心理治疗老年抑郁症疗效的系统评价_《中国循证医学杂志》

作者：

王锋 , 吴红梅 , 黄昶荃 , 卢振产 , 董碧蓉

四川大学华西医院老年科（成都 610041）;

关键词：

心理治疗抑郁症老年人，系统评价

DOI：

10.7507/1672-2531.20080237

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价心理治疗对老年抑郁症的疗效。
方法　检索Cochrane图书馆临床对照试验资料库（1990 ～ 2007.8）、MEDLINE（1966 ～ 2007.8）、EMbase（1980 ～ 2007.8）、CBMdisc（1990 ～ 2007.8）中所有心理治疗老年抑郁症的随机对照试验（RCT），根据纳入和排除标准筛选文献、提取资料和进行质量评价，并用RevMan4.2 软件对数据进行Meta 分析。
结果　共纳入10个RCT。与空白对照比较，Meta分析显示心理治疗在减少抑郁评分方面有效［SMD= – 0.63，95%CI（– 0.84，– 0.42）］。亚组分析显示认知行为治疗、怀旧治疗和一般心理治疗均优于空白对照［SMD= – 0.70, 95%CI（ – 1.12，– 0.27）；SMD= – 0.54，95%CI（– 0.81，– 0.26），SMD= – 0.84，95%CI（– 1.34，– 0.34）］。然而心理治疗作为一种辅助治疗并不能明显增加抗抑郁药物的疗效［SMD= – 0.35，95%CI （– 0.74， 0.05）］。在改善抑郁症状方面认知行为治疗与怀旧治疗没有差别［SMD= 0.13，95%CI （– 0.30， 0.56）］。使用心理治疗组与未使用心理治疗组的失访率差异无统计学意义［RR= 1.03，95%CI（0.55，1.94）］。
结论　各种形式的心理治疗对老年抑郁症的治疗都有效。但是作为抗抑郁药物的一种辅助治疗，心理治疗并不能够增加抗抑郁药物的疗效。

引用本文： 王锋,吴红梅,黄昶荃,卢振产,董碧蓉. 心理治疗老年抑郁症疗效的系统评价. 中国循证医学杂志, 2008, 08(12): 1079-1085. doi: 10.7507/1672-2531.20080237 复制

