Sylwer fod y cymhwysiad hwn dan ddatblygiad. Os ydych chi'n gweld unrhyw gamgymeriadau neu os nad yw rhywbeth yn gweithio, cysylltwch â ni yn evidence.service@wales.nhs.uk.
Adolygiad Systematig
Dywed yr awduron:
"To review the evidence on screening (benefits and harms of screening, accuracy of screening, benefits and harms of treatment) for suicide risk, anxiety, and depression in children and adolescents in settings relevant to primary care in the United States for the U.S. Preventive Services Task Force."
Dywed yr awduron:
"KQ 4. Does Treatment (Psychotherapy, Pharmacotherapy, or Collaborative Care) of Depression, Anxiety, or Suicide Risk Result in Improved Health Outcomes in Children and Adolescents?
We included 16 RCTs of good or fair quality (described in 23 articles). Nine of these studies are new to this update.
Psychotherapy, Counseling, Support, or Combined Interventions vs. Treatment as Usual or Attention Control:
Three studies reported on the effects of suicide or self-harm interventions with variable intensity and duration on suicide deaths at the end of treatment (19 weeks to 12 months). Studies compared dialectical behavior therapy (DBT), youth-nominated support team, or group therapy with TAU. Two of the interventions were high contact (>3 sessions), and one intervention was low contact (<3 sessions). Two studies reported no suicide deaths at the end of treatment in either arm. One study, using a youth-nominated support team approach (n=346) reported no statistically significant differences between intervention and control at the end of treatment (0 vs. 1, p=NR). A longer term followup of that study, 11 to 14 years after psychiatric hospitalization for suicide risk (baseline for the study), found no statistically significant differences in suicide-related deaths. One study of DBT continued to record no deaths in either arm at the 3-year followup.
Nine studies reported on the effects of suicide or self-harm interventions with variable intensity and duration on suicide attempts or episodes of deliberate self-harm at the end of treatment (0 to 36 months). Included studies compared DBT-informed CBT, family therapy, group psychotherapy, MBT, youth-nominated support team, DBT, mentalization-based treatment, or developmental group therapy with TAU. Eight of the interventions were high contact (>3 sessions), and one intervention was low contact (<3 sessions). Studies reported on a variety of outcomes including mean number of self-harm events, number of self-harm events, number of suicide attempts, frequency of self-harm, severity of self-harm, Risk-Taking and Self-Harm Inventory for Adolescents (RTSHI), nonsuicidal self-injury, and percentage with suicide ideation. Study sample sizes ranged from 42 to 832. The most commonly reported measures were mean number of self-harm events and number of self-harm events. The detailed results of the included studies are summarized in Appendix F Table 1.
Table 5 presents pooled estimates of effect for end-of-treatment measures, specifically mean number of self-harm events (3 studies) and proportion of self-harm events (5 studies). Both estimates of effect were not statistically significant and had wide confidence intervals. One study, included in the meta-analysis of posttreatment results, continued to report statistically nonsignificant differences in number of self-harm events between arms at the 1-year. At the 3-year followup, unadjusted analyses favored the intervention. After adjustment for variables used in stratification at randomization (gender, presence of depressive disorder at the time of randomization, and having had at least one suicide attempt within the last 4 months), the differences were no longer statistically significant.
Suicide Attempts or Episode of Deliberate Self-Harm for Suicide or Self-Harm Interventions: Pooled Estimates.
Five studies reported on other suicide attempt or deliberate self-harm outcomes (number of suicide attempts, frequency of self-harm, severity of self-harm, number of persons repeating self-harm, nonsuicidal self-injury, percentage with suicide ideation, and RTSHI) posttreatment (0 to 12 months). Included studies compared DBT-informed CBT, group psychotherapy, MBT, youth-nominated support team, or developmental group therapy with TAU. Four of the interventions were high contact (>3 sessions), and one intervention was low contact (<3 sessions). These results did not consistently demonstrate statistically significant differences favoring the intervention arm. Studies reported significant differences between intervention and TAU on the outcomes of number of persons repeating self-harm (6% vs. 32%; OR, 6.3 [95% CI, 1.4 to 28.7]), percentage with suicide ideation (0% vs. 18.2%; p=0.01), and nonsuicidal self-injury (estimated probabilities of survival without: 0.55 vs. 0.43; p=0.05). No statistically significant differences were reported when the intervention was compared with TAU on the number of suicide attempts, frequency of self-harm, severity of self-harm, and RTSHI scores. A study of group psychotherapy continued to report no statistically significant differences in frequency and severity of self-harm between arms at 6 to 12 months. A study of MBT continued to report no statistically significant differences in RTSHI total score and RTSHI self-harm subscales between arms at 24 and 36 weeks."
Dywed yr awduron:
"We found no eligible studies that reported on benefits directly arising from screening when compared with usual care or no screening. Limited direct evidence suggests no short-term harms from screening for suicide risk. The evidence for screening for suicide risk, anxiety, and depression in children and adolescents relied on indirect evidence on the accuracy of screening and the benefits and harms of treatment. The evidence suggests that some screening instruments are reasonably accurate for anxiety and depression, but the evidence is limited for suicide risk screening instruments. Both pharmacotherapy and psychotherapy treatments have some benefit for some depression and anxiety outcomes (specifically, CBT for anxiety alone was reviewed); the evidence is limited for suicide risk interventions. Harms are rare in treatment studies but more frequent in pharmacotherapy arms when compared with placebo. Evidence gaps persist in children younger than age 11 years for test accuracy; depression and suicide risk interventions; and screening and treatment differences by sex, race/ethnicity, sexual orientation, and gender identity."