Meta-analysis of the intervention effect of self-compassion training on depressive symptoms and its influencing factors
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摘要:
目的 检索近年来公开发表的自悯训练干预抑郁症状的随机对照试验，采用meta分析方法探究自悯训练对于抑郁症状的效果及其影响因素。 方法 计算机检索Web of Science、Embase、the Cochrane Library、PubMed、知网(CNKI)、万方和维普(VIP)等数据库，检索时限为建库至2021年5月。收集所有自悯训练干预抑郁症状的随机对照试验，由2名独立的研究者根据纳入与排除标准筛选文献，并运用CMA V3.3软件进行效应量合并以及调节效应分析。 结果 共计纳入文献28篇(n=3 312)，meta分析显示合并效应量g=0.423(95% CI：0.291~0.555，P < 0.001)，填补发表偏倚后g=0.296(95% CI：0.143~0.449，P < 0.001)；调节效应分析表明，仅考虑单个变量的调节作用时，干预效果受到国家地域、参与者女性比例、脱落率3个变量的影响(均P < 0.05)；在多元回归模型中，对照组类型、研究质量类型对干预效果的调节作用显著(均P < 0.05)，其他调节变量的调节作用不显著。 结论 自悯训练项目对于抑郁症状的干预效果较好，未来可以在中国文化背景下扩大人群范围继续探索自悯训练的干预效果。 Abstract:Objective To retrieve recently published randomised controlled trials of self-compassion training on depressive symptoms and explore the effect of self-compassion training on depressive symptoms and its influencing factors using meta-analysis. Methods Databases, such as Web of Science, Embase, the Cochrane Library, PubMed, China National Knowledge Infrastructure (CNKI), Wanfang and VIP, were searched. The retrieval time limit was from the establishment of the database to May 2021. All randomised controlled trials with self-compassion training intervening with depressive symptoms were collected. Two independent investigators screened the literature in accordance with the inclusion and exclusion criteria and CMA V3.3 software was used to combine the effect size and moderate effect analysis. Results A total of 28 articles (n=3 312) were included. Meta-analysis showed that the combined effect size was g=0.423 (95%CI: 0.291-0.555, P < 0.001), and after the publication bias was filled, g=0.296 (95%CI: 0.143-0.449, P < 0.001). Moderating effect analysis showed that when considering only the moderating effect of a single variable, the intervention effect was affected by country and region, proportion of female participants and dropout rate (all P < 0.05). In the multiple regression model, the type of control group and research quality showed significant moderating influence on the intervention effect (all P < 0.05), whereas the other moderating variables were not significant. Conclusion The self-compassion training program has a good intervention effect on depressive symptoms. In the future, we can expand the scope of the population to continue the exploration of the intervention effect of self-compassion training in the context of Chinese culture. -
Key words:
- Self-compassion training /
- Depression /
- Intervention /
- Meta-analysis
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表 1 纳入文献的基本特征
Table 1. Basic informations of the included research
