Intervention Review

Marital therapy for depression

  1. Angelo Barbato*,
  2. Barbara BD D'Avanzo

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 19 APR 2006

Assessed as up-to-date: 9 FEB 2006

DOI: 10.1002/14651858.CD004188.pub2

How to Cite

Barbato A, D'Avanzo BBD. Marital therapy for depression. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD004188. DOI: 10.1002/14651858.CD004188.pub2.

Author Information

  1. Istituto di Ricerche Farmacologiche "Mario Negri", Unit of Epidemiology and Social Psychiatry, Milano, Italy

*Angelo Barbato, Unit of Epidemiology and Social Psychiatry, Istituto di Ricerche Farmacologiche "Mario Negri", Via Eritrea 62, Milano, 20157, Italy. barbato@marionegri.it.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 APR 2006

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Marital therapy for depression has the two-fold aim of modifying negative interaction patterns and increasing mutually supportive aspects of couple relationships, thus changing the interpersonal context linked to depression.

Objectives

1. To conduct a meta-analysis of all intervention studies comparing marital therapy to other psychosocial and pharmacological treatments, or to non-active treatments.
2. To conduct an assessment of the internal validity and external validity.
3. To assess the overall effectiveness of marital therapy as a treatment for depression.
4. To identify mediating variables through which marital therapy is effective in depression treatment.

Search methods

CCDANCTR-Studies was searched on 5-9-2005, Relevant journals and reference lists were checked.

Selection criteria

Randomised controlled trials examining the effectiveness of marital therapy versus individual psychotherapy, drug therapy or waiting list/no treatment/minimal treatment for depression were included in the review. Quasi-randomised controlled trials were also included.

Data collection and analysis

Data were extracted using a standardised spreadsheet. Where data were not included in published papers, two attempts were made to obtain the data from the authors. Data were synthesised using Review Manager software. Dichotomous data were pooled using the relative risk (RR), and continuous data were pooled using the standardised mean difference (SMD), and 95% confidence intervals (CIs) were calculated. The random effects model was employed for all comparisons. A formal test for heterogeneity, the natural approximate chi-squared test, was also calculated.

Main results

Eight studies were included in the review. No significant difference in effect was found between marital therapy and individual psychotherapy, either for the continuous outcome of depressive symptoms, based on six studies: SMD -0.12 (95% CI -0.56 to 0.32), or the dichotomous outcome of proportion of subjects remaining at caseness level, based on three studies: RR 0.84 (95% CI 0.32 to 2.22). In comparison with drug therapy, a lower drop-out rate was found for marital therapy: RR 0.31 (95% CI 0.15 to 0.61), but this result was greatly influenced by a single study. The comparison with no/minimal treatment, showed a large significant effect in favour of marital therapy for depressive symptoms, based on two studies: SMD -1.28 (95% CI -1.85 to -0.72) and a smaller significant effect for persistence of depression, based on one study only. The findings were weakened by methodological problems affecting most studies, such as the small number of cases available for analysis in almost all comparisons, and the significant heterogeneity among studies.

Authors' conclusions

There is no evidence to suggest that marital therapy is more or less effective than individual psychotherapy or drug therapy in the treatment of depression. Improvement of relations in distressed couples might be expected from marital therapy. Future trials should test whether marital therapy is superior to other interventions for distressed couples with a depressed partner, especially considering the role of potential effect moderators in the improvement of depression.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Marital therapy for depression

Marital therapy has been suggested as a treatment for couples with a depressed spouse on the basis of the strong association between depressive symptoms and marital distress; the role played by marital negative factors on onset and maintenance of depressive disorders; and the possible buffering effect of interpersonal support and enhanced intimacy on depressive symptoms. Therefore, marital therapy has the two-fold aim of modifying negative interactional patterns and increasing mutually supportive aspects of couple relationships. This review aimed to provide an overall assessment of the role of marital therapy among psychological treatments for depression. The meta-analysis showed that there was no evidence to consider marital therapy as more or less effective than individual psychotherapy, either reducing depressive symptoms or the proportion of participants who remained depressed at caseness level (persistence of depression). The absence of a significant difference also held true when only distressed couples were included. However, in comparison to no/minimal treatment, the outcome for depressive symptoms and persistence of depression was better in the marital therapy group. There were no significant differences in the number of dropouts between the marital therapy group than in the individual psychotherapy group, this was also true when only distressed couples were analysed. Marital distress was significantly lower and persistence of marital distress significantly less frequent in the marital therapy group than in the individual treatment group. This effect was enhanced when distressed couples were considered separately. In comparison with drug therapy only data from two studies about dropout rates were available, showing significant relative risk in favour of marital therapy. All the results should be regarded in light of the methodological limitations of the studies, which, in general, are affected by small sample sizes; assessments at the end of treatment or short follow-up; unclear sample representation; and loss of patients at follow-up. The mediating role of other variables, such as improvement in marital satisfaction, could not be adequately tested. Although there is no evidence to consider marital therapy as more or less effective than individual psychotherapy or drug therapy for depression, the evidence for improvement in couple relationships due to marital therapy may favour the choice of marital therapy when marital distress is perceived as a major problem. Otherwise, the choice rests on patient preference and availability of specific resources.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

