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Psychological treatment of depression: Results of a series of meta-analyses
Abstract and Figures
In the past few decades, a considerable number of studies have examined the effects of psychotherapies for adult depression.
We described the results of a series of meta-analyses examining what this large body of research has contributed to our knowledge of these treatments of depression.
We found that different types of psychotherapy are efficacious in the treatment of adult depression, including cognitive behavior therapy, interpersonal psychotherapy, problem-solving therapy, non-directive supportive therapy and behavioral activation therapy. Differences between types of psychotherapy are small. The efficacy of psychotherapy for mild to moderate depression is about the same as the efficacy of pharmacotherapy, and that combined treatment is more effective than psychotherapy alone and pharmacotherapy alone. Psychotherapy is not only effective in depressed adults in general, but also in older adults, women with postpartum depression, patients with general medical disorders, in inpatients, in primary care patients, patients with chronic depression and in subthreshold depression.
We found no evidence showing that psychotherapy is less efficacious in severe depression (with mean baseline Hamilton Depression Rating Scale scores up to 31, mean Beck Depression Inventory scores up to 35.85 and mean Beck Depression Inventory-II scores up to 36.50), but effects are smaller in chronic depression. We also found that the effects of psychotherapy are probably overestimated because of publication bias and the relatively low quality of many studies in the field.
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... Beberapa pengobatan psikologis depresi meliputi terapi kognitif-perilaku (cognitive behavioral therapy: CBT), psikoterapi interpersonal, terapi pemecahan masalah (problem-solving), terapi dukungan tidak langsung (non-Directive supportive), terapi psikodinamika (psychodynamic), dan terapi aktivasi perilaku (behavioral activation). Penelitian menunjukkan keunggulan psikoterapi interpersonal daripada terapi lainnya (Cuijpers et al., 2011). ...
... Terapis dapat memberikan psikoterapi interpersonal individual, ke-lompok, atau dengan format memandu pasien untuk dapat melakukan pertolongan mandiri (selfhelp) (Cuijpers et al., 2011). Meskipun riset telah mengindikasikan keunggulan pendekatan psikoterapi interpersonal daripada pendekatan terapi lainnya (Cuijpers et al., 2016;Duffy et al., 2019;Hees et al., 2013;Sockol et al., 2013), beberapa studi mengindikasikan efektivitas psikoterapi interpersonal dalam memitigasi depresi orang dewasa mungkin telah ditaksir terlalu tinggi (Cuijpers et al., 2011). ...
... Terapis dapat memberikan psikoterapi interpersonal individual, ke-lompok, atau dengan format memandu pasien untuk dapat melakukan pertolongan mandiri (selfhelp) (Cuijpers et al., 2011). Meskipun riset telah mengindikasikan keunggulan pendekatan psikoterapi interpersonal daripada pendekatan terapi lainnya (Cuijpers et al., 2016;Duffy et al., 2019;Hees et al., 2013;Sockol et al., 2013), beberapa studi mengindikasikan efektivitas psikoterapi interpersonal dalam memitigasi depresi orang dewasa mungkin telah ditaksir terlalu tinggi (Cuijpers et al., 2011). Penelitian ini bertujuan menguji efektivitas psikoterapi inter-personal dalam memitigasi depresi selama 22 tahun terakhir. ...
Depresi adalah gangguan mental yang umum dan telah menyebabkan banyak kematian akibat bunuh diri. Penelitian ini bertujuan menguji efektivitas psikoterapi interpersonal terhadap depresi dengan menggunakan teknik meta analisis. Secara spesifik, kami memeriksa 12 literatur internasional yang melibatkan 848 partisipan. Analisis data menggunakan jumlah partisipan (N), rerata (M), dan standar deviasi (SD) dari hasil pasca perlakuan baik kelompok eksperimen (mendapatkan psikoterapi interpersonal) maupun kelompok kontrol (tidak mendapatkan terapi atau mendapat terapi selain psikoterapi interpersonal). Hasil penelitian menunjukkan bahwa psikoterapsi interpersonal efektif menurunkan depresi. Kata kunci: depresi, interpersonal psikoterapi, meta-analisis
... Albeit more generalizable to mothers than fathers given differences in parenting intervention involvement, while evidence, including from a recent review [23] suggests that parental psychological distress does not negatively impact parenting intervention effectiveness, successful intervention programmes for children's mental health commonly have components that aim to lower parental psychological distress as well as improve parenting behaviors [24]. Since psychological distress in adults shows considerable treatment success outside of the parenting context [25], it is plausible that such treatment also reduces harsh parenting, providing a costeffective means to improve outcomes for children also. This notion is empirically supported: for example, a meta-analysis of the effectiveness of interventions aiming to prevent adverse psychological outcomes in children of parents with mental illness suggested that there was "no strong evidence supporting the hypothesis that interventions involving parents and children were more beneficial than interventions aimed at parents only" [26, p.14]. ...
