标准化的效果大小远远不是"标准化":抑郁症心理治疗元分析中的初步和经验说明
Mathias Harrer1,2, Clara Miguel1, Yan Luo3
1Department of Clinical, Neuro and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands.
PLOS mental health
|February 9, 2026
概括
计算标准化平均差异 (SMD) 的不同方法在元分析中显著改变了心理治疗效果大小. 这种变化会影响治疗效益的解释,特别是在抑郁症心理治疗中.
科学领域:
- 心理学和精神病学 心理学和精神病学
- 生物统计学 生物统计学
- 临床研究方法论 临床研究方法论
背景情况:
- 标准化平均差异 (SMD) 对于评估心理治疗和进行元分析至关重要.
- 关于从随机试验中精确计算SMDs存在缺乏共识.
- 不同的SMD计算方法可能会损害元分析中的标准化目的.
研究的目的:
- 调查不同SMD计算方法对抑郁症心理治疗的元分析效果大小估计的影响.
- 为了比较心理治疗与对照对照心理治疗与药物治疗对照效果估计的变化.
- 确定预测差异效应估计的研究特征.
主要方法:
- 从443个随机试验 (48,221名参与者) 的数据库中计算出各种SMD版本 (终点和变化得分),将抑郁症心理治疗与药物治疗和非活性对照进行比较.
- 对每个SMD变体进行了聚合数据元分析,假设前后相关性从0.2到0.8.8.
- 利用双变量元分析来检查SMD变体之间的关系,并调查差异估计的预测因素.
主要成果:
- 基于SMD计算方法,心理治疗与对照组的聚合效应估计差异很大 (SMD = 0.651.24).
- 心理治疗与药物治疗之间的差异较小 (SMD = 0.050.14).
- 变化得分SMD与终点SMD有所不同,特别是高 (r=0.8) 或低 (r=0.2) 的前后相关性,在高效果大小的子领域有最大的差异.
结论:
- 在SMD计算方法中的差异可能导致心理治疗的效果大小估计显著不同.
- 选择SMD计算方法,特别是使用具有极端前后相关性的变化得分,深刻影响了元分析结果.
- 研究人员应该考虑优先考虑终点SMD和人口级标准化,以提高心理研究中的元分析可比性.
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