1.	中华医学会精神科学分会. 中国抑郁障碍防治指南. 2003.
2.	赵瑛, 肖世富, 夏斌, 等. 主编. 老年神经精神病学. 上海: 第二军医大学出版社, 2005, 705-715.
3.	闫芳, 李淑然. 老年抑郁症的发病率及其随访研究. 中国心理卫生杂志, 2000, 14(6): 392-394.
4.	闫芳, 李淑然, 刘津, 等. 老年期痴呆和老年抑郁症的流行病学调查. 中华医学杂志, 2002, 82(15): 20-23.
5.	Baldwin RC, Anderson D, Black S, et al. Guideline for the management of late-life depression in primary care. Int J Geriatr Psychiatry, 2003, 18: 829-838.
6.	Van Schaik DJ, Klijn AF, VanHout HP, et al. Patients’ preferences in the treatment of depressive disorder in primary care. Gen Hosp Psychiatry, 2004, 26: 184-189.
7.	Klaus Grawe. Chief Editor. Psychological therapy. Toronto: Hogrefe ＆ Huber Publishers, 2004.
8.	Bartels SJ, Coakley EH, Zubritsky C, et al. Improving access to geriatric mental health services: a randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use. Am J Psychiatry, 2004, 161: 1455-1462.
9.	Miller MD, Wolfson L, Frank E, et al. Using interpersonal psychotherapy (IPT) in a combined p sychotherapy/medication research protocol with depressed elders. A descriptive report with case vignettes. J Psychother Pract Res, 1997, 7: 47-55.
10.	Jones C, Griffiths RD, Humphris G, et al. Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med, 2001, 29(3): 573-580.
11.	McCloskey JC, Bulechek GM, Donahue W. Nursing interventions core to specialty practice. Nurs Outlook, 1998, 46(2): 67-76.
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14.	Beth A, Mastel S, Judith MF, et al. Improving Depressive Symptoms in Community-Dwelling Older Adults. Journal of Gerontological Nursing, 2007, 33(5): 13-19.
15.	Wang JJ, Hsu YC, Cheng SF. The effects of reminiscence in promoting mental health of Taiwanese elderly. International Journal of Nursing Studies, 2005, 42(1): 31-36.
16.	Serrano JP, Latorre JM, Gatz M, et al. Life review therapy using autobiographical retrieval practice for older adults with depressive symptomatology. Psychology and Aging, 2004, 19(2): 272-277.
17.	Arean PA, Perri MG, Nezu AM, et al. Comparative effectiveness of social problem-solving therapy and reminiscence therapy as treatments for depression in older adults. J Consult Clin Psychol, 1993, 61(6): 1003-1010.
18.	Lynch TR, Morse JQ, Mendelson T, et al. Dialectical behavior therapy for depressed older adults: A randomized pilot study. Am J Geriatr Psychiatry, 2003, 11(1): 33-45.
19.	Thompson LW, Coon DW, Gallagher TD, et al. Comparison of desipramine and cognitive/behavioral therapy in the treatment of elderly outpatients with mild-to-moderate depression. Am J Geriatr Psychiatry, 2001, 9(3): 225-240.
20.	Scogin F, Jamison C, Gochneaur K. Comparative efficacy of cognitive and behavioral bibliotherapy for mildly and moderately depressed older adults. J Consult Clin Psychol, 1989, 57(3): 403-407.
21.	Beutler LE, Scogin F, Kirkish P, et al. Group cognitive therapy and alprazolam in the treatment of depression in older adults. J Consult Clin Psychol, 1987, 55(4): 550-556.
22.	Steuer JL, Mintz J, Hammen CL, et al. Cognitive-behavioral and psychodynamic group psychotherapy in treatment of geriatric depression. J Consult Clin Psychol, 1984, 52(2): 180-189.
23.	Schulberg HC, Post EP, Raue PJ, et al. Treating late-life depression with interpersonal psychotherapy in the primary care sector. Int J Geriatr Psychiatry, 2007, 22(2): 106-114.
24.	van Schaik A, van Marwijk H, Ader H, et al. Interpersonal psychotherapy for elderly patients in primary care. Am J Geriatr Psychiatry, 2006, 14(9): 777-786.
25.	张继志译. 去甲替林和人际心理治疗作为复发重性抑郁的维持治疗: 59岁以上患者的随机对照试验. 美国医学会杂志中文版, 2000, 19(2): 66-68.
26.	Lenze EJ, Mazumdar S, Begley AE, et al. Combined pharmacotherapy and psychotherapy as maintenance treatment for late-life depression: Effects on social adjustment. Am J Psychiatry, 2002, 159(3): 466-468.
27.	Shah A, Odutoye K, De T. Depression in acutely medically ill elderly inpatients: A pilot study of early identification and intervention by formal psychogeriatric consultation. J Affect Disord, 2001, 62(3): 233-240.
28.	Reynolds CF, Miller MD, Pasternak RE, et al. Treatment of bereavement-related major depressive episodes in later life: a controlled study of acute and continuation treatment with nortriptyline and interpersonal psychotherapy. Am J Psychiatry, 1999, 156(2): 202-208.
29.	Jones ED. Reminiscence therapy for older women with depression. Effects of nursing intervention classification in assisted-living longterm care. J Gerontol Nurs, 2003, 29(7): 26-33; quiz 56-57.
30.	Chao SY, Liu HY, Wu CY, et al. The effects of group reminiscence therapy on depression, self esteem, and life satisfaction of elderly nursing home residents. J Nurs Res, 2006, 14(1): 36-45.

