 0090118.
[24]Tyrer P,Thompson S,Schmidt U,et al. Randomized controlled trial of brief cognitive behaviour therapy versus treatment as usual in recurrent deliberate self-harm:the POPMACT study[J]. Psychol Med,2003,33(6):969-976.
[25]Weinberg I,Gunderson JG,Hennen J,et al. Manual assisted cognitive treatment for deliberate self-harm in borderline personality disorder patients[J]. J Pers Disord,2006,20(5):482-492.
[26]付佳林,李鸣.认知行为治疗对抑郁症患者外显、内隐自杀态度的影响[J].神经损伤与功能重建,2016,11(6):526-528.
[27]李桂林,陈炯华,张玉琦,等.认知行为干预对抑郁症患者自杀意念的影响[J].中华护理杂志,2014,49(10):1202-1206.
[28]Davidson K,Norrie J,Tyrer P,et al. The effectiveness of cognitive behavior therapy for borderline personality disorder:results from the borderline personality disorder study of cognitive therapy(BOSCOT)trial[J]. J Pers Disord,2006,20(5):450-465.
[29]张娟,杨帆,王晓彦,等.边缘型人格障碍患者自杀意念特征及危险因素分析[J].中华行为医学与脑科学杂志,2017,26(5):426-430.
[30]Asarnow JR,Hughes JL,Babeva KN, et al. Cognitive-behavioral family treatment for suicide attempt prevention:a randomized controlled trial[J]. J Am Acad Child Adolesc Psychiatry,2017,56(6):506-514.
[31]Goodyer IM,Reynolds S, Barrett B, et al. Cognitive-behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression(IMPACT):a multicentre,pragmatic,observer-blind,randomised controlled trial[J]. Health Technol Assess,2017,21(12):1-94.
[32]Gustavson KA,Alexopoulos GS,Niu GC, et al. Problem-solving therapy reduces suicidal ideation in depressed older adults with executive dysfunction[J]. Am J Geriatr Psychiatry,2016,24(1):11-17.