Objective:
Parental psychological distress (depression, anxiety) is detrimental to child mental health. A key reason for this is that depressed and anxious parents are at risk of engaging in more negative, reactive and harsh parenting. While treatment for psychological distress has a long history of success in adults, less is known about how treatment for parental psychological distress may positively influence parenting behaviours, particularly in the general population. We examined the moderating role of mothers receiving treatment for depression or anxiety on the longitudinal relationship between maternal psychological distress and the development of harsh parenting (smacking and shouting) across early childhood (ages 3 to 7).
Method:
Using prospective data from 16,131 families participating in the UK's Millennium Cohort Study, we conducted moderator analysis within a multilevel repeated measures model to test whether receiving treatment for mental health problems could protect mothers with high psychological distress from engaging in harsh parenting.
Results:
In each wave, about 7% of mothers reported undergoing treatment for depression or anxiety at that time. Maternal psychological distress was associated with increased use of harsh parenting and that, adjusting for psychological distress, receiving psychological treatment was related to decreased use of harsh parenting. Importantly, receiving psychological treatment buffered the negative effect of psychological distress on harsh parenting.
Conclusion:
In early-to-middle childhood, mental health treatment may help mothers with depression or anxiety to be less harsh toward their children, thereby benefiting their child's psychological adjustment.
... 4,5 Pharmacological therapy is recommended in the treatment of moderate to severe depression, along with psychological treatments such as cognitive behaviour therapy. 6,7 Most commonly prescribed antidepressants include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors and tricyclic antidepressants. However, the side effects and sometimes the unresponsiveness pose risks to patients and can be unpleasant. ...
Background:
Antidepressants are the primary treatment for depression, and social support from social media may offer another support route. Whilst Twitter has become an interactive platform for healthcare providers and their patients, previous studies found low engagement of healthcare providers when discussing antidepressants on Twitter. This study aims to analyse the Twitter posts of healthcare providers related to antidepressants and to explore the healthcare providers' engagement and their areas of interest.
Method:
Tweets within a 10-day period were collected through multiple searches with a list of keywords within Twitter. The results were filtered against several inclusion criteria, including a manual screening to identify healthcare providers. A content analysis was conducted on eligible tweets where correlative themes and subthemes were identified.
Key findings:
Healthcare providers contributed 5.9% of the antidepressant-related tweets (n = 770/13,005). The major clinical topics referred to in the tweets were side effects, antidepressants for the treatment of COVID-19, and antidepressant studies of psychedelics. Nurses posted more tweets sharing personal experiences with commonly negative attitudes, in contrast to physicians. Links to external webpages were commonly used among healthcare providers, especially users representing healthcare organisations.
Conclusions:
A relatively low proportion of healthcare providers' engagement on Twitter regarding antidepressants (5.9%) was identified, with a minimal increase throughout the COVID-19 pandemic when compared to previous studies. The major clinical topics referred to in the tweets were side effects, antidepressants for the treatment of COVID-19 and antidepressant studies of psychedelics, which have been made publicly available. In general, the findings confirmed that social media platforms are a mechanism by which healthcare providers, organisations and students support patients, share information about adverse drug effects, communicate personal experiences, and share research. It is plausible that this could impact the belief and behaviours of people with lived experience of depression who may see these tweets.
... 36 A possible explanation to our findings, is that insomnia needs to be treated with specific methods that have specific effects, 37,38 while many different types of depression treatment have been found effective, as long as they were structured and delivered with quality. 39 In fact, several previous studies of CBT-i have reported reduced levels of co-occurring depressive symptoms after treatment. [40][41][42] In a qualitative study of the sample in our study, we found that participants in ICBT-i were more positive about the treatment than those in ICBT-d, and that higher symptom levels and additional comorbidities were more hindering in the work with ICBT-d. ...
... The primary research center of the study is the Department of Psychiatry of the Leiden University Medical Center (LUMC) together with GGZ Rivierduinen, a large mental healthcare provider in the Netherlands. The inclusion criteria for participating patients are as follows: a diagnosis of recurrent or chronic major depressive disorder (duration of at least two years) according to the DSM-IV [2] or PDD according to the DSM-5 [3]; age of 18 years or older; a treatment indication for rehabilitation as speci ed by the clinician, with a minimum of at least one already received psychological treatment and at least two medication trials according to the (inter)national multidisciplinary guidelines for depressive disorders [11,[22][23][24][25][26][27]. ...