1. 中华医学会精神科学分会. 中国抑郁障碍防治指南. 2003.
2. 赵瑛, 肖世富, 夏斌, 等. 主编. 老年神经精神病学. 上海: 第二军医大学出版社, 2005, 705-715.
3. 闫芳, 李淑然. 老年抑郁症的发病率及其随访研究. 中国心理卫生杂志, 2000, 14(6): 392-394.
4. 闫芳, 李淑然, 刘津, 等. 老年期痴呆和老年抑郁症的流行病学调查. 中华医学杂志, 2002, 82(15): 20-23.
5. Baldwin RC, Anderson D, Black S, et al. Guideline for the management of late-life depression in primary care. Int J Geriatr Psychiatry, 2003, 18: 829-838.
6. Van Schaik DJ, Klijn AF, VanHout HP, et al. Patients’ preferences in the treatment of depressive disorder in primary care. Gen Hosp Psychiatry, 2004, 26: 184-189.
7. Klaus Grawe. Chief Editor. Psychological therapy. Toronto: Hogrefe ＆ Huber Publishers, 2004.
8. Bartels SJ, Coakley EH, Zubritsky C, et al. Improving access to geriatric mental health services: a randomized trial comparing treatment engagement with integrated versus enhanced referral care for depression, anxiety, and at-risk alcohol use. Am J Psychiatry, 2004, 161: 1455-1462.
9. Miller MD, Wolfson L, Frank E, et al. Using interpersonal psychotherapy (IPT) in a combined p sychotherapy/medication research protocol with depressed elders. A descriptive report with case vignettes. J Psychother Pract Res, 1997, 7: 47-55.
10. Jones C, Griffiths RD, Humphris G, et al. Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med, 2001, 29(3): 573-580.
11. McCloskey JC, Bulechek GM, Donahue W. Nursing interventions core to specialty practice. Nurs Outlook, 1998, 46(2): 67-76.
12. Bulechek GM, McCloskey J. All users of NIC encouraged to submit new interventions, suggest revisions. Iowa Intervention Project Research Team. Image J Nurs Sch, 1997, 29(1): 10.
13. Paul DR, Judith A, Tomhave ZJ. Self-Management Therapy and Educational Group Therapy for Depressed Elders. Cognitive Therapy and Research, 2000, 24(1): 99-119.
14. Beth A, Mastel S, Judith MF, et al. Improving Depressive Symptoms in Community-Dwelling Older Adults. Journal of Gerontological Nursing, 2007, 33(5): 13-19.
15. Wang JJ, Hsu YC, Cheng SF. The effects of reminiscence in promoting mental health of Taiwanese elderly. International Journal of Nursing Studies, 2005, 42(1): 31-36.
16. Serrano JP, Latorre JM, Gatz M, et al. Life review therapy using autobiographical retrieval practice for older adults with depressive symptomatology. Psychology and Aging, 2004, 19(2): 272-277.
17. Arean PA, Perri MG, Nezu AM, et al. Comparative effectiveness of social problem-solving therapy and reminiscence therapy as treatments for depression in older adults. J Consult Clin Psychol, 1993, 61(6): 1003-1010.
18. Lynch TR, Morse JQ, Mendelson T, et al. Dialectical behavior therapy for depressed older adults: A randomized pilot study. Am J Geriatr Psychiatry, 2003, 11(1): 33-45.
19. Thompson LW, Coon DW, Gallagher TD, et al. Comparison of desipramine and cognitive/behavioral therapy in the treatment of elderly outpatients with mild-to-moderate depression. Am J Geriatr Psychiatry, 2001, 9(3): 225-240.
20. Scogin F, Jamison C, Gochneaur K. Comparative efficacy of cognitive and behavioral bibliotherapy for mildly and moderately depressed older adults. J Consult Clin Psychol, 1989, 57(3): 403-407.
21. Beutler LE, Scogin F, Kirkish P, et al. Group cognitive therapy and alprazolam in the treatment of depression in older adults. J Consult Clin Psychol, 1987, 55(4): 550-556.
22. Steuer JL, Mintz J, Hammen CL, et al. Cognitive-behavioral and psychodynamic group psychotherapy in treatment of geriatric depression. J Consult Clin Psychol, 1984, 52(2): 180-189.
23. Schulberg HC, Post EP, Raue PJ, et al. Treating late-life depression with interpersonal psychotherapy in the primary care sector. Int J Geriatr Psychiatry, 2007, 22(2): 106-114.
24. van Schaik A, van Marwijk H, Ader H, et al. Interpersonal psychotherapy for elderly patients in primary care. Am J Geriatr Psychiatry, 2006, 14(9): 777-786.
25. 张继志译. 去甲替林和人际心理治疗作为复发重性抑郁的维持治疗: 59岁以上患者的随机对照试验. 美国医学会杂志中文版, 2000, 19(2): 66-68.
26. Lenze EJ, Mazumdar S, Begley AE, et al. Combined pharmacotherapy and psychotherapy as maintenance treatment for late-life depression: Effects on social adjustment. Am J Psychiatry, 2002, 159(3): 466-468.
27. Shah A, Odutoye K, De T. Depression in acutely medically ill elderly inpatients: A pilot study of early identification and intervention by formal psychogeriatric consultation. J Affect Disord, 2001, 62(3): 233-240.
28. Reynolds CF, Miller MD, Pasternak RE, et al. Treatment of bereavement-related major depressive episodes in later life: a controlled study of acute and continuation treatment with nortriptyline and interpersonal psychotherapy. Am J Psychiatry, 1999, 156(2): 202-208.
29. Jones ED. Reminiscence therapy for older women with depression. Effects of nursing intervention classification in assisted-living longterm care. J Gerontol Nurs, 2003, 29(7): 26-33; quiz 56-57.
30. Chao SY, Liu HY, Wu CY, et al. The effects of group reminiscence therapy on depression, self esteem, and life satisfaction of elderly nursing home residents. J Nurs Res, 2006, 14(1): 36-45.

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心理治疗老年抑郁症疗效的系统评价

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《中国循证医学杂志》

心理治疗老年抑郁症疗效的系统评价

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