Pub Date : 2024-12-19DOI: 10.1016/s2215-0366(24)00363-8
<h3>Background</h3>High-quality estimates of the epidemiology of the autism spectrum and the health needs of autistic people are necessary for service planners and resource allocators. Here we present the global prevalence and health burden of autism spectrum disorder from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 following improvements to the epidemiological data and burden estimation methods.<h3>Methods</h3>For GBD 2021, a systematic literature review involving searches in PubMed, Embase, PsycINFO, the Global Health Data Exchange, and consultation with experts identified data on the epidemiology of autism spectrum disorder. Eligible data were used to estimate prevalence via a Bayesian meta-regression tool (DisMod-MR 2.1). Modelled prevalence and disability weights were used to estimate health burden in years lived with disability (YLDs) as the measure of non-fatal health burden and disability-adjusted life-years (DALYs) as the measure of overall health burden. Data by ethnicity were not available. People with lived experience of autism were involved in the design, preparation, interpretation, and writing of this Article.<h3>Findings</h3>An estimated 61·8 million (95% uncertainty interval 52·1–72·7) individuals (one in every 127 people) were on the autism spectrum globally in 2021. The global age-standardised prevalence was 788·3 (663·8–927·2) per 100 000 people, equivalent to 1064·7 (898·5–1245·7) autistic males per 100 000 males and 508·1 (424·6–604·3) autistic females per 100 000 females. Autism spectrum disorder accounted for 11·5 million (7·8–16·3) DALYs, equivalent to 147·6 (100·2–208·2) DALYs per 100 000 people (age-standardised) globally. At the super-region level, age-standardised DALY rates ranged from 126·5 (86·0–178·0) per 100 000 people in southeast Asia, east Asia, and Oceania to 204·1 (140·7–284·7) per 100 000 people in the high-income super-region. DALYs were evident across the lifespan, emerging for children younger than age 5 years (169·2 [115·0–237·4] DALYs per 100 000 people) and decreasing with age (163·4 [110·6–229·8] DALYs per 100 000 people younger than 20 years and 137·7 [93·9–194·5] DALYs per 100 000 people aged 20 years and older). Autism spectrum disorder was ranked within the top-ten causes of non-fatal health burden for people younger than 20 years.<h3>Interpretation</h3>The high prevalence and high rank for non-fatal health burden of autism spectrum disorder in people younger than 20 years underscore the importance of early detection and support to autistic young people and their caregivers globally. Work to improve the precision and global representation of our findings is required, starting with better global coverage of epidemiological data so that geographical variations can be better ascertained. The work presented here can guide future research efforts, and importantly, decisions concerning allocation of health services that better address the needs of all autistic individuals
背景：对自闭症谱系的流行病学和自闭症患者的健康需求进行高质量的估计对于服务计划者和资源分配者是必要的。在此，我们介绍了全球疾病、伤害和风险因素负担研究（GBD） 2021中自闭症谱系障碍的全球患病率和健康负担，并对流行病学数据和负担估计方法进行了改进。方法：对于GBD 2021，系统的文献综述包括PubMed、Embase、PsycINFO、全球健康数据交换（Global Health Data Exchange）的检索，并咨询专家，确定了自闭症谱系障碍的流行病学数据。使用符合条件的数据通过贝叶斯元回归工具（dismod - mr2.1）估计患病率。模型患病率和残疾权重用于估计残疾生活年数（YLDs）作为非致命性健康负担的衡量标准和残疾调整生命年数（DALYs）作为总体健康负担的衡量标准。没有按种族分类的数据。有自闭症生活经验的人参与了这篇文章的设计、准备、解释和写作。据估计，2021年全球有6180万（95%不确定区间为52.1 - 72.7）人（每127人中有1人）属于自闭症谱系。全球年龄标准化患病率为每10万人788·3(663·8-927·2)，相当于每10万男性中有1064·7（898·5-1245·7）名自闭症男性和每10万女性中有508·1（424·6-604·3）名自闭症女性。自闭症谱系障碍占1150万（7.8 - 16.3）DALYs，相当于全球每10万人（年龄标准化）14.6 (100 - 20.8)DALYs。在超级区域层面上，年龄标准化的DALY比率从东南亚、东亚和大洋洲的每10万人126·5（86·0 - 178·0）到高收入超级区域的每10万人204·1（140·7 - 284·7）不等。DALYs在整个生命周期中都很明显，在5岁以下儿童中出现（每10万人169·2[115·0-237·4]DALYs），随着年龄的增长而减少（每10万20岁以下人群163·4[110·6-229·8]DALYs，每10万20岁及以上人群137·7[93·9-194·5]DALYs）。自闭症谱系障碍被列为20岁以下人群非致命性健康负担的十大原因之一。自闭症谱系障碍在20岁以下人群中的高患病率和高非致命性健康负担突出了全球范围内早期发现和支持自闭症年轻人及其照顾者的重要性。需要努力提高我们研究结果的准确性和全球代表性，首先要提高流行病学数据的全球覆盖率，以便更好地确定地理差异。这里介绍的工作可以指导未来的研究工作，重要的是，可以指导有关更好地满足所有自闭症患者需求的卫生服务分配的决定。资助昆士兰州卫生和法案& &；梅琳达·盖茨基金会。
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Pub Date : 2024-12-17DOI: 10.1016/s2215-0366(24)00360-2
Edoardo G Ostinelli, Marcel Schulze, Caroline Zangani, Luis C Farhat, Anneka Tomlinson, Cinzia Del Giovane, Samuel R Chamberlain, Alexandra Philipsen, Susan Young, Phil J Cowen, Andrea Bilbow, Andrea Cipriani, Samuele Cortese
<h3>Background</h3>The comparative benefits and harms of available interventions for ADHD in adults remain unclear. We aimed to address these important knowledge gaps.<h3>Methods</h3>In this systematic review and component network meta-analysis (NMA), we searched multiple databases for published and unpublished randomised controlled trials (RCTs) investigating pharmacological and non-pharmacological interventions for ADHD in adults from database inception to Sept 6, 2023. We included aggregate data from RCTs comparing interventions against controls or any other eligible active intervention for the treatment of symptoms in adults (ages ≥18 years) with a formal diagnosis of ADHD. Pharmacological therapies were included only if their maximum planned doses were considered eligible according to international guidelines. We included RCTs of at least 1-week duration for medications, of at least four sessions for psychological therapies, and of any length deemed appropriate for neurostimulation. For RCTs of medications, cognitive training, or neurostimulation alone, we included only double-blind RCTs. At least two authors independently screened the identified records and extracted data from eligible RCTs. Our primary outcomes were efficacy (change in ADHD core symptom severity on self-rated and clinician-rated scales at timepoints closest to 12 weeks) and acceptability (all-cause discontinuation). We estimated standardised mean differences (SMDs) and odds ratios (ORs) using random effects pairwise and component NMA, dismantling interventions into specific therapeutic components. This study was registered with PROSPERO (CRD42021265576). People with relevant lived experience were involved in the conduct of the research and writing process.