Evidence from high-income countries on the effectiveness of psychosocial interventions to improve mental health, wellbeing and quality of life for adults living with HIV: a systematic review and meta-analysis

IF 4.6 1区 医学 Q2 IMMUNOLOGY
Ada R. Miltz, Janey Sewell, Fumiyo Nakagawa, Sophia M. Rein, Lorraine Sherr, Alison Rodger, Andrew N. Phillips, Sanne vanLuenen, Nadia Garnefski, Vivian Kraaij, Colette J. Smith, Valentina Cambiano, Fiona C. Lampe
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引用次数: 0

Abstract

Introduction

There is a need to synthesize recent evidence on the effectiveness of psychosocial interventions to improve mental health, quality of life and wellbeing in adults living with HIV in high-income countries. A systematic review and meta-analysis was conducted to address this research gap.

Methods

Medline, Embase, Psychinfo and Web of science were searched (from 2008 to December 2023). In total, 67 randomized controlled trials (RCTs) of psychosocial intervention among adults living with HIV in high-income countries were eligible.

Results

In the meta-analysis, there was an overall positive effect of interventions on reducing depression (N = 40; standardized mean difference [SMD] −0.19 [95% CI: −0.29, −0.10]), anxiety (N = 15; SMD −0.12 [−0.23, −0.02]), stress (N = 13; SMD −0.22 [−0.41, −0.04]), and other measures of poor wellbeing (N = 19; SMD −0.18 [−0.35, −0.02]) and increasing levels of coping/self-efficacy (N = 8; SMD 0.17 [0.04, 0.31]). For depression, interventions that used symptom screening above a threshold score to identify eligible individuals were more effective than those without such an eligibility criterion (SMD −0.29 vs. -0.10, p = 0.023). Interventions compared to standard care controls had a greater effect on depression versus interventions compared to not standard care controls, when the latter category included standard care controls that received intentional support (SMD -0.28 vs. -0.11, p = 0.035). There was also weak evidence of an overall positive effect on: reducing stigma (N = 7; SMD −0.17 [−0.35, 0.02]), and improving social support/participation (N = 6; SMD 0.17 [−0.02, 0.35]), mental health quality of life (N = 12; SMD 0.09 [−0.01, 0.19]), physical health quality of life (N = 11; SMD 0.07 [−0.02, 0.16]) and quality of social life (N = 6; SMD 0.10 [−0.04, 0.24]). There was no evidence found for an effect on loneliness, although data were limited.

Discussion

Pooled effect estimates were small or small tomoderate. In line with previous literature, there was no evidence of differential effects on depression according to the intervention type (psychotherapeutic vs. other).

Conclusions

Evidence from RCTs suggest that psychosocial interventions are effective in improving mental health for adults living with HIV in high-income settings. Interventions were more effective at reducing depression when targeted at those screening positive for mental health symptoms and when compared to a standard care only control group. There was some evidence that longer, more intensive interventions were more effective.

Abstract Image

来自高收入国家的关于社会心理干预措施改善艾滋病毒感染者成人心理健康、福祉和生活质量有效性的证据:系统审查和荟萃分析
有必要综合最近关于社会心理干预措施在改善高收入国家成人艾滋病毒感染者的精神健康、生活质量和福祉方面的有效性的证据。进行了系统回顾和荟萃分析以解决这一研究空白。方法检索2008年至2023年12月的Medline、Embase、Psychinfo和Web of science。总共有67项针对高收入国家成年艾滋病毒感染者的社会心理干预的随机对照试验(rct)符合条件。结果在meta分析中,干预措施对减少抑郁有总体积极作用(N = 40;标准化平均差[SMD] - 0.19 [95% CI: - 0.29, - 0.10]),焦虑(N = 15;SMD = - 0.12[- 0.23, - 0.02]),应力(N = 13;SMD - 0.22[- 0.41, - 0.04]),以及其他健康状况不佳的指标(N = 19;SMD - 0.18[- 0.35, - 0.02])和应对/自我效能感水平的提高(N = 8;SMD = 0.17[0.04, 0.31])。对于抑郁症,使用高于阈值评分的症状筛查来识别合格个体的干预措施比没有这种资格标准的干预措施更有效(SMD - 0.29 vs. -0.10, p = 0.023)。与标准护理对照相比,干预措施对抑郁症的影响更大,而与非标准护理对照相比,后者包括接受有意支持的标准护理对照(SMD -0.28比-0.11,p = 0.035)。也有微弱的证据表明,总体上积极的影响:减少耻辱(N = 7;SMD = - 0.17[- 0.35, 0.02]),改善社会支持/参与(N = 6;SMD = 0.17[−0.02,0.35]),心理健康生活质量(N = 12;SMD为0.09[−0.01,0.19]),身体健康生活质量(N = 11;SMD = 0.07[−0.02,0.16])和社会生活质量(N = 6;SMD 0.10[−0.04,0.24])。虽然数据有限,但没有证据表明它对孤独感有影响。讨论汇总效应估计很小或小到中等。与之前的文献一致,没有证据表明干预类型(心理治疗与其他)对抑郁症有不同的影响。结论:来自随机对照试验的证据表明,社会心理干预在改善高收入环境中成年艾滋病毒感染者的心理健康方面是有效的。当针对那些心理健康症状筛查呈阳性的人群,以及与只接受标准治疗的对照组相比,干预措施在减少抑郁方面更有效。有证据表明,时间更长、强度更大的干预措施更有效。
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来源期刊
Journal of the International AIDS Society
Journal of the International AIDS Society IMMUNOLOGY-INFECTIOUS DISEASES
CiteScore
8.60
自引率
10.00%
发文量
186
审稿时长
>12 weeks
期刊介绍: The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.
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