Background: Treatment of obsessive-compulsive disorder (OCD) in children and adolescents frequently involves cognitive behavioral therapy (CBT), selective serotonin reuptake inhibitors (SSRIs), or their combination. However, how adding CBT to SSRIs affects the trajectory and magnitude of improvement has not been evaluated meta-analytically. Methods: We performed a meta-analysis using weekly data from prospective randomized parallel group trials of CBT and SSRIs in pediatric patients with OCD. Response was modeled for the change in the Child Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) using a Bayesian hierarchical model over 12 weeks. Results: Fourteen studies included pharmacotherapy arms, 4 studies included combined pharmacotherapy and psychotherapy, and 10 studies included a placebo or control arm. The studies included 1146 patients (mean age 12.7 ± 1.3 years, mean 42.1% female). In the logarithmic model of response, statistically significant differences in treatment effects for CBT+SSRI and SSRI monotherapy were observed compared with placebo (SSRI β = -3.59, credible interval [95% CrI]: -4.13 to -3.02, p < 0.001; SSRI+CBT β = -4.07, 95% CrI: -5.05 to -3.04, p < 0.001). Adding CBT to an SSRI produced numerically (but not statistically significantly) greater improvement over 12 weeks. Greater improvement was observed in studies with more boys (p < 0.001), younger patients (p < 0.001), and in studies with greater baseline symptom severity (p < 0.001). Conclusions: In children and adolescents with OCD, compared with placebo, both SSRIs and SSRI+CBT produced early and sustained improvement over 12 weeks, although the improvement was also related to sample characteristics. Longer term studies are needed to determine when the additive benefit of CBT emerges relative to SSRI monotherapy.

中文翻译：

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认知行为疗法和选择性血清素再摄取抑制剂相结合对患有强迫症的青少年有什么额外好处？贝叶斯分层建模元分析。

背景：儿童和青少年强迫症（OCD）的治疗通常涉及认知行为疗法（CBT）、选择性血清素再摄取抑制剂（SSRI）或其组合。然而，在 SSRI 中添加 CBT 如何影响改善的轨迹和幅度尚未经过荟萃分析评估。方法：我们使用来自强迫症儿科患者 CBT 和 SSRIs 前瞻性随机平行组试验的每周数据进行荟萃分析。使用贝叶斯分层模型在 12 周内针对儿童耶鲁-布朗强迫量表 (CY-BOCS) 的变化对反应进行建模。结果：14 项研究包括药物治疗组，4 项研究包括药物治疗和心理治疗联合治疗，10 项研究包括安慰剂或对照组。该研究纳入了 1146 名患者（平均年龄 12.7 ± 1.3 岁，平均 42.1% 为女性）。在对数反应模型中，与安慰剂相比，CBT+SSRI 和 SSRI 单药治疗的治疗效果存在统计学显着差异（SSRI β = -3.59，可信区间 [95% CrI]：-4.13 至 -3.02，p < 0.001； SSRI+CBT β = -4.07，95% CrI：-5.05 至 -3.04，p < 0.001)。在 SSRI 中添加 CBT 在 12 周内产生了数值上（但统计上不显着）的更大改善。在男孩较多（p < 0.001）、年轻患者（p < 0.001）的研究以及基线症状严重程度较高（p < 0.001）的研究中观察到更大的改善。结论：在患有强迫症的儿童和青少年中，与安慰剂相比，SSRIs 和 SSRI+CBT 在 12 周内均产生了早期且持续的改善，尽管这种改善也与样本特征有关。需要进行更长期的研究来确定 CBT 相对于 SSRI 单一疗法的额外益处何时出现。