憂鬱症的婚姻治療

憂鬱症的婚姻治療有兩個目的,修正伴侶間的負向互動,及增加雙方的相互支持,因此改善與憂鬱症相關的人際問題。

目標

1.以後設分析比較婚姻治療與其他心理社會治療取向及藥物治療,或其他非積極性治療。 2.評估內在效度與外在效度。 3.評估憂鬱症婚姻治療的整體有效性。4.確定在憂鬱症治療中,透過婚姻治療產生效用的中介變項。

搜尋策略

2005年5月9日搜尋CCDANCTRStudies,檢查相關的期刊與參考文獻列表。

選擇標準

以隨機對照試驗研究檢視憂鬱症的婚姻治療與個人心理治療、藥物治療或等候治療/不治療/最少的治療的有效性。半隨機對照研究也包括在內。

資料收集與分析

以標準化的電子表格取出資料。當數據不在出版的論文裡,會嘗試兩次向作者取得資料。資料以Review Manager軟體整合。二分項資料使用relative risk(RR)來統整,連續性的資料則以standardised mean difference (SMD)統整,並計算95%confidence intervals (CIs)。隨機效果模式(random effects model)則用於所有的比較。異質性則以正式的檢測進行,the natural approximate chisquared test。

主要結論

有8項研究納入這篇回顧。但在婚姻治療與個別治療之間並沒有顯著差異,也沒有憂鬱症狀的連續性結果出現。有六個研究結果如下:SMD −0.12(95% CI −0.56 to 0.32) ,三個研究中維持在憂鬱狀態的個案比例,二分變項的結果:RR 0.84(95% CI 0.32 to 2.22)。與藥物治療相比,婚姻治療的中輟率低:RR 0.31(95%CI 0.15 to 0.61) ,但這個結果只有在一個研究當中有顯著的影響。與沒有治療/最小治療比較,顯示婚姻治療對憂鬱症狀有顯著的效果,有兩個研究支持:SMD −1.28 (95% CI −1.85 to −0.72)。有一個研究顯示對持續性的憂鬱症有較小地顯著效果。有些發現因為其研究方法學的問題而受影響,在幾乎所有的比較中,能夠分析的個案數過少,在這些研究當中的異質性都很高。

作者結論

沒有任何證據顯示,婚姻治療在治療憂鬱症方面比個別治療或藥物治療有效或比較沒效。但期待藉由婚姻治療能夠改善痛苦的夫妻關係,未來的試驗應著重在檢驗婚姻治療在處理有憂鬱配偶的夫妻關係方面的改善,是否優於其他的處遇方式,特別是另一半的角色在改善憂鬱症狀上是否有潛在的調節作用。

翻譯人

本摘要由彰化基督教醫院陳美貴翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

婚姻療法已被建議用來治療有憂鬱症狀的夫婦,且其憂鬱症狀與婚姻問題是相關連的;婚姻的負向因素扮演了促發的角色,並且讓憂鬱症持續;在憂鬱症狀上,人際支持具有緩衝的效果,並且提昇親密度。因此婚姻治療兩方面的目的是修正負向的互動模式與增加夫妻關係的相互支持。本次回顧的目的在於提供一個全面性的評估,瞭解婚姻治療在憂鬱症的心理治療當中的角色。後設分析方面顯示有沒充足的證據顯示婚姻治療比個別治療更有效或更無效,在減輕憂鬱症狀或減少持續憂鬱的族群上也沒有明顯的差別。當加入有婚姻困難的配偶時則結果仍舊一樣。然而,相較於沒有/最小治療時,憂鬱症狀與持續憂鬱的結果,婚姻治療組的成效比較好。在中輟率方面,個別治療與婚姻治療兩組並沒有顯著差異,如果只分析痛苦的配偶時也一樣。在經過婚姻治療後,比接受個別治療者,在婚姻困難方面有所改善,也出現婚姻問題的頻率也減少了。如果將痛苦的配偶分開來,成效也會提昇。有兩個研究是與藥物治療相較,中輟率的數據顯示,在婚姻治療組在風險質表現顯著較佳。所有的研究結果都應考量其研究方法的限制,一般而言,都受小樣本所影響,只在治療最後才評估,或是追蹤期短;樣本分佈不清楚;以及在追蹤期病人流失。其他變項的調節角色無法適切地評估,像是改善婚姻滿意度。雖然沒有證據認為婚姻治療比個別治療或藥物治療在治療憂鬱症方面是更有效或更無效,但有證據指出如果婚姻困難是主要的問題,藉由婚姻治療改善婚姻關係是有幫助的。除此之外,選擇取決於病人的偏好及特定資源的可利用性。