Preliminary evidence suggests beneficial effects of cognitive remediation in depression. An update of the current evidence is needed. The aim was to systematically assess the effectiveness of cognitive remediation in depression on three outcomes.

The meta-analysis was pre-registered on PROSPERO (CRD42019124316). PubMed, PsycINFO, Embase and Cochrane Library were searched on 2 February 2019 and 8 November 2020 for peer-reviewed published articles. We included randomized and non-randomized clinical trials comparing cognitive remediation to control conditions in adults with primary depression. Random-effects models were used to calculate Hedges' g, and moderators were assessed using mixed-effects subgroup analyses and meta-regression. Main outcome categories were post-treatment depressive symptomatology (DS), cognitive functioning (CF) and daily functioning (DF).

We identified 5221 records and included 21 studies reporting on 24 comparisons, with 438 depressed patients receiving cognitive remediation and 540 patients in a control condition. We found a small effect on DS (g = 0.28, 95% CI 0.09–0.46, I2 40%), a medium effect on CF (g = 0.60, 95% CI 0.37–0.83, I2 44%) and a small effect on DF (g = 0.22, 95% CI 0.06–0.39, I2 3%). There were no significant effects at follow-up. Confounding bias analyses indicated possible overestimation of the DS and DF effects in the original studies.

Cognitive remediation in depression improves CF in the short term. The effects on DS and DF may have been overestimated. Baseline depressive symptom severity should be considered when administering cognitive remediation.

初步证据表明认知矫正对抑郁症有有益作用。需要更新当前证据。目的是系统地评估抑郁症认知治疗对三种结果的有效性。

荟萃分析已在 PROSPERO (CRD42019124316) 上预注册。2019 年 2 月 2 日和 2020 年 11 月 8 日在 PubMed、PsycINFO、Embase 和 Cochrane Library 中搜索了经过同行评审的已发表文章。我们纳入了随机和非随机临床试验，比较认知矫正与控制条件对原发性抑郁症成人的影响。使用随机效应模型计算 Hedges' g，并使用混合效应亚组分析和元回归评估调节剂。主要结果类别是治疗后抑郁症状 (DS)、认知功能 (CF) 和日常功能 (DF)。

我们确定了 5221 条记录，并纳入了 21 项研究，报告了 24 项比较，其中 438 名抑郁症患者接受了认知治疗，540 名患者处于对照状态。我们发现对 DS 的影响较小 ( g = 0.28, 95% CI 0.09–0.46, I 2 40%)，对 CF 的影响中等 ( g = 0.60, 95% CI 0.37–0.83, I 2 44%) 和较小的影响对 DF 的影响 ( g = 0.22, 95% CI 0.06–0.39, I 2 3%)。随访无明显影响。混杂偏倚分析表明可能高估了原始研究中的 DS 和 DF 效应。

抑郁症的认知矫正可在短期内改善 CF。对 DS 和 DF 的影响可能被高估了。在进行认知治疗时，应考虑基线抑郁症状的严重程度。