抑郁症状是乳腺癌患者常见的合并症。运动和心理治疗等非药物疗法可以减轻抑郁症状，但是随机对照研究结果不一，证据尚无定论。

2019年2月16日，欧洲乳腺癌专科医师学会《乳腺》在线发表墨西哥国家公共卫生研究院的研究报告，对非药物疗法能否减少乳腺癌患者抑郁症状的随机对照研究进行了系统回顾和荟萃分析。

该研究系统回顾与荟萃分析对8个数据库2006～2017年以英语、葡萄牙语、西班牙语发表的乳腺癌患者非药物疗法随机对照研究文献进行检索，入选标准为：随机对照研究、以抑郁症状作为主要或次要结局、不包括药物干预、包括未干预对照组、至少30例非终末期乳腺癌患者、当时无精神疾病。通过随机效应模型，对各种非药物疗法进行荟萃分析，以及敏感性分析，对各个研究的异质性和发表偏倚进行评定。

结果，共计41项随机对照研究符合条件。总体而言，非药物疗法可以显著减轻抑郁症状，抑郁评分平均减少0.516（95%置信区间：-0.814～-0.218，异质性：96.2%）。

其中，抑郁评分平均（95%置信区间）：

心理疗法：-0.819（-1.608～-0.030，5项研究，异质性：91.53%）

社会支持：-0.426 (-1.151～+0.299，14项研究，异质性：98.03%）

艺术疗法：-0.091（-0.257～+0.074，2项研究，异质性：0.0%）

大笑疗法：-0.317（-0.849～+0.215，2项研究，异质性：41.27%）

运动疗法：-0.138（-0.322～+0.046，9项研究，异质性：30.5%）

伴侣疗法：-2.208（-5.036～+0.621，2项研究，异质性：97.37%）

正念疗法：-0.241（-0.412～-0.070，6项研究，异质性：28.6%）

瑜伽疗法：-0.305（-0.602～-0.007，5项研究，异质性：41.0%）

未见发表偏倚证据。

因此，该研究结果表明，心理疗法和心身疗法可以减轻乳腺癌女性的抑郁症状，对于大笑疗法和夫妻疗法有必要进一步研究。

相关阅读

Non-pharmacological therapies for depressive symptoms in breast cancer patients: Systematic review and meta-analysis of randomized clinical trials

HIGHLIGHTS

Psychotherapy and yoga may reduce depressive symptoms in breast cancer patients.

MBSR and imagery reduce depressive symptoms in postmenopausal patients.

Further evidence is needed for laughter and couple therapies.

OBJECTIVE: Depressive symptoms are common comorbidities among breast cancer (BC) patients. Non-pharmacological therapies (NPTs) such as exercise and psychotherapy may reduce depressive symptoms; however, the evidence is inconclusive. The objective of this study is to evaluate if NPTs reduce depressive symptoms among BC patients.

METHODS: A systematic review and meta-analysis of randomized clinical trials (RCTs) of NPTs for BC patients were performed. A literature search was conducted from eight databases in English, Portuguese and Spanish from 2006 to 2017. Inclusion criteria were: RCTs that evaluated depressive symptoms as a primary or secondary outcome that did not include pharmacological interventions and did include a non-intervened control group, with at least 30 participants in non-terminal BC stage with no current psychiatric illness. A meta-analysis for each NPT was performed with DerSimonian and Laird's method for the random effects model. Sensitivity analyses were conducted. Heterogeneity and publication bias were assessed.

RESULTS: A total of 41 eligible RCTs were identified. Overall, NPTs significantly reduced depressive symptoms (Summary standardized mean difference (SMD) = -0.516; 95%CI: -0.814, -0.218; I2 = 96.2). Of the types of NPTs, psychotherapy significantly reduced depressive symptoms (Summary SMD = -0.819; 95% CI: -1.608, -0.030; I2 = 91.53). A significant difference emerged for Mindfulness (Summary SMD = -0.241; 95% CI: -0.412, -0.070; I2 = 28.6%) and yoga (Summary SMD = -0.305; 95% CI: -0.602, -0.007; I2 = 41.0%) when the heterogeneity was reduced. No evidence of publication bias was observed.

CONCLUSIONS: Psychotherapy and mind-body therapies may reduce depressive symptoms in women with BC. Laughter and couples therapy warrant attention in future studies.

KEYWORDS: Depressive symptoms, Breast cancer, Non-pharmacological, Therapeutics

DOI: 10.1016/j.breast.2019.01.006

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抑郁相关测评

抑郁筛查量表（PHQ-9）
简明精神问题量表（BPRS）
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