摘要
目的探讨9种积极心理干预改善癌症幸存者抑郁情绪的效果。方法计算机检索PubMed、Web of Science、中国知网、万方等数据库,搜集积极心理干预改善抑郁的随机对照试验(RCT),检索时限从2000年1月至2021年5月。由两位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用Stata 14.2进行网状meta分析。结果共纳入28个RCTs,网状meta分析结果显示:与对照组比较,感恩干预[MD=-1.25,95%CI(-3.08,-0.58),P<0.0001]改善癌症幸存者抑郁效果最好,其次为接纳承诺疗法[MD=-2.19,95%CI(-4.24,-0.15),P=0.002]、正念认知疗法[MD=-2.13,95%CI(-3.19,-0.57),P=0.021]、积极心理治疗[MD=-1.24,95%CI(-4.24,-1.76),P=0.022]、人生回顾[MD=-1.77,95%CI(-3.09,-0.44),P=0.019]、正念减压疗法[MD=-1.87,95%CI(-3.26,-0.48),P=0.026]、回忆疗法[MD=-0.42,95%CI(-1.09,-0.25),P=0.047]与对照组比较,差异有统计学意义,希望疗法[MD=-1.09,95%CI(-4.84,2.66),P=0.215]、意义疗法[MD=-0.00,95%CI(-3.64,2.44),P=0.608]与对照组比较,差异无统计学意义。不同干预措施的概率图下面积排序分别为感恩干预(73.3%)>接纳承诺疗法(66.8%)>人生回顾(62.4%)>正念认知疗法(59.6%)>积极心理治疗(53.7%)>正念减压疗法(52.0%)>希望疗法(46.1%)>意义疗法(37.7%)>回忆疗法(33.6%)>常规心理护理(14.8%)。感恩干预在短期内改善癌症幸存者抑郁情绪最佳。结论感恩干预、正念减压疗法、正念认知疗法、接纳承诺疗法和积极心理治疗都可能是改善癌症幸存者抑郁情绪的最优疗法,具有推广价值。意义疗法、人生回顾、回忆疗法与希望疗法可能更加适用于姑息治疗患者,应依据患者病情选择合适的心理干预。
Objective To explore the effect of nine kinds of positive psychological intervention on improving depression in cancer survivors.Methods Randomized controlled trials(RCTs)of positive psychological intervention to improve depression were collected from PubMed,Web of Science,CNKI and Wanfang database during January 2000 to May 2021.After two reviewers independently screened the literature,extracted the data and evaluated the risk of bias in the included studies,a net meta-analysis was performed using Stata 14.2.Results A total of 28 RCTs were included,the results of mesh meta-analysis showed that:compared with the control group,gratitude intervention(MD=-1.25,95%CI[-3.08,-0.58],P<0.001)had the best effect on depression in cancer survivors,followed by acceptance and commitment therapy[MD=-2.19,95%CI(-4.24,-0.15),P=0.002],mindfulness based cognitive therapy[MD=-2.13,95%CI(-3.19,-0.57),P=0.021],positive psychological therapy[MD=-1.24,95%CI(-4.24,-1.76),P=0.022],life review[MD=-1.77,95%CI(-3.09,-0.44),P=0.019],mindfulness based stress reduction[MD=-1.87,95%CI(-3.26,-0.48),P=0.026],reminiscence therapy[MD=-0.42,95%CI(-1.09,-0.25),P=0.047)compared with the control group,hope therapy[MD=-1.09,95%CI(-4.84,2.66),P=0.215],meaning making intervention[MD=-0.00,95%CI(-3.64,2.44),P=0.608]and there was no significant difference compared with the control group;the order of surface under the cumulative ranking for different interventions were gratitude intervention(73.3%)>acceptance and commitment therapy(66.8%)>life review(62.4%)>mindfulness based cognitive therapy(59.6%)>positive psychological therapy(53.7%)>mindfulness based stress reduction(52.0%)>hope therapy(46.1%)>meaning making intervention(37.7%)>reminiscence therapy(33.6%)>routine psychological nursing(14.8%).Gratitude intervention was the best in improving depression in cancer survivors in the short term.Conclusion The evidence suggests that gratitude intervention,mindfulness based stress reduction,cognitive therapy with mindfulness,acceptance commitment therapy and positive psychotherapy may be the best therapy to improve the depression of cancer survivors,which has the value of promotion.Meaning therapy,life review,recall therapy and hope therapy may be more suitable for palliative care patients.Appropriatepsychological intervention should be selected according to the patient’s condition.
作者
叶金婵
朱娓
孔维蕾
马静
苏建萍
YE Jinchan;ZHU Wei;KONG Weilei;MA Jing;SU Jianping(School of Nursing,Xinjiang Medical University,Xinjiang Uygur Autonomous Region,Urumqi 830017,China;Department of Lymphoma,Cancer Hospital Affiliated to Xinjiang Medical University,Xinjiang Uygur Autonomous Region,Urumqi 830002,China;Hospice,Cancer Hospital Affiliated to Xinjiang Medical University,Xinjiang Uygur Autonomous Region,Urumqi 830002,China)
出处
《中国医药导报》
CAS
2022年第16期165-169,共5页
China Medical Herald
基金
新疆维吾尔自治区自然科学基金项目(2020D01 C154)。
