【摘要】背景：心理干预越来越多地被讨论作为一种预防已经出现亚临床抑郁状态的成年人患上重度抑郁症 (MDD) 的方法。在这项个人参与者数据荟萃分析中，我们量化了预防干预措施对该人群中 MDD 发病的控制效果，并探索了效果调节因素。方法：在这项系统评价和个人参与者数据荟萃分析中，我们筛选了Metapsy研究领域内符合条件的研究全文，以寻找关于抑郁症心理干预的文章，这些文章从数据库建立到2023年5月1日，以英语、德语、西班牙语和荷兰语发表。我们纳入了随机试验的个人参与者数据，比较了心理干预与对照组对基线时有亚临床抑郁状态但没有MDD的成年人MDD发病的影响，并通过标准化诊断访谈确认。使用RoB 2工具评估偏倚风险。使用单阶段个体参与者数据荟萃分析分析了对MDD发病的影响（主要结果）和调节因素。进行了生存分析以检查对12个月内 MDD 发病时间的影响。我们让有相关生活经历的人参与研究设计和实施。这项研究已在PROSPERO注册，编号为 CRD42017058585。结果：42项符合条件的随机对照试验中有30项纳入我们的分析，共有7201名参与者（2227 [30.9%] 名男性、4957 [68.9%] 名女性，17 [0.2%] 名不愿报告性别）（3697名参与者接受了干预，3504名参与者接受了对照）。参与者的平均年龄为49.9岁（标准差19.2）。在3152名报告种族的参与者中，1608名（51.0%）是白人。五项研究的偏倚风险评级较高。心理干预与治疗后MDD发病率显著降低（发病率比 [IRR] 0.57 [95% CI 0.35–0.93]；τ2=0.29；18 项研究）、6个月内（0.58 [0.39–0.88]；τ2=0.11；18项研究）和12月内（0.67 [0.51–0.88]；τ2=0.05；19 项研究）有关。24个月时未观察到显著影响（IRR 1.16 [95% CI 0.66–2.03]；τ2=0.10；6 项研究）。与接受过心理治疗的人（0.92 [0.61–1.36]；p=0.029；七项研究）相比，未接受过心理治疗的人的预防效果更强（IRR 0.39 [95% CI 0.25–0.62]）。虽然没有发现总体线性关联，但基线抑郁（患者健康问卷-9）和焦虑症状（广泛性焦虑症-7）评分越高，MDD发病风险就越低。在研究层面，传递方式似乎对结果有缓和作用，电话会议比面对面、基于互联网和其他形式的传递方式更有效（p=0.002），尽管这仅基于两项电话会议研究和四项比较。其他因素（例如年龄）没有显示出显著的差异效应。解释：我们的研究结果表明，预防性心理干预对亚临床抑郁状态有效。制定干预措施以考虑参与者层面和研究层面的因素可能有助于增加此类干预措施对人口层面的影响。

      [Summary] Background: Psychological interventions are increasingly discussed as a method to prevent major depressive disorder (MDD) in adults who already experience subthreshold depressive symptoms. In this individual participant data meta-analysis, we quantify the effect of preventive interventions against control on MDD onset in this population, and explore effect modifiers. Methods: In this systematic review and individual participant data meta-analysis, we screened full-texts of eligible studies within the Metapsy research domain for articles on psychological interventions for depression, from database inception to May 1, 2023, published in English, German, Spanish, and Dutch. We included individual participant data of randomised trials comparing psychological interventions with a control group regarding their effects on MDD onset in adults with subthreshold depressive symptoms but no MDD at baseline, confirmed by standardised diagnostic interviews. Risk of bias was assessed using the RoB 2 tool. Effect on the onset of MDD (the primary outcome) and moderators were analysed using one-stage individual participant data meta-analysis. Survival analyses were conducted to examine effects on time to MDD onset within 12 months. We involved people with related lived experience in the study design and implementation. This study is registered with PROSPERO, CRD42017058585. Findings: 30 of 42 eligible randomised controlled trials with 7201 participants (2227 [30·9%] male, 4957 [68·9%] female, and 17 [0·2%] preferred not to report their sex) were included in our analysis (3697 participants had intervention and 3504 participants had control). The mean age of participants was 49·9 years (SD 19·2). Of the 3152 participants with reported ethnicity, 1608 (51·0%) were White. Five studies received a high risk of bias rating. Psychological interventions were associated with significantly reduced MDD incidence at post-treatment (incidence rate ratio [IRR] 0·57 [95% CI 0·35–0·93]; τ2=0·29; 18 studies), within 6 months (0·58 [0·39–0·88]; τ2=0·11; 18 studies), and within 12 months (0·67 [0·51–0·88]; τ2=0·05; 19 studies). No significant effect was observed at 24 months (IRR 1·16 [95% CI 0·66–2·03]; τ2=0·10; six studies). Preventive effects were stronger for individuals who had not previously had psychotherapy (IRR 0·39 [95% CI 0·25–0·62]) compared with those who had received psychotherapy before (0·92 [0·61–1·36]; p=0·029; seven studies). Although no overall linear association was identified, higher baseline depressive (Patient Health Questionnaire-9) and anxiety symptom (Generalized Anxiety Disorder-7) scores were associated with greater reductions in MDD onset risk. On the study level, delivery type appeared to moderate outcomes, with conference telephone calls being more effective than delivery via face-to-face, internet-based, and other formats (p=0·002), albeit based on only two studies of conference telephone calls with four comparisons. Other factors (eg, age) showed no significant differential effects. Interpretation: Our findings show the effectiveness of preventive psychological interventions for subthreshold depressive symptoms. Tailoring interventions to consider participant-level and study-level factors could help to increase the impact of such interventions on a population level.

      论文原文：Claudia Buntrock, Mathias Harrer, Antonia A Sprenger, Susan Illing, Masatsugu Sakata, Toshi A Furukawa, et al (2024). Psychological interventions to prevent the onset of major depression in adults: a systematic review and individual participant data meta-analysis. The Lancet - Psychiatry, Volume 11, Issue 12, Pages 990-1001, December 2024.

https://doi.org/10.1016/S2215-0366(24)00316-X