Abstract：
BACKGROUND: Self-help interventions may offer a scalable adjunct to traditional care, but their effectiveness in relapse prevention is not well-established. Objectives: This review aimed to assess their effectiveness in preventing relapses among individuals with mood disorders.
METHODS: We systematically reviewed the pertinent trial literature in Web of Science, EMBASE, PubMed, PsycINFO, and Cochrane databases until May 2024. Randomized controlled trials that examined the self-help interventions among individuals diagnosed with major depressive disorder (MDD) or bipolar disorder (BD) were included. The random-effects model computed the pooled risk ratios of relapse, with subgroup analyses and meta-regression analyses to explore heterogeneity sources.
RESULTS: Fifteen papers and 16 comparisons of randomized trials involving 2735 patients with mood disorders were eligible for this meta-analysis. Adjunct self-help interventions had a small but significant effect on reducing the relapse rates of major depressive disorder (pooled risk ratio: 0.78, 95% confidence interval (CI): 0.66-0.92, P = 0.0032, NNT = 11), and were marginally better in bipolar disorder (pooled risk ratio: 0.62, 95% CI: 0.40-0.97, P = .0344, NNT = 12), as compared to treatment as usual (TAU). No subgroup difference was found based on intervention components, settings, delivery method, or guidance levels. The average dropout rate for self-help interventions (18.9%) did not significantly differ from TAU dropout rates. The examination of treatment adherence was highly variable, precluding definitive conclusions.
CONCLUSIONS: Self-help interventions demonstrate a modest preventative effect on relapse in mood disorders, despite low to very low certainty. Future research is essential to identify which elements of self-help interventions are most effective.
METHODS: We systematically reviewed the pertinent trial literature in Web of Science, EMBASE, PubMed, PsycINFO, and Cochrane databases until May 2024. Randomized controlled trials that examined the self-help interventions among individuals diagnosed with major depressive disorder (MDD) or bipolar disorder (BD) were included. The random-effects model computed the pooled risk ratios of relapse, with subgroup analyses and meta-regression analyses to explore heterogeneity sources.
RESULTS: Fifteen papers and 16 comparisons of randomized trials involving 2735 patients with mood disorders were eligible for this meta-analysis. Adjunct self-help interventions had a small but significant effect on reducing the relapse rates of major depressive disorder (pooled risk ratio: 0.78, 95% confidence interval (CI): 0.66-0.92, P = 0.0032, NNT = 11), and were marginally better in bipolar disorder (pooled risk ratio: 0.62, 95% CI: 0.40-0.97, P = .0344, NNT = 12), as compared to treatment as usual (TAU). No subgroup difference was found based on intervention components, settings, delivery method, or guidance levels. The average dropout rate for self-help interventions (18.9%) did not significantly differ from TAU dropout rates. The examination of treatment adherence was highly variable, precluding definitive conclusions.
CONCLUSIONS: Self-help interventions demonstrate a modest preventative effect on relapse in mood disorders, despite low to very low certainty. Future research is essential to identify which elements of self-help interventions are most effective.
摘要：
背景：自助干预可能为传统护理提供可扩展的辅助手段，但是它们在预防复发方面的有效性还没有得到很好的证实。目的：本综述旨在评估其预防情绪障碍患者复发的有效性。
方法：我们系统回顾了WebofScience的相关试验文献，EMBASE,PubMed,PsycINFO,和Cochrane数据库，直到2024年5月。包括随机对照试验，这些试验检查了被诊断为重度抑郁症（MDD）或双相情感障碍（BD）的个体中的自助干预措施。随机效应模型计算了复发的合并风险比，通过亚组分析和荟萃回归分析探索异质性来源。
结果：15篇论文和16项随机试验的比较，涉及2735名情绪障碍患者，符合这项荟萃分析的条件。辅助自助干预对降低重度抑郁症的复发率有很小但显著的影响（合并风险比：0.78，95％置信区间（CI）：0.66-0.92，P=0.0032，NNT=11），并且在双相情感障碍中略有好转（合并风险比：0.62，95％CI：0.40-0.97，P=.0344，NNT=12），与常规治疗（TAU）相比。根据干预成分没有发现亚组差异，设置，交货方式,或指导水平。自助干预措施的平均辍学率（18.9％）与TAU辍学率没有显着差异。治疗依从性的检查是高度可变的，排除明确的结论。
结论：自助干预对情绪障碍的复发具有适度的预防作用，尽管确定性很低到很低。未来的研究对于确定自助干预措施的哪些要素最有效至关重要。
方法：我们系统回顾了WebofScience的相关试验文献，EMBASE,PubMed,PsycINFO,和Cochrane数据库，直到2024年5月。包括随机对照试验，这些试验检查了被诊断为重度抑郁症（MDD）或双相情感障碍（BD）的个体中的自助干预措施。随机效应模型计算了复发的合并风险比，通过亚组分析和荟萃回归分析探索异质性来源。
结果：15篇论文和16项随机试验的比较，涉及2735名情绪障碍患者，符合这项荟萃分析的条件。辅助自助干预对降低重度抑郁症的复发率有很小但显著的影响（合并风险比：0.78，95％置信区间（CI）：0.66-0.92，P=0.0032，NNT=11），并且在双相情感障碍中略有好转（合并风险比：0.62，95％CI：0.40-0.97，P=.0344，NNT=12），与常规治疗（TAU）相比。根据干预成分没有发现亚组差异，设置，交货方式,或指导水平。自助干预措施的平均辍学率（18.9％）与TAU辍学率没有显着差异。治疗依从性的检查是高度可变的，排除明确的结论。
结论：自助干预对情绪障碍的复发具有适度的预防作用，尽管确定性很低到很低。未来的研究对于确定自助干预措施的哪些要素最有效至关重要。
