实例Meta分析评述

1、Meta-Analysis CritiqueThe Efficacy of Relapse Prevention on Substance Use DisordersAshlee Carter 11/7/051ReferenceIrvin, J.E., Bowers, C.A., Dunn, M.E., & Wang, M.C. (1999). Efficacy of Relapse Prevention: A Meta-Analytic Review. Journal of Consulting and Clinical Psychology, 67, 563-570.2Research D

2、omainClinical PsychologyTherapeutic InterventionsSubstance Use DisordersAlcohol UseCocaine UseSmoking (Tobacco)Polysubstance Use3Central QuestionsWhat is the effect of RP on substance use behavior What is the effect of RP on overall psychosocial adjustment?4Potential Moderating VariablesClass of sub

3、stance use disorderTreatment modalitySetting of treatmentAdjunctive use of medicationOutcome measuresComparative efficacy of RPLength of posttreatment follow-up5MethodsStudy identification:Computerized databasesReference listsContact prominent researchers to request unpublished dataInclusion/Exclusi

4、on criteriaResult: 26 studies, 70 hypothesis tests, 9,504 participants6MethodsMain effect sizes converted to rMini meta-analysis within studiesr transformed to Fishers zWeighted average z score calculatedz converted back to rAggregate r across studies95% CI calculatedWeighted average r7ResultsOveral

5、l treatment effect of RP interventions for alcohol use disorders, substance use disorders, and smoking is r = .14 (95% CI = .10 .17, n = 22). Overall treatment effect of RP interventions on improving psychosocial adjustment is r = .48 (95% CI = .42 to .53, n = 10). 8Results: bias?Fail-safe n = 388 (

6、p = 0.05) Number of undiscovered studies averaging no effect of RP interventions that would be required to reduce the obtained relationship to zeroConclusion: The main effect is tolerant to future undiscovered null results9Results: Moderator AnalysisContrast analysesZ scoresProblems:Small sample siz

7、esDifferences in effect sizes due to class of substance use disorderMedication varies10Results: Moderating Variables1)More effective in treating alcohol and polysubstance use than smoking or cocaine use.2)Equally effective in group and individual formats.3)Equally effective in outpatient and inpatie

8、nt formats.4) More effective with adjunctive medication than without.5) Reported more effective in studies that used self-report versus biochemically validated self-report measures.11Results: Moderating Variables6) Effective when evaluated with pretest-posttest designs and when compared to physician

9、 advice; only moderately effective when compared with psychoeducational groups or discussion controls.7)Treatment effects were largest when outcomes were assessed immediately following treatment and tended to become smaller as the length of follow-up increased.12Conclusions: Done wellLarge sample of

10、 studiesAppropriate methodsWeighted averaged rMini meta-analysis in zMethods clearly outlinedFormulas includedTableOriginal statistic included Coding for moderator clearly described13Conclusions: Done wellDot PlotGeneral progression of effect sizeNo gaps Published and unpublished studies bias addressedStatistics consistently presentedLimitations admitted14C