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背景:关于使用选择性5-羟色胺再摄取抑制剂(SSRIs)与自杀意念或行为的关系,一些系统综述已发表,但是对这些报告的质量并没有做过正式的评估。目的:评估有关使用SSRI与自杀意念和行为之间关系的系统综述的方法学质量;并提供在此评估的基础上得出的总体结论。方法 :通过检索Pubmed,Embase,Cochrane图书馆,EBSCO,PsycINFO,中国国家知网,中国科技期刊重庆维普数据库,万方数据库,和中国生物医学文献数据库来确定相关的系统综述,这些系统综述纳入了比较SSRI类药物与安慰剂、以自杀意念或行为作为关键变量的随机对照试验。两个专家评估者独自采用多系统综述11项评估量表(AMSTAR)对纳入评估的文献进行方法学质量的评估。结果 :共检出12篇系统综述和meta分析。AMSTAR总体质量评分的评分者信度非常好(ICC=0.86),但11个AMSTAR项目中有5项的评分者信度较差(Kappa值<0.60)。根据AMSTAR总分,仅1篇为高质量等级,8篇为中等质量等级,3篇为低质量等级。这篇高质量综述和3篇中等质量的综述均报告SSRI组中自杀意念或行为的风险显著高于安慰剂组。4篇仅限于儿童和青少年的综述中有3篇报道服用帕罗西汀和患有抑郁症的青少年有显著增加自杀意念或行为的风险。结论 :现有证据表明,青少年使用SSRI类药物可能会增加自杀意念和行为的风险,尤其是抑郁症患者和服用帕罗西汀的患者。但是,相关高质量的综述很少,所以对这一结论还存有疑问。AMSTAR量表对于提高系统综述质量也许是有用的,但对量表中的某些项目需要严格操作标准。
BACKGROUND: A number of systematic reviews have been published on the relationship between the use of selective serotonin reuptake inhibitors (SSRIs) and suicidal ideation or behavior but no formal assessment of the quality of these reports has been made. Purpose: To assess the methodological quality of a systematic review of the relationship between SSRI and suicidal ideation and behavior; and to provide an overall conclusion based on this assessment. Methods: The related systematic reviews were searched by searching Pubmed, Embase, Cochrane Library, EBSCO, PsycINFO, China National Knowledge Network, Chinese Science and Technology Journal Chongqing Vip Database, Wanfang Database, and China Biomedical Literature Database. These systematic reviews included Randomized controlled trials comparing SSRIs to placebo with suicidal ideation or behavior as key variables. Two expert evaluators independently assessed the methodological quality of the included literature using the Multi-Systematic Review 11 Assessment Scale (AMSTAR). Results: A total of 12 systematic reviews and meta-analyzes were found. The score of AMSTAR overall quality score was very good (ICC = 0.86), but 5 out of 11 AMSTAR items had poor reliability (Kappa value <0.60). According to the AMSTAR score, only 1 was of high quality, 8 of middle quality and 3 of low quality. This high-quality review and three moderate-quality reviews reported significantly higher risks of suicidal ideation or behavior in the SSRI group than in the placebo group. Three of the four reviews for children and adolescents reported that paroxetine and teenagers with depression significantly increased the risk of suicidal ideation or behavior. CONCLUSIONS: Available evidence suggests that adolescent use of SSRIs may increase the risk of suicidal ideation and behavior, especially in patients with depression and those taking paroxetine. However, there are few relevant high-quality reviews, so there are questions about this conclusion. The AMSTAR scale may be useful for improving the quality of systematic reviews, but requires rigorous standards of practice for some items in the scale.