METHODS: We searched eight-databases, two trial registries (2011-November 2023). Randomised controlled trials (RCTs) of adults (≥18 years) with depression/anxiety diagnosis, reporting remission/change in symptom severity were eligible. Random effects meta-analyses were conducted for: short-(0-6 months), medium-(7-12 months), long-(13-24 months), and very long-term (≥25 months) follow-up. Quality was assessed with Cochrane RoB2 tool. PROSPERO registration: CRD42022380407.
RESULTS: Searches identified 7494 studies, 12 trials involving 13,531 participants were included; nine had low-risk of bias. CC was more effective than usual care for depression: dichotomous outcomes (short-term, 7 studies, relative risk (RR) 1.39, 95%CI 1.31, 1.48; medium-term, 6 studies, RR 1.35, 95%CI 1.28, 1.43); and continuous outcomes (short-term, 8 studies, standardised mean difference (SMD) -0.51, 95%CI -0.80, -0.23; medium-term, 8 studies, SMD -0.59, 95%CI -1.00, -0.17). CC was found to be effective at long-term (one study), but not at very long-term. Improvement in anxiety outcomes with CC (2 studies, 340 participants) reported up to 12-months; improvements in quality-of-life were not statistically significant (3 studies, 796 participants, SMD 0.62, 95%CI -0.10, 1.34).
CONCLUSIONS: Pooled estimates showed high heterogeneity.
CONCLUSIONS: In LMICs, CC was more effective than usual care for improving depression outcomes at short and medium-term follow-up. A similar improvement was found for anxiety outcomes, but evidence is limited.
方法:我们搜索了八个数据库,两个试验登记处(2011年至2023年11月)。成人(≥18岁)诊断为抑郁/焦虑的随机对照试验(RCT),报告缓解/症状严重程度的变化是合格的.进行了随机效应荟萃分析:短期(0-6个月),中期(7-12个月),长-(13-24个月),和非常长期(≥25个月)的随访。用CochraneRoB2工具评估质量。PROSPERO注册:CRD42022380407。
结果:搜索确定了7494项研究,纳入了12项试验,涉及13,531名参与者;9项有低偏倚风险。CC比常规治疗抑郁症更有效:二分法结果(短期,7研究,相对风险(RR)1.39,95CI1.31,1.48;中期,6研究,RR1.35,95CI1.28,1.43);和连续结果(短期,8研究,标准化平均差(SMD)-0.51,95CI-0.80,-0.23;中期,8研究,SMD-0.59,95CI-1.00,-0.17)。CC被发现是有效的长期(一项研究),但不是很长期的。CC改善焦虑结果(2项研究,340名参与者)报告长达12个月;生活质量的改善没有统计学意义(3项研究,796名参与者,SMD0.62,95CI-0.10,1.34)。
结论:集合估计显示高度异质性。
结论:在LMIC中,在短期和中期随访中,CC在改善抑郁结果方面比常规治疗更有效。焦虑结果也有类似的改善,但证据有限.