PDF(Pubmed)
Abstract：
BACKGROUND: Home treatment in child and adolescent psychiatry offers an alternative to conventional inpatient treatment by involving the patient\'s family, school, and peers more directly in therapy. Although several reviews have summarised existing home treatment programmes, evidence of their effectiveness remains limited and data synthesis is lacking.
METHODS: We conducted a meta-analysis on the effectiveness of home treatment compared with inpatient treatment in child and adolescent psychiatry, based on a systematic search of four databases (PubMed, CINAHL, PsychINFO, Embase). Primary outcomes were psychosocial functioning and psychopathology. Additional outcomes included treatment satisfaction, duration, costs, and readmission rates. Group differences were expressed as standardised mean differences (SMD) in change scores. We used three-level random-effects meta-analysis and meta-regression and conducted both superiority and non-inferiority testing.
RESULTS: We included 30 studies from 13 non-overlapping samples, providing data from 1795 individuals (mean age: 11.95 ± 2.33 years; 42.5% female). We found no significant differences between home and inpatient treatment for postline psychosocial functioning (SMD = 0.05 [- 0.18; 0.30], p = 0.68, I2 = 98.0%) and psychopathology (SMD = 0.10 [- 0.17; 0.37], p = 0.44, I2 = 98.3%). Similar results were observed from follow-up data and non-inferiority testing. Meta-regression showed better outcomes for patient groups with higher levels of psychopathology at baseline and favoured home treatment over inpatient treatment when only randomised controlled trials were considered.
CONCLUSIONS: This meta-analysis found no evidence that home treatment is less effective than conventional inpatient treatment, highlighting its potential as an effective alternative in child and adolescent psychiatry. The generalisability of these findings is reduced by limitations in the existing literature, and further research is needed to better understand which patients benefit most from home treatment.
BACKGROUND: Registered at PROSPERO (CRD42020177558), July 5, 2020.
METHODS: We conducted a meta-analysis on the effectiveness of home treatment compared with inpatient treatment in child and adolescent psychiatry, based on a systematic search of four databases (PubMed, CINAHL, PsychINFO, Embase). Primary outcomes were psychosocial functioning and psychopathology. Additional outcomes included treatment satisfaction, duration, costs, and readmission rates. Group differences were expressed as standardised mean differences (SMD) in change scores. We used three-level random-effects meta-analysis and meta-regression and conducted both superiority and non-inferiority testing.
RESULTS: We included 30 studies from 13 non-overlapping samples, providing data from 1795 individuals (mean age: 11.95 ± 2.33 years; 42.5% female). We found no significant differences between home and inpatient treatment for postline psychosocial functioning (SMD = 0.05 [- 0.18; 0.30], p = 0.68, I2 = 98.0%) and psychopathology (SMD = 0.10 [- 0.17; 0.37], p = 0.44, I2 = 98.3%). Similar results were observed from follow-up data and non-inferiority testing. Meta-regression showed better outcomes for patient groups with higher levels of psychopathology at baseline and favoured home treatment over inpatient treatment when only randomised controlled trials were considered.
CONCLUSIONS: This meta-analysis found no evidence that home treatment is less effective than conventional inpatient treatment, highlighting its potential as an effective alternative in child and adolescent psychiatry. The generalisability of these findings is reduced by limitations in the existing literature, and further research is needed to better understand which patients benefit most from home treatment.
BACKGROUND: Registered at PROSPERO (CRD42020177558), July 5, 2020.
摘要：
背景：儿童和青少年精神病学的家庭治疗通过让患者的家人参与，为传统的住院治疗提供了一种替代方案，学校,和同龄人更直接的治疗。尽管一些评论总结了现有的家庭治疗计划，其有效性的证据仍然有限，缺乏数据综合。
方法：我们对儿童和青少年精神病学中家庭治疗与住院治疗的有效性进行了荟萃分析，基于对四个数据库的系统搜索(PubMed，CINAHL,心理信息,Embase)。主要结果是心理社会功能和精神病理学。其他结果包括治疗满意度，持续时间,成本,和再入院率。组差异表示为变化分数的标准化平均差异（SMD）。我们使用三级随机效应荟萃分析和荟萃回归，并进行了优势和非劣效性测试。
结果：我们纳入了来自13个非重叠样本的30项研究，提供来自1795名个体的数据（平均年龄：11.95±2.33岁；42.5%为女性）。我们发现家庭和住院治疗后的心理社会功能没有显着差异（SMD=0.05[-0.18;0.30]，p=0.68，I2=98.0％）和精神病理学（SMD=0.10[-0.17；0.37]，p=0.44，I2=98.3%)。从随访数据和非劣效性测试中观察到类似的结果。Meta回归显示，基线时精神病理学水平较高的患者组的预后更好，并且仅考虑随机对照试验时，家庭治疗优于住院治疗。
结论：这项荟萃分析没有发现证据表明家庭治疗比传统的住院治疗效果差，强调其作为儿童和青少年精神病学有效替代方案的潜力。这些发现的普遍性由于现有文献的局限性而降低，需要进一步的研究，以更好地了解哪些患者从家庭治疗中受益最大。
背景：在PROSPERO注册（CRD42020177558），2020年7月5日。
方法：我们对儿童和青少年精神病学中家庭治疗与住院治疗的有效性进行了荟萃分析，基于对四个数据库的系统搜索(PubMed，CINAHL,心理信息,Embase)。主要结果是心理社会功能和精神病理学。其他结果包括治疗满意度，持续时间,成本,和再入院率。组差异表示为变化分数的标准化平均差异（SMD）。我们使用三级随机效应荟萃分析和荟萃回归，并进行了优势和非劣效性测试。
结果：我们纳入了来自13个非重叠样本的30项研究，提供来自1795名个体的数据（平均年龄：11.95±2.33岁；42.5%为女性）。我们发现家庭和住院治疗后的心理社会功能没有显着差异（SMD=0.05[-0.18;0.30]，p=0.68，I2=98.0％）和精神病理学（SMD=0.10[-0.17；0.37]，p=0.44，I2=98.3%)。从随访数据和非劣效性测试中观察到类似的结果。Meta回归显示，基线时精神病理学水平较高的患者组的预后更好，并且仅考虑随机对照试验时，家庭治疗优于住院治疗。
结论：这项荟萃分析没有发现证据表明家庭治疗比传统的住院治疗效果差，强调其作为儿童和青少年精神病学有效替代方案的潜力。这些发现的普遍性由于现有文献的局限性而降低，需要进一步的研究，以更好地了解哪些患者从家庭治疗中受益最大。
背景：在PROSPERO注册（CRD42020177558），2020年7月5日。
