チャイルド・マルトリートメント経験と精神疾患を併せ持つ患者への医療専門家の介入：システマティックレビューとメタアナリシス

Intervention of Healthcare Professionals for Patients With Experience of Child Maltreatment and Mental Disorders: A Systematic Review and Meta Analyses

要旨

　目的：チャイルド・マルトリートメント経験と精神疾患を持つ患者に対する治療的介入の効果を比較検討する．

　方法：PubMed等4件のデータベースから文献検索を行い，システマティックレビューとメタアナリシスを実施した．

　結果：7件のランダム化比較試験から，治療的介入は精神症状に対して小から中程度の効果を示した（効果量-0.45，95％CI：-0.79，-0.11）．対人関係には統計的に有意な効果は確認されなかった（効果量-0.16,95％CI：-0.59，0.27）．双方に高い異質性があったが，STAIR/PE（情動調整訓練/曝露療法）と他の介入で統計的有意差はなかった（対人関係：χ²＝0.27，P＝0.60；精神症状：χ²＝0.00，P＝0.96）．

　結論：本研究ではSTAIR/PEが精神症状の改善に有益な可能性を示したが，有効性を断定するためには追加の調査が必要である．

　Background: Patients with histories of child maltreatment and mental disorders present a significant challenge for healthcare professionals. This study systematically reviews and metaanalyzes therapeutic interventions to determine their efficacy for this patient group, aiming to provide evidence-based recommendations for clinical practice.

　Methods: We conducted a literature search in four databases including PubMed, applying the Cochrane Handbook v6.3 and PRISMA guidelines. The selection process entailed both primary and secondary screenings, conducted by two independent reviewers using Covidence. Initial and secondary screenings were performed using Covidence, risk of bias was assessed using the GRADE approach, and meta-analysis was conducted with RevMan Web. This review protocol was registered with PROSPERO(CRD42023417819).

　Results: From seven identified RCTs, therapeutic interventions demonstrated small to moderate effects on primary psychiatric symptoms(effect size -0.45, 95% CI: -0.79, -0.11). No statistically significant effects were found on interpersonal relationships(effect size -0.16, 95% CI: -0.59, 0.27). However, a high level of heterogeneity was observed in both outcomes(I² = 75% for interpersonal relationships and I² = 70% for psychiatric symptoms), and subgroup analysis did not indicate that the combination of STAIR/PE interventions produced statistically significant different effects compared to other interventions(χ² = 0.27, P = 0.60, I² = 0% for interpersonal relationships, and χ² = 0.00, P = 0.96, I² = 0% for psychiatric symptoms).

　Conclusion: This study has indicated that STAIR/PE may offer potential benefits in improving interpersonal relationships and psychiatric symptoms in patients. However, additional research is required to definitively determine its effectiveness.