Objective

Depression and anxiety cause a high burden of disease and have high relapse rates (39%-72%). This meta-analysis systematically examined effectiveness of relapse prevention strategies on risk of and time to relapse in youth who remitted.

Method

PubMed, PsycInfo, Embase, Cochrane, and ERIC databases were searched up to June 15, 2021. Eligible studies compared relapse prevention strategies to control conditions among youth (mean age 13-25 years) who were previously depressed or anxious or with ≥30% improvement in symptoms. Two reviewers independently assessed titles, abstracts, and full texts; extracted study data; and assessed risk of bias and overall strength of evidence. Random-effects models were used to pool results, and mixed-effects models were used for subgroup analyses. Main outcome was relapse rate at last follow-up (PROSPERO ID: CRD42020149326).

Results

Of 10 randomized controlled trials (RCTs) that examined depression, 9 were eligible for analysis: 4 included psychological interventions (n = 370), 3 included antidepressants (n = 80), and 2 included combinations (n = 132). No RCTs for anxiety were identified. Over 6 to 75 months, relapse was half as likely following psychological treatment compared with care as usual conditions (k = 6; odds ratio 0.56, 95% CI 0.31 to 1.00). Sensitivity analyses including only studies with ≥50 participants (k = 3), showed similar results. Over 6 to 12 months, relapse was less likely in youth receiving antidepressants compared with youth receiving pill placebo (k = 3; OR 0.29, 95% CI 0.10 to 0.82). Quality of studies was suboptimal.

Conclusion

Relapse prevention strategies for youth depression reduce risk of relapse, although adequately powered, high-quality RCTs are needed. This finding, together with the lack of RCTs on anxiety, underscores the need to examine relapse prevention in youth facing these common mental health conditions.

中文翻译：

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荟萃分析：缓解青少年和年轻人抑郁和焦虑的复发预防策略

客观的

抑郁和焦虑导致疾病负担高，复发率高（39%-72%）。这项荟萃分析系统地检查了复发预防策略对病情缓解的年轻人复发风险和复发时间的有效性。

方法

搜索了截至 2021 年 6 月 15 日的 PubMed、PsycInfo、Embase、Cochrane 和 ERIC 数据库。符合条件的研究将复发预防策略与以前抑郁或焦虑或≥30% 的年轻人（平均年龄 13-25 岁）的控制条件进行了比较改善症状。两名审稿人独立评估标题、摘要和全文；提取的研究数据；并评估了偏倚风险和整体证据强度。随机效应模型用于汇总结果，混合效应模型用于亚组分析。主要结果是最后一次随访时的复发率（PROSPERO ID：CRD42020149326）。

结果

在 10 项检查抑郁症的随机对照试验 (RCT) 中，9 项符合分析条件：4 项包括心理干预 (n = 370)，3 项包括抗抑郁药 (n = 80)，2 项包括组合 (n = 132)。没有确定关于焦虑的随机对照试验。在 6 到 75 个月的时间里，与照常护理相比，心理治疗后复发的可能性是后者的一半（k = 6；比值比 0.56，95% CI 0.31 至 1.00）。仅包括 ≥ 50 名参与者 (k = 3) 的研究的敏感性分析显示出相似的结果。在 6 至 12 个月内，与接受安慰剂的青少年相比，接受抗抑郁药的青少年复发的可能性较小（k = 3；OR 0.29，95% CI 0.10 至 0.82）。研究质量欠佳。

结论

青少年抑郁症的复发预防策略可降低复发风险，但仍需要足够有力的高质量随机对照试验。这一发现，加上缺乏关于焦虑的随机对照试验，强调需要检查面临这些常见心理健康状况的青年的复发预防。