Nonpharmacological interventions to reduce posttraumatic stress disorder, depression, or anxiety symptoms after trauma: A systematic review and meta-analysis.

IF 3.7 2区 医学 Q2 CRITICAL CARE MEDICINE
Justin Solarczyk, Matt Ciminero, Sheila Sprague, Heather A Vallier, Saam Morshed
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引用次数: 0

Abstract

Background: Recent novel digital interventions may be transformative in overcoming persistent barriers to access in-person psychological therapies.

Objective: This study aimed to synthesize evidence from randomized controlled trials (RCTs) of nonpharmacological interventions that prevents or treats anxiety, depression, or posttraumatic stress disorder (PTSD) among civilians recovering from physical traumatic injury.

Methods: We searched PubMed, Embase, Web of Science, PsychINFO, Cochrane Central Register of Controlled Trials, and Google Scholar for articles since inception to December 28, 2023. We performed English-language RCTs of patients 18 years or older who sustained a physical injury and were assessed for symptoms of PTSD, depression, or anxiety within 1 year of injury. Dual reviewers performed screening for advancement to full-text review, data extraction, and final eligibility for systematic review and meta-analysis, and conflicts were resolved by the senior author. Meta-analysis used random effects. The primary outcome was standardized mean difference (SMD) between intervention and comparator groups.

Results: We identified 3,001 articles for title and abstract review. Overall, nonpharmacological interventions significantly prevented or treated PTSD (pooled SMD, -0.71; 95% confidence interval [CI], -1.06 to -0.36), depression (pooled SMD, -0.42; 95% CI, -0.68 to -0.17), and anxiety (pooled SMD, -0.69; 95% CI, -1.01 to -0.37). Cognitive behavioral therapy (CBT) was associated with decreased symptoms of PTSD (pooled SMD, -1.10; 95% CI, -1.54 to -0.66), depression (pooled SMD, -0.87; 95% CI, -1.22 to -0.52), and anxiety. Non-CBT significantly reduced anxiety (pooled SMD, -0.40; 95% CI, -0.74 to -0.07). Collaborative care, non-CBT, and digital treatments failed to reach significance for PTSD and depression.

Conclusion: Our systematic review and meta-analysis of RCTs suggest efficacy of CBT for PTSD, depression, and anxiety and non-CBT for anxiety, after physical trauma.

Level of evidence: Systematic Review and Meta-analysis; Level III.

减少创伤后应激障碍、抑郁或焦虑症状的非药物干预:一项系统回顾和荟萃分析
背景:最近的新型数字干预措施可能在克服获得面对面心理治疗的持续障碍方面具有变革性。目的:本研究旨在综合来自随机对照试验(rct)的证据,证明非药物干预可以预防或治疗平民身体创伤后应激障碍(PTSD)。方法:检索PubMed、Embase、Web of Science、PsychINFO、Cochrane Central Register of Controlled Trials和谷歌Scholar,检索自建刊至2023年12月28日的文章。我们对18岁或以上的身体损伤患者进行了英语随机对照试验,并在受伤后1年内评估了创伤后应激障碍、抑郁或焦虑的症状。双审稿人对论文进行全文评审、数据提取、最终系统评价和meta分析资格筛选,冲突由资深作者解决。荟萃分析采用随机效应。主要结局是干预组和比较组之间的标准化平均差异(SMD)。结果:我们确定了3,001篇文章进行标题和摘要审查。总体而言,非药物干预可显著预防或治疗PTSD(综合SMD, -0.71;95%可信区间[CI], -1.06 ~ -0.36),抑郁(合并SMD, -0.42;95% CI, -0.68至-0.17)和焦虑(综合SMD, -0.69;95% CI, -1.01 ~ -0.37)。认知行为疗法(CBT)与PTSD症状减轻相关(综合SMD, -1.10;95% CI, -1.54 ~ -0.66),抑郁(综合SMD, -0.87;95% CI, -1.22至-0.52)和焦虑。非cbt显著降低焦虑(综合SMD, -0.40;95% CI, -0.74 ~ -0.07)。协作治疗、非cbt和数字化治疗对创伤后应激障碍和抑郁症没有显著意义。结论:我们对随机对照试验的系统回顾和荟萃分析表明,身体创伤后,CBT对创伤后应激障碍、抑郁和焦虑有效,非CBT对焦虑有效。证据水平:系统评价和荟萃分析;第三层次。
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来源期刊
CiteScore
6.00
自引率
11.80%
发文量
637
审稿时长
2.7 months
期刊介绍: The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.
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