Abstract：
BACKGROUND: Prolonged grief disorder (PGD), a condition characterized by severe, persistent, and disabling grief, is newly included in ICD-11 and DSM-5-TR. Psychotherapies are among the most recommended treatments for PGD, but which should be considered as first-line treatment needs to be clarified. The purpose of this systematic review and network meta-analysis was to synthesize the available evidence to compare five outcomes of different psychotherapies on PGD in adults and identify the optimal psychotherapy modality to inform clinical decision-making for the treatment of PGD.
METHODS: A comprehensive search was conducted in 7 databases from inception until March 20th, 2023. In the frequentist framework, pairwise and network meta-analyses using random-effects models were performed for outcomes with 95 % confidence interval (CI).
RESULTS: There were 2962 records found and 55 studies (1,0330 participants) assessing 11 different psychological interventions were included. Compared with the waiting list, behavioral therapy (SMD=-1.05; 95 %CI=-1.71, -0.38), third-wave cognitive behavior therapy (SMD=-1.00; 95 %CI =-1.41, -0.58), family therapy (SMD=-0.87; 95 %CI=-1.59, -0.16), psychodynamic therapy (SMD=-0.88; 95 %CI=-1.67, -0.10) and cognitive therapy (SMD=-0.84; 95 %CI=-1.57, -0.12) were statistically effective in reducing grief symptom. Only cognitive behavior therapy (OR =0.48; 95 %CI = 0.27, 0.85) was more acceptable than waiting list. In terms of secondary outcome, third-wave CBT can statistically significantly reduce depression (SMD= -0.60; 95 %CI =- 0.84, -0.36), PTSD (SMD=-0.99; 95 %CI =- 1.62, -0.36) and anxiety (SMD= -1.44; 95 %CI =-2.63, -0.25) respectively.
CONCLUSIONS: Most psychological interventions are effective, but only cognitive behavior therapy has the highest acceptability. Third-wave CBT with higher efficacy rates may be more beneficial for reducing secondary outcomes. To provide more robust evidence, high-quality trials should be conducted in the future.
METHODS: A comprehensive search was conducted in 7 databases from inception until March 20th, 2023. In the frequentist framework, pairwise and network meta-analyses using random-effects models were performed for outcomes with 95 % confidence interval (CI).
RESULTS: There were 2962 records found and 55 studies (1,0330 participants) assessing 11 different psychological interventions were included. Compared with the waiting list, behavioral therapy (SMD=-1.05; 95 %CI=-1.71, -0.38), third-wave cognitive behavior therapy (SMD=-1.00; 95 %CI =-1.41, -0.58), family therapy (SMD=-0.87; 95 %CI=-1.59, -0.16), psychodynamic therapy (SMD=-0.88; 95 %CI=-1.67, -0.10) and cognitive therapy (SMD=-0.84; 95 %CI=-1.57, -0.12) were statistically effective in reducing grief symptom. Only cognitive behavior therapy (OR =0.48; 95 %CI = 0.27, 0.85) was more acceptable than waiting list. In terms of secondary outcome, third-wave CBT can statistically significantly reduce depression (SMD= -0.60; 95 %CI =- 0.84, -0.36), PTSD (SMD=-0.99; 95 %CI =- 1.62, -0.36) and anxiety (SMD= -1.44; 95 %CI =-2.63, -0.25) respectively.
CONCLUSIONS: Most psychological interventions are effective, but only cognitive behavior therapy has the highest acceptability. Third-wave CBT with higher efficacy rates may be more beneficial for reducing secondary outcomes. To provide more robust evidence, high-quality trials should be conducted in the future.
摘要：
背景：长期悲伤障碍（PGD），一种以严重为特征的疾病，持久性,和致残的悲伤，新包含在ICD-11和DSM-5-TR中。心理治疗是PGD最推荐的治疗方法之一，但哪些应该被认为是一线治疗需要澄清。本系统综述和网络荟萃分析的目的是综合现有证据，以比较成人PGD不同心理治疗的五种结果，并确定最佳心理治疗方式，以告知PGD治疗的临床决策。
方法：从开始到3月20日，在7个数据库中进行了全面搜索，2023年。在频率论框架中，使用随机效应模型对结局进行配对和网络meta分析,置信区间为95%.
结果：共发现2962条记录和55项研究（1,0330名参与者），评估了11种不同的心理干预措施。与等待名单相比，行为治疗（SMD=-1.05；95CI=-1.71，-0.38），第三波认知行为治疗（SMD=-1.00；95CI=-1.41，-0.58），家庭治疗（SMD=-0.87；95CI=-1.59，-0.16），心理动力疗法(SMD=-0.88;95CI=-1.67,-0.10)和认知疗法(SMD=-0.84;95CI=-1.57,-0.12)在减轻悲伤症状方面具有统计学效果.只有认知行为疗法（OR=0.48；95CI=0.27，0.85）比等待列表更可接受。就次要结果而言，第三波CBT可以显著降低抑郁症（SMD=-0.60；95CI=-0.84，-0.36），PTSD（SMD=-0.99；95CI=-1.62，-0.36）和焦虑（SMD=-1.44；95CI=-2.63，-0.25）。
结论：大多数心理干预措施是有效的，但只有认知行为疗法具有最高的可接受性。具有较高有效率的第三波CBT可能更有利于减少次要结果。为了提供更有力的证据，今后应开展高质量的试验.
方法：从开始到3月20日，在7个数据库中进行了全面搜索，2023年。在频率论框架中，使用随机效应模型对结局进行配对和网络meta分析,置信区间为95%.
结果：共发现2962条记录和55项研究（1,0330名参与者），评估了11种不同的心理干预措施。与等待名单相比，行为治疗（SMD=-1.05；95CI=-1.71，-0.38），第三波认知行为治疗（SMD=-1.00；95CI=-1.41，-0.58），家庭治疗（SMD=-0.87；95CI=-1.59，-0.16），心理动力疗法(SMD=-0.88;95CI=-1.67,-0.10)和认知疗法(SMD=-0.84;95CI=-1.57,-0.12)在减轻悲伤症状方面具有统计学效果.只有认知行为疗法（OR=0.48；95CI=0.27，0.85）比等待列表更可接受。就次要结果而言，第三波CBT可以显著降低抑郁症（SMD=-0.60；95CI=-0.84，-0.36），PTSD（SMD=-0.99；95CI=-1.62，-0.36）和焦虑（SMD=-1.44；95CI=-2.63，-0.25）。
结论：大多数心理干预措施是有效的，但只有认知行为疗法具有最高的可接受性。具有较高有效率的第三波CBT可能更有利于减少次要结果。为了提供更有力的证据，今后应开展高质量的试验.
