药物和营养保健干预在青少年心理健康障碍中的代表性和包容性：系统评价和荟萃分析
药物和营养保健干预在青少年心理健康障碍中的代表性和包容性：系统评价和荟萃分析
Representativeness and Inclusivity in Pharmacological and Nutraceutical Interventions in Youth Mental Health Disorders: A Systematic Review and Meta-Analysis
——《自然-心理健康》第4卷第10期，2026年10月——
【摘要】随机对照试验（RCTs）指导着针对患有精神障碍青少年的治疗决策，但人们对其结果的普适性（可推广性）仍存疑虑。本研究遵循“系统评价和荟萃分析优先报告条目”（PRISMA）指南进行了一项系统评价与荟萃分析（注册号：CRD42024629137），旨在评估针对患有《精神障碍诊断与统计手册》（DSM）和/或《国际疾病分类》（ICD）所定义精神障碍的儿童及青少年进行的药物和营养制剂干预试验的包容性与代表性。研究按疾病类型进行了随机效应荟萃分析，并评估了时间趋势。主要结局指标为RCTs在性别（女性参与者的合并比例）和种族/族裔（种族和族裔群体的分布）方面的代表性；次要结局指标包括对关键临床人群（如自闭症患者、智力障碍者及有自杀风险者）的排除情况。本研究共纳入397项RCTs（涉及46,989名参与者；平均年龄10.2 ± 3.1岁），主要针对注意缺陷多动障碍（34.5%）或自闭症谱系障碍（29.7%）。女性参与者占28.3%。仅53.7%的RCTs报告了种族数据；在这些数据中，白人占75.0%，黑人占10.1%，西班牙裔占6.2%，亚裔占2.0%。分别有56.5%和44.3%的试验将自闭症患者和学习障碍者排除在外；76.0%针对抑郁症的RCTs排除了有自杀风险的参与者。受精神障碍影响最严重的青少年群体与RCTs纳入的受试者群体之间，始终存在不匹配现象。包括有色人种、女性及特殊人群在内的部分弱势群体似乎代表性不足，亟需采取更具包容性的实践，以支持公平且有效的医疗护理。
[Abstract] Randomized controlled trials (RCTs) guide treatment decisions in youth with mental health disorders, yet concerns remain about their generalizability. Here we conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review and meta-analysis (CRD42024629137) to assess the inclusivity and representativeness of RCTs on pharmacological and nutraceutical interventions in children and adolescents with Diagnostic and Statistical Manual of Mental Disorders and/or International Classification of Diseases-defined mental disorders. Random-effects meta-analyses were conducted by disorder, and temporal trends were assessed. Primary outcomes were the representativeness of RCTs with respect to sex (pooled proportion of female participants) and race/ethnicity (distribution of racial and ethnic groups); secondary outcomes included the exclusion of key clinical populations (for example, autistic individuals, those with intellectual disability and those with suicide risk). A total of 397 RCTs (46,989 participants; mean age 10.2 ± 3.1 years) were included, mostly targeting attention deficit hyperactivity disorder (34.5%) or autism spectrum disorder (29.7%). Female participants represented 28.3%. Only 53.7% of RCTs reported racial data; 75.0% were white, 10.1% Black, 6.2% Hispanic and 2.0% Asian. Autistic individuals and those with learning disabilities were excluded in 56.5% and 44.3% of trials, respectively; 76.0% of depression RCTs excluded participants at suicide risk. There is a persistent mismatch between the youth most affected by mental health disorders and those included in RCTs. Some vulnerable populations including people of colour, women and special populations seem to be under-represented, requiring more inclusive practice to support equitable and effective care.
论文原文：Claudia Aymerich, Javier Torres-Cortés, Antonio Melillo, et al. (2026). Representativeness and inclusivity in pharmacological and nutraceutical interventions in youth mental health disorders: a systematic review and meta-analysis. Nature / Mental Health, Volume 4, Issue 10, Pages 1592–1603. October 2026.
https://doi.org/10.1038/s44220-026-00722-5
（翻译兼责任编辑：MARY）
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