Journal of the Korea Academia-Industrial cooperation Society (한국산학기술학회논문지)

The Korea Academia-Industrial cooperation Society (한국산학기술학회)
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Effect of Cognitive Behavioral Therapy (CBT) for Perinatal Depression: A Systematic Review and Meta-Analysis

산전우울 임부를 위한 인지행동치료 프로그램의 효과: 체계적 문헌고찰 및 메타분석

  • Received : 2016.08.08
  • Accepted : 2016.11.10
  • Published : 2016.11.30
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Abstract

This study was carried out to evaluate the efficacy of CBT for perinatal depression through systematic literature review and meta-analysis. The following databases were used to search the literature: CINAHL, PubMed, EMBASE, Koreamed, Library of Korean Congress, KISS, and Korean Academic Publication Database. Keywords included 'perinatal depression,' 'pregnant women,' and 'cognitive behavioral therapy,' and the evaluated articles were published up to May 2016. Using the R program, the effect size of perinatal depression and anxiety were calculated by random-effects model. The heterogeneity of the effect size was analyzed by data moderator analysis using the meta-ANOVA. Furthermore, the funnel plot, Egger's regression test, fail-safe N, trim-and-fill test, and publication bias analysis were conducted and used to verify the results. Out of the 180 selected articles, 16 clinical trial studies were meta-analyzed. Each articles were evaluated for the risk of bias by the checklist of SIGN; the overall risk of bias was low. The effect size of CBT for perinatal depression was Hedges' g=-0.55 (95% CI: -0.76~-0.33), which was a moderate level, while for anxiety reduction, Hedges' g=-0.20 (95% CI: -0.48~-0.08) and it was not statistically significant. Heterogeneity or risk of publication bias were low. This meta-analytic study found that CBT is moderately effective in reducing perinatal depression in pregnant women.

본 연구는 임부의 산전우울에 대한 인지행동치료 중재의 효과를 검증하기 위해 수행된 체계적 문헌고찰 및 메타분석 연구이다. 데이터베이스는 CINAHL, PubMed, EMBASE 및 Koreamed, 국회도서관, 한국학술정보(Korean studies Information Service System, KISS), 한국의학논문데이터베이스 등 국내외 domain을 활용하였다. 검색은 ((Perinatal OR Antenatal OR Antepartum OR Pregnant) AND Depression) AND Women AND (CBT OR (Cognitive behavioral AND (Therapy OR Treatment)))와 '산전우울', '임부', '인지행동치료' 등의 검색어로 2016년 5월까지 출판된 문헌을 검토하였다. 분석은 R을 이용한 임의효과모형을 적용하여 산전우울과 불안의 효과크기를 각각 산출하였으며, 효과크기의 이질성을 검증하기위해 메타 ANOVA를 활용하여 조절효과분석을 실시하였다. 그리고 funnel plot, Egger's regression test, fail-safe N, trim-and-fill 분석을 활용한 출간오류분석과 민감성 분석을 실시하여 전체 연구 결과의 타당성을 검증하였다. 연구결과 총 180편의 문헌이 검색되었으며, 선택배제기준에 따라 최종적으로는 clinical trials 16편을 분석하였다. 분석에 포함된 개별문헌은 Scottish Intercollegiate Guideline Network (SIGN)의 checklist를 통해 비뚤림 위험을 평가하였으며, 대체로 비뚤림 위험은 낮았다. 연구결과 본 연구에서 중재의 산전우울에 대한 효과크기는 Hedges' g=-0.55(95% CI: -0.76~-0.33)로 통계적으로 유의하게 낮았으며, 불안에 대한 효과크기는 Hedges' g=-0.20(95% CI: -0.48~-0.08)이었으나, 통계적으로 유의한 차이는 없었다. 문헌의 이질성, 출판오류의 위험성 등은 낮았다. 본 메타분석결과에 의하면 인지행동치료는 임신부의 산전우울 증세 완화에 보통 정도의 효과가 있음이 밝혀졌다.

Keywords

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