Self-help interventions for depressive disorders and depressive symptoms: A systematic review

Orygen Youth Health Research Centre, Department of Psychiatry, University of Melbourne, Parkville, Australia.
Annals of General Psychiatry (Impact Factor: 1.4). 09/2008; 7(1):13. DOI: 10.1186/1744-859X-7-13
Source: PubMed


Research suggests that depressive disorders exist on a continuum, with subthreshold symptoms causing considerable population burden and increasing individual risk of developing major depressive disorder. An alternative strategy to professional treatment of subthreshold depression is population promotion of effective self-help interventions that can be easily applied by an individual without professional guidance. The evidence for self-help interventions for depressive symptoms is reviewed in the present work, with the aim of identifying promising interventions that could inform future health promotion campaigns or stimulate further research.
A literature search for randomised controlled trials investigating self-help interventions for depressive disorders or depressive symptoms was performed using PubMed, PsycINFO and the Cochrane Database of Systematic Reviews. Reference lists and citations of included studies were also checked. Studies were grouped into those involving participants with depressive disorders or a high level of depressive symptoms, or non-clinically depressed participants not selected for depression. A number of exclusion criteria were applied, including trials with small sample sizes and where the intervention was adjunctive to antidepressants or psychotherapy.
The majority of interventions searched had no relevant evidence to review. Of the 38 interventions reviewed, the ones with the best evidence of efficacy in depressive disorders were S-adenosylmethionine, St John's wort, bibliotherapy, computerised interventions, distraction, relaxation training, exercise, pleasant activities, sleep deprivation, and light therapy. A number of other interventions showed promise but had received less research attention. Research in non-clinical samples indicated immediate beneficial effects on depressed mood for distraction, exercise, humour, music, negative air ionisation, and singing; while potential for helpful longer-term effects was found for autogenic training, light therapy, omega 3 fatty acids, pets, and prayer. Many of the trials were poor quality and may not generalize to self-help without professional guidance.
A number of self-help interventions have promising evidence for reducing subthreshold depressive symptoms. Other forms of evidence such as expert consensus may be more appropriate for interventions that are not feasible to evaluate in randomised controlled trials. There needs to be evaluation of whether promotion to the public of effective self-help strategies for subthreshold depressive symptoms could delay or prevent onset of depressive illness, reduce functional impairment, and prevent progression to other undesirable outcomes such as harmful use of substances.

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    • "The significant decrease in the endorsement of inappropriate pharmacological treatments among training participants is an important finding given that, whilst vitamins, tonics and herbal medicines may be relatively harmless, appetite stimulants and sleeping pills are of doubtful value and in some cases may be harmful. Similarly, the drop in endorsement for special diets is desirable given the lack of good evidence to support this as an intervention for depression or psychosis [47]. While psychiatric medications were not asked about explicitly, the increasing endorsement of the "other pharmacological" category suggests an improvement in awareness of appropriate psychiatric medication options that have an important role to play in recovery, particularly from severe mental illness. "
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    ABSTRACT: Unmet needs for mental health treatment in low income countries are pervasive. If mental health is to be effectively integrated into primary health care in low income countries like India then grass-roots workers need to acquire relevant knowledge and skills to be able to recognise, refer and support people experiencing mental disorders in their own communities. This study aims to provide a mental health training intervention to community health workers in Bangalore Rural District, Karnataka, India, and to evaluate the impact of this training on mental health literacy. A pre-test post-test study design was undertaken with assessment of mental health literacy at three time points; baseline, completion of the training, and three month follow-up. Mental health literacy was assessed using the interviewer-administered Mental Health Literacy Survey. The training intervention was a four day course based on a facilitator's manual developed specifically for community health workers in India. 70 community health workers from Doddaballapur, Bangalore Rural District were recuited for the study. The training course improved participants' ability to recognize a mental disorder in a vignette, and reduced participants' faith in unhelpful and potentially harmful pharmacological interventions. There was evidence of a minor reduction in stigmatizing attitudes, and it was unclear if the training resulted in a change in participants' faith in recovery following treatment. The findings from this study indicate that the training course demonstrated potential to be an effective way to improve some aspects of mental health literacy, and highlights strategies for strengthening the training course.
    International Journal of Mental Health Systems 08/2011; 5(1):17. DOI:10.1186/1752-4458-5-17 · 1.06 Impact Factor
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    • "Systematic reviews of research examining self-help interventions for anxiety and depressive disorders indicate their effectiveness (e.g. Bower et al. 2001 ; Morgan & Jorm, 2008), but temper their conclusions because of the heterogeneous mix of self-help interventions reviewed. Other reviews within the area have either not been systematic (e.g. "
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    ABSTRACT: Cognitive-behavioural therapy (CBT)-based guided self-help (GSH) has been suggested to be an effective intervention for mild to moderate anxiety and depression, yet the evidence seems inconclusive, with some studies reporting that GSH is effective and others finding that GSH is ineffective. GSH differs in important respects from other levels of self-help, yet the literature regarding exclusively guided self-help interventions for anxiety and depression has not been reviewed systematically. A literature search for randomized controlled trials (RCTs) examining CBT-based GSH interventions for anxiety and depressive disorders was conducted. Multiple electronic databases were searched; several journals spanning key disciplines were hand-searched; reference lists of included review articles were scanned and relevant first authors were contacted. Thirteen studies met the inclusion criteria. Meta-analysis indicated the effectiveness of GSH at post-treatment, although GSH was found to have limited effectiveness at follow-up or among more clinically representative samples. Studies that reported greater effectiveness of GSH tended to be of lower methodological quality and generally involved participants who were self-selected rather than recruited through clinical referrals. Although there is support for the effectiveness of CBT-based GSH among media-recruited individuals, the finding that the reviewed RCTs had limited effectiveness within routine clinical practice demonstrates that the evidence is not conclusive. Further rigorous evidence based on clinical populations that examines longer-term outcomes is required before CBT-based GSH interventions can be deemed effective for adults accessing primary care services for treatment of anxiety and depression. Psychological Medicine 41(11) 2239-2252
    Psychological Medicine 06/2011; 41(11):2239-52. DOI:10.1017/S0033291711000900 · 5.94 Impact Factor
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    • "Melatonergic [100, 104, 131, 139] and serotonergic [104, 130, 138, 143] agents as well as hypnotics, antidepressants, vitamin B12, physical activity [140], chronotherapy, and bright light in the morning or during the daytime [168] and darkness during nighttime [169] are conventional approaches used to treat asynchronization. Low dose sulpiride, known to exert antidepressant activity through the blockade of D2/D3 receptors [170], might be another promising choice for the treatment. "
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    DNA research: an international journal for rapid publication of reports on genes and genomes 06/2011; 9(2):330-41. DOI:10.2174/157015911795596522 · 3.05 Impact Factor
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