Background: After regular treatment, patients with persistent depressive disorder (PDD) may remain in specialized psychiatric outpatient care without achieving remission. Lacking other options, these patients often receive long-term, non-protocolized care as usual (CAU) that does not involve the partner/caregiver of the patient. Although the revised depression treatment guidelines suggest focusing on psychiatric rehabilitation and self-management as the next treatment step for PDD, an evidence-based cost-effective self-management protocol for PDD is lacking. This study investigates the “Patient and Partner Education Program for All Chronic Illnesses” (PPEP4All) as a brief self-management protocol that could lead to lower costs, higher quality of life, and less disease burden in PDD patients and their partners/caregivers.
Methods: Presented is the rationale and methods of a multicenter pragmatic randomized controlled trial to evaluate the clinical efficacy and cost-effectiveness of PPEP4All for patients with PDD and their partners/caregivers. In accordance with current recommendations, a mixed-methods approach is used with both quantitative and qualitative data. A total of 178 eligible outpatients with PDD and their partners/caregivers are recruited and randomized to either PPEP4All or CAU. Those assigned to PPEP4All receive nine weekly self-management sessions with a trained PPEP4All-therapist. Primary and secondary outcome measurements are at 3, 6, 12 months.
Discussion: This project will result in the implementation of a self-management intervention for patients with PDD, meeting an urgent need in mental healthcare. Using PPEP4All can optimize the quality and efficiency of care for both patients with PDD and their partners/caregivers.
Trial registration: Netherlands Trial Register Identifier: NTR5973. Registered on 20 July 2016.
... The low treatment rates and poor clinical outcomes are primarily due to the poorer awareness of these patients with regard to psychiatric disorders. Therefore, it becomes more challenging to identify a patient's psychological symptoms in clinical practice (Cuijpers et al. 2011). ...
Premature ovarian insufficiency (POI) appears to be associated with depressive and anxiety symptoms. However, there is a lack of high-quality evidence relating to the risk of patients with POI developing depression or anxiety. Therefore, we conducted a systematic review and meta-analysis to quantify the risk of depressive and anxiety symptoms in women with POI. We searched English and Chinese databases to evaluate the risk of depression and anxiety disorders in patients with POI. The final search date was November 2021. The risk was quantified using meta-analysis, with an estimation of pooled odds ratio (OR) and 95% confidence interval (CI). Sources of heterogeneity were explored by subgroup analysis. A total of seven primary studies with 1316 individuals were included, five of which were related to depression and six to anxiety disorders. All included articles were case–control studies of high quality. Patients with POI were associated with a higher odds of depression and anxiety (depression: OR = 3.33, 95% CI = 2.31–4.81, P < 0.001; anxiety: OR = 4.89, 95% CI = 3.28–7.30, P < 0.001). Subgroup analysis also indicated that patients with POI are at a higher risk of anxiety and depression. POI appears to be associated with a high risk of depression and anxiety. Early psychosocial assessment and regular screening of patients with POI are also necessary. In addition, it is important to consider the mental health of patients with POI.
Unter kognitiver Verhaltenstherapie (KVT) versteht man einen problemzentrierten, strukturierten, psychologischen Behandlungsansatz, der bezogen auf akute, rezidivierende, chronische und therapieresistente Depressionen bei unipolaren wie bei bipolaren Verläufen folgenden Schwerpunkte verfolgt: Überwindung von Inaktivität, Rückzug, Energielosigkeit, Verhaltensaktivierung und Life-Balance, Verbesserung des Sozial-, Kommunikations- und Interaktionsverhaltens, Korrektur der dysfunktionalen Einstellungen und negativen Denkstilen, Aufbau eines Bewältigungs- und Problemlöserepertoires und Rückfallprophylaxe. KVT wird mit Erfolg im stationären und im ambulanten Rahmen, häufig in Kombination mit antidepressiver und stimmungsstabilisierender Medikation angewendet.
Das Cognitive Behavioral Analysis System of Psychotherapy (CBASP) und die Interpersonelle Therapie (IPT) sind störungsspezifische Ansätze zur Behandlung von Depressionen. Dabei wurde CBASP speziell für chronische bzw. persistierende Depressionsverläufe entwickelt, während die IPT als Kurzzeitintervention auf die Überwindung akuter depressiver oder manischer Episoden abzielt. Beide Verfahren können als interpersonelle Lerntherapien verstanden werden, da sie die Bedeutung zwischenmenschlicher Beziehungen für die Entstehung, den Verlauf und die Bewältigung von Depressionen in den Fokus rücken. Da insbesondere CBASP für die Behandlung chronischer bzw. persistierender und therapieresistenter Depressionen konzipiert wurde, wird CBASP in diesem Kapitel ausführlicher praxisnah dargestellt.
