荟萃分析：低收入和中等收入国家青少年心理治疗干预措施的有效性

Meta-analysis: The Effectiveness of Youth Psychotherapy Interventions in Low- and Middle-Income Countries

<Journal of the American Academy of Child & Adolescent Psychiatry > 62 (8), 2023

【摘要】目的：由于大多数青少年心理疗法是在高收入国家开发和测试的，因此人们对其在低收入和中等收入国家（LMIC）的有效性或调节因素知之甚少。为了解决这一差距，我们对中低收入国家中患有多种精神疾病的青少年测试心理治疗的随机对照试验 (RCT) 进行了荟萃分析，并对候选主持人进行了测试。方法：我们检索了9个国际数据库，查找截至2021年1月发布的中低收入国家青少年心理治疗随机对照试验。这些随机对照试验针对的是青少年焦虑（包括创伤后应激障碍 [PTSD] 和强迫症）、抑郁、品行问题和注意力问题的加重症状。使用稳健的方差估计，我们估计了干预与控制条件下治疗后和随访时的汇总效应大小 (Hedges g)。结果：在确定的5,145篇文章中，有34篇文章（43篇治疗对照比较和4,176名参与者）符合方法学标准并被纳入。治疗后与缩尾异常值的总体汇总量（g）分别为1.01 (95% CI=0.72-1.29, p<.001) 和随访时的0.68 (95% CI=0.29-1.07, p=.003)。专业临床医生提供的干预措施明显优于非专业提供者提供的干预措施（g=1.59 vs 0.53），但所有针对行为问题的干预措施均由专业人员提供，针对内化问题的干预措施的差异（g=1.33 vs 0.53）并不显著。非本地制定的干预措施如果不适应当地情况，则比本地适应的干预措施更有效（g=2.31 vs 0.66），这突出表明需要进一步研究有效的适应措施。发现了显著的偏倚风险。结论：总体而言，中低收入国家青年心理治疗的综合效应明显大于最近可比的非中低收入国家荟萃分析，后者显示青年心理治疗的效应为中小。研究结果强调了中低收入国家青年心理治疗的潜在益处，以及需要更多随机对照试验和提高研究质量。

【关键词】全球心理健康；儿童和青少年心理治疗；文化适应；外行提供者；荟萃分析

[Abstract] Objective: Because most youth psychotherapies are developed and tested in high-income countries, relatively little is known about their effectiveness or moderators in low- and middle-income countries (LMICs). To address this gap, we conducted a meta-analysis of randomized controlled trials (RCTs) testing psychotherapies for youth with multiple psychiatric conditions in LMICs, and we tested candidate moderators. Method: We searched 9 international databases for RCTs of youth psychotherapies in LMICs published through January 2021. The RCTs targeted elevated symptoms of youth anxiety (including posttraumatic stress disorder [PTSD] and obsessive-compulsive disorder), depression, conduct problems, and attention problems. Using robust variance estimation, we estimated the pooled effect sizes (Hedges g) at posttreatment and follow-up for intervention vs control conditions. Results: Of 5,145 articles identified, 34 articles (with 43 treatment−control comparisons and 4,176 participants) met methodological standards and were included. The overall pooled g with winsorized outliers was 1.01 (95% CI = 0.72-1.29, p < .001) at posttreatment and 0.68 (95% CI = 0.29-1.07, p = .003) at follow-up. Interventions delivered by professional clinicians significantly outperformed those delivered by lay providers (g = 1.59 vs 0.53), but all interventions for conduct problems were delivered by professionals, and the difference for interventions targeting internalizing problems (g = 1.33 vs .53) was not significant. Interventions developed non-locally were more effective if they were not adapted to local contexts than if they were adapted locally (g = 2.31 vs 0.66), highlighting a need for further research on effective adaptations. Significant risk of bias was identified. Conclusion: Overall, pooled effects of youth psychotherapies in LMICs were markedly larger than those in recent comparable non-LMIC meta-analyses, which have shown small-to-medium effects for youth psychotherapies. Findings highlight the potential benefits of youth psychotherapies in LMICs, as well as a need for more RCTs and improved study quality.

[Key words] global mental health; child and adolescent psychotherapy; cultural adaptations; lay-providers; meta-analysis

论文原文：Katherine E. Venturo-Conerly, Danielle Eisenman, Akash R. Wasil, Daisy R. Singla, John R. Weisz (2023). Meta-analysis: The Effectiveness of Youth Psychotherapy Interventions in Low- and Middle-Income Countries. Journal of the American Academy of Child & Adolescent Psychiatry. Volume 62, Issue 8, August 2023, Pages 859-873.

https://doi.org/10.1016/j.jaac.2022.12.005  

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