第一作者及年份 国家/地区 样本量 平均年龄(岁) 研究对象 干预形式 干预措施 质量评分 BEAUMONT E, 2016[16] 英国 17 42.31 接受创伤后应激障碍治疗的群体 团体 怜悯聚焦疗法+认知行为疗法 2 SHAHAR B, 2015[17] 以色列 38 30.62 自我批评得分 > 30分 团体 慈心禅 2 KO C M, 2018[18] 美国 58 19.80 大学生 团体 同情心研讨会 2 DUNDAS I, 2017[19] 欧洲 158 25.00 大学生 团体 正念自悯团体 3 LENNARD G R, 2020[20] 澳大利亚 470 32.56 孩子小于2岁的母亲 个体 在线自悯干预 2 BRITO-PONS G, 2018(a)[21] 智利 50 36.20 普通群体 团体 同情心培养训练 3 BRITO-PONS G, 2018(b)[21] 智利 58 39.70 普通群体 团体 同情心培养训练 3 HAUKAAS R B, 2018[22] 挪威 81 22.90 大学生 团体 正念自悯团体 3 LO H, 2015[23] 中国香港 82 44.30 普通群体 团体 正念慈悲疗法 3 HUANG J, 2021[24] 中国 69 20.56 大学生 团体 自悯团体干预 2 GAMMER I, 2020[25] 美国 206 35.19 产后第1年的母亲 个体 在线自我关怀训练 3 WILLIAMSON J, 2020(a)[26] 美国 129 19.43 大学生 个体 自悯休息训练 3 WILLIAMSON J, 2020(b) [26] 美国 129 19.43 大学生 个体 自悯休息训练 3 BLUTH K, 2016[27] 美国 34 - 14~17岁青少年 团体 正念自悯训练 1 ZIEMER K S, 2015[28] 美国 116 49.60 慢性疼痛病患者 团体 自怜书写 2 ARIMITSU K, 2016[29] 日本 40 21.34 自悯得分低于17.35分 团体 自悯加强训练 2 TOBIAS K, 2019[30] 瑞士 122 22.93 自我批评得分≥20分 个体 在线怜悯聚焦疗法 2 LINCOLN T M, 2013[31] 德国 71 23.20 学生 个体 怜悯聚焦疗法 3 SOMMERS-SPIJKERMAN M, 2018[32] 荷兰 243 52.87 健康成年人 个体 阅读自悯书籍 2 TORRIJOS-ZARCERO M, 2021[33] 西班牙 123 48.76 慢性疼痛病患者 团体 正念自悯团体 2 MATOS M, 2017[34] 欧洲 117 23.34 普通群体 团体 怜悯心训练 1 NADEAU M M, 2021[35] 美国 63 38.12 女性 个体 在线自悯训练 2 AL-REFAE M, 2021[36] 加拿大 245 25.24 普通居民 个体 在线自悯App 3 NEFF K D, 2012[5] 美国 54 50.10 普通群体 团体 正念自悯团体 2 LOPARO D, 2018[37] 美国 252 42.40 自杀未遂非裔美国人 团体 以认知为基础的同情心团体训练 3 SAVARI Y, 2021[38] 伊朗 30 24.30 本科生、硕士生 团体 怜悯聚焦疗法 3 TRINDADE I A, 2020[39] 葡萄牙 49 56.08 乳腺癌女性 个体 TAU+怜悯心训练 1 WONG C C Y, 2016[40] 中国 112 20.51 大学生 个体 在线自悯书写 4 刘玲娜, 2019[41] 中国 76 28.95 双相抑郁患者 团体 怜悯团体护理 1 杨琳, 2015[42] 中国 20 24.39 大学生 团体 正念自悯团体 2 注：表格中的“-”表示原文缺失相应数据。 
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表 2 自悯训练干预抑郁症状的单因素回归模型
Table 2. Single-factor regression model of self-compassion training intervention on depressive symptoms
调节变量 B SE 95% CI Z值 P值 调节分析 Q P VAF 国家地域 11.548 < 0.001 0.391 东方 0.504 0.148 0.213~0.795 4.682 < 0.001 年龄 0.002 0.006 -0.010~0.014 0.319 0.749 0.102 0.749 0 女性占比 -0.862 0.411 -1.668~-0.057 -2.097 0.036 4.398 0.036 0.125 干预形式 3.464 0.063 0.008 团体 0.255 0.137 -0.014~0.523 1.861 0.063 线下干预 3.270 0.071 0.004 是 0.250 0.138 -0.021~0.521 1.808 0.071 对照组 7.359 0.061 0.229 Blank 0.283 0.302 -0.308~0.874 0.938 0.348 TAU 0.626 0.288 0.062~1.191 2.174 0.03 WL 0.311 0.140 0.037~0.585 2.224 0.026 Jadad分数 -0.087 0.092 -0.268~0.094 -0.944 0.345 0.891 0.345 0 脱落率 -0.010 0.004 -0.018~-0.002 -2.535 0.011 6.424 0.011 0.249 分析方式 0.980 0.323 0 ITT -0.141 0.143 -0.421~0.139 -0.988 0.323 注：西方地区、个人干预、非线下干预、AA、PP在纳入回归时选定为参照变量。
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表 3 自悯训练干预抑郁症状的多因素回归模型
Table 3. Multi-factor regression model of self-compassion training intervention on depressive symptoms
调节变量 B SE Z值 P值 95% CI 国家地域 东方 0.283 0.182 1.552 0.121 -0.074~0.639 年龄 0.006 0.005 1.112 0.266 -0.004~0.016 女性占比 -0.206 0.432 -0.476 0.634 -1.054~0.642 干预形式 团体 0.415 0.542 -0.766 0.444 -0.648~1.478 线下干预 是 -0.269 0.506 -0.533 0.594 -1.261~0.722 对照组 Blank 0.993 0.563 1.764 0.078 -0.111~2.097 TAU 0.891 0.39 2.283 0.022 0.126~1.655 WL 0.446 0.172 2.596 0.009 0.109~0.783 Jadad分数 0.194 0.096 2.020 0.043 0.006~0.382 脱落率 -0.004 0.003 -1.411 0.158 -0.010~0.002 分析方式 ITT -0.063 0.112 -0.566 0.571 -0.282~0.156 注：Q=54.272, P < 0.001, R2=0.963。
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