BJPsych：心理社会干预可改善抑郁症及精神分裂症患者社会功能

　　近期《英国精神病学杂志》》(The British Journal of Psychiatry) 网络版发布的一项研究认为，在门诊及基层医疗单位中对抑郁症患者进行心理社会干预可有效的提高患者的社会功能，应与其他疗法联合应用以提高服务质量。

　　既往的研究认为，心理社会干预或可通过改善患者的社会功能，减轻中低收入国家（LAMI）的精神障碍疾病负担。但至今未进行过相关的系统综述研究。

　　本研究对心理社会干预对LAMI国家抑郁症及精神分裂症患者社会功能的改善进行了系统综述和荟萃分析。

　　研究选取2011年3月之前的相关数据，采用随机对照试验，将干预组与接受安慰剂或常规疗法的对照组进行比较。分别对抑郁症、精神分裂症及不同干预类型的随机影响试验进行了的荟萃分析。

　　共有24项试验达到选择标准，其中的21项试验数据完整，足以列入荟萃分析。11项抑郁症试验显示心理社会干预对社会功能的改善具有适度的积极影响（标准均数差SMD=0.46，95%CI 0.24-0.69，n=4009），10项精神分裂症试验显示社会心理干预对社会功能的改善起到显著的积极影响（SMD=0.84，95%CI 0.49-1.19，n=1671）。其中的7项试验质量较低，尽管排除这些试验后，分析的精确度在本质上有所下降，但排除这些试验后，社会心理干预对社会功能影响的大小和方向并无本质上的改变（SMD=0.89,95%CI 0.05-1.72，n=863）。

　　由于缺乏高质量的试验证据，且大量试验人群来自于中国住院病人，因此使精神分裂症试验结果的普遍性受到限制。故评价心理社会干预对精神分裂症患者社会功能的影响还需在门诊病人中进行更多高质量的试验研究。

与抑郁症相关的拓展阅读：

• EJPC：生活方式干预延缓抑郁症状进展
• Pain Medicine：初级护理患者的疼痛、慢性疾病、抑郁症与IL-6
• Lupus：血清肿瘤坏死因子-α水平与系统性红斑狼疮患者的生活质量和抑郁症状相关
• Eur J Prev Cardiol：生活方式干预延缓抑郁症状进展
• Am J Psychiatry：老年抑郁症转归的调节因素 更多信息请点击：有关抑郁症更多资讯

Effect of psychosocial interventions on social functioning in depression and schizophrenia: meta-analysis
Background
Psychosocial interventions may contribute to reducing the burden of mental disorders in low- and middle-income (LAMI) countries by improving social functioning, but the evidence has not been systematically reviewed.
Aims
Systematic review and meta-analysis of the effect of psychosocial interventions on social functioning in people with depression and schizophrenia in LAMI countries.
Method
Studies were identified through database searching up to March 2011. Randomised controlled trials were included if they compared the intervention group with a control group receiving placebo or treatment as usual. Random effects meta-analyses were performed separately for depressive disorders and schizophrenia and for each intervention type.
Results
Of the studies that met the inclusion criteria (n = 24), 21 had sufficient data to include in the meta-analysis. Eleven depression trials showed good evidence for a moderate positive effect of psychosocial interventions on social functioning (standardised mean difference (SMD) = 0.46, 95% CI 0.24–0.69, n = 4009) and ten schizophrenia trials showed a large positive effect on social functioning (SMD = 0.84, 95% CI 0.49–1.19, n = 1671), although seven of these trials were of low quality. Excluding these did not substantially affect the size or direction of effect, although the precision of the estimate was substantially reduced (SMD = 0.89, 95% CI 0.05–1.72, n = 863).
Conclusions
Psychosocial interventions delivered in out-patient and primary care settings are effective at improving social functioning in people with depression and should be incorporated into efforts to scale up services. For schizophrenia there is an absence of evidence from high-quality trials and the generalisabilty of the findings is limited by the over-representation of trials conducted in populations of hospital patients in China. More high-quality trials of psychosocial interventions for schizophrenia delivered in out-patient settings are needed.