<h3>Findings</h3>Of 32 416 records, 113 unique RCTs encompassing 14 887 participants were eligible for analysis (6787 [45·6%] females, 7638 [51·3%] males, 462 [3·1%] sex not reported). The RCTs encompassed pharmacological therapies (63 [55·8%] of 113 RCTs; 6875 participants), psychological therapies (28 [24·8%] of 113 RCTs; 1116 participants), neurostimulatory therapy and neurofeedback (ten [8·8%] of 113 RCTs; 194 participants), and control conditions (97 [85·8%] of 113 RCTs; 5770 participants). For reduction of ADHD core symptoms at 12 weeks on both self-reported and clinician-reported rating scales, atomoxetine (self-reported scale SMD –0·38, 95% CI –0·56 to –0·21; clinician-reported scale –0·51, –0·64 to –0·37) and stimulants (0·39, –0·52 to –0·26; –0·61, –0·71 to –0·51) had higher efficacy than placebo (Confidence in Network Meta-Analysis [CINeMA] ranging between very low and moderate). Cognitive behavioural therapy (–0·76, –1·26 to –0·26), cognitive remediation (–1·35, –2·42 to –0·27), mindfulness (–0·79, –1·29 to –0·29), psychoeducation (–0·77, –1·35 to –0·18), and transcranial direct current stimulation (–0·78; –1·13 to –0·43) were better than placebo only on clinician-reported measures. Regarding acceptability, al
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Pub Date : 2024-12-09DOI: 10.1016/s2215-0366(24)00333-x
Carolina Seybert, Nina Schimmers, Lucio Silva, Joost J Breeksema, Jolien Veraart, Bárbara S Bessa, Dora d'Orsi, Robert A Schoevers, Albino J Oliveira-Maia
Although studies of psychedelic-assisted psychotherapy are accumulating, there is no consensus regarding best practice of the psychotherapeutic component. In this systematic review, we summarised the quality of reporting on psychological interventions in research about psychedelic treatments. The design followed PRISMA guidelines and was preregistered in PROSPERO (CRD42022319221). We searched MEDLINE, PsycINFO, and Embase for original studies on psychedelic-assisted psychotherapy and included 45 studies assessing psilocybin, 3,4-methylenedioxymethamphetamine (MDMA), lysergic acid diethylamide (known as LSD), or ayahuasca, for the treatment of mental disorders. Psychological interventions were done heterogeneously across studies, and completeness of information reported about these interventions was mostly low, according to an adaptation of the Template for Intervention Description and Replication checklist. In studies including MDMA, psychotherapy was more homogeneous and more procedural details were provided. Improved reporting on psychological interventions of psychedelic treatments will support replicability, generalisability, and accurate interpretation of research, while enhancing feasibility and safety of future clinical research and real-world implementation of treatments.
{"title":"Quality of reporting on psychological interventions in psychedelic treatments: a systematic review","authors":"Carolina Seybert, Nina Schimmers, Lucio Silva, Joost J Breeksema, Jolien Veraart, Bárbara S Bessa, Dora d'Orsi, Robert A Schoevers, Albino J Oliveira-Maia","doi":"10.1016/s2215-0366(24)00333-x","DOIUrl":"https://doi.org/10.1016/s2215-0366(24)00333-x","url":null,"abstract":"Although studies of psychedelic-assisted psychotherapy are accumulating, there is no consensus regarding best practice of the psychotherapeutic component. In this systematic review, we summarised the quality of reporting on psychological interventions in research about psychedelic treatments. The design followed PRISMA guidelines and was preregistered in PROSPERO (CRD42022319221). We searched MEDLINE, PsycINFO, and Embase for original studies on psychedelic-assisted psychotherapy and included 45 studies assessing psilocybin, 3,4-methylenedioxymethamphetamine (MDMA), lysergic acid diethylamide (known as LSD), or ayahuasca, for the treatment of mental disorders. Psychological interventions were done heterogeneously across studies, and completeness of information reported about these interventions was mostly low, according to an adaptation of the Template for Intervention Description and Replication checklist. In studies including MDMA, psychotherapy was more homogeneous and more procedural details were provided. Improved reporting on psychological interventions of psychedelic treatments will support replicability, generalisability, and accurate interpretation of research, while enhancing feasibility and safety of future clinical research and real-world implementation of treatments.","PeriodicalId":48784,"journal":{"name":"Lancet Psychiatry","volume":"94 1","pages":""},"PeriodicalIF":64.3,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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