The authors examined the amount and durability of change in the cognitive content of 156 adult outpatients with recurrent major depressive disorder after treatment with cognitive therapy. The pre– post magnitude of change was large for the Attributional Style Questionnaire Failure composite (d = 0.79), Dysfunctional Attitudes Scale (d = 1.05), and Self-Efficacy Scale (d = 0.83), and small for the Attributional Style Questionnaire Success composite (d = 0.30). Changes in cognitive content were clinically significant, as defined by their 64%–87% scores overlapping with score distributions from community dwellers. Improvement was durable over a 2-year follow-up. Changes in negative cognitive content could be detected early and distinguished responders from nonresponders. In responders, continuation-phase cognitive therapy was associated with further improvements on only 1 measure of cognitive content. Early changes in negative cognitive content did not predict later changes in depressive symptoms, which the authors discuss in the context of methodological challenges and the cognitive theory of depression.
Background: A large number of studies have shown that psychological
treatments have significant effects on depression. Although several studies have
examined the relative effects of psychological and combined treatments, this has
not been studied satisfactorily in recent statistical meta-analyses. Method: We
conducted a meta-analysis of randomized studies in which a psychological
treatment was compared to a combined treatment consisting of the same
psychological treatment with a pharmacological therapy. For each of these
studies we calculated the effect size indicating the difference between the
psychological and the combined treatment. Results: All inclusion criteria were
met by 18 studies, with a total of 1,838 subjects. The mean effect size indicating
the difference between psychological and combined treatment was 0.35 (95% CI:
0.24 0.45; Po0.001), with low heterogeneity. Subgroup analyses indicated
that the difference between psychological and combined treatments was
significantly smaller in studies in which cognitive behavior therapy was
examined. We also found a trend (Po0.1) indicating that the difference
between psychological and combined treatment was somewhat larger in studies
aimed at specific populations (older adults, chronic depression, HIV patients)
than in studies with adults, and in studies in which Trycyclic antidepressants or
SSRIs were examined, compared to studies in which a medication protocol or
another antidepressant was used. At follow-up, no difference between
psychological and combined treatments was found. Conclusion: We conclude
that combined treatment is more effective than psychological treatment alone.
However, it is not clear whether this difference is relevant from a clinical
perspective. Depression and Anxiety 26:279–288, 2009.
In randomized clinical trails (RCTs), effect sizes seen in earlier studies guide both the choice of the effect size that sets the appropriate threshold of clinical significance and the rationale to believe that the true effect size is above that threshold worth pursuing in an RCT. That threshold is used to determine the necessary sample size for the proposed RCT. Once the RCT is done, the data generated are used to estimate the true effect size and its confidence interval. Clinical significance is assessed by comparing the true effect size to the threshold effect size. In subsequent meta-analysis, this effect size is combined with others, ultimately to determine whether treatment (T) is clinically significantly better than control (C). Thus, effect sizes play an important role both in designing RCTs and in interpreting their results; but specifically which effect size? We review the principles of statistical significance, power, and meta-analysis, and commonly used effect sizes. The commonly used effect sizes are limited in conveying clinical significance. We recommend three equivalent effect sizes: number needed to treat, area under the receiver operating characteristic curve comparing T and C responses, and success rate difference, chosen specifically to convey clinical significance.
• We investigated the effectiveness of two brief psychotherapies, interpersonal psychotherapy and cognitive behavior therapy, for the treatment of outpatients with major depressive disorder diagnosed by Research Diagnostic Criteria. Two hundred fifty patients were randomly assigned to one of four 16-week treatment conditions: interpersonal psychotherapy, cognitive behavior therapy, imipramine hydrochloride plus clinical management (as a standard reference treatment), and placebo plus clinical management. Patients in all treatments showed signifi-cant reduction in depressive symptoms and improvement in functioning over the course of treatment. There was a consistent ordering of treatments at termination, with imipramine plus clinical management generally doing best, placebo plus clinical management worst, and the two psychotherapies in between but generally closer to imipramine plus clinical management. In analyses carried out on the total samples without regard to initial severity of illness (the primary analyses), there was no evidence of greater effectiveness of one of the psychotherapies as compared with the other and no evidence that either of the psychotherapies was significantly less effective than the standard reference treatment, imipramine plus clinical management.
Comparing each of the psychotherapies with the placebo plus clinical management condition, there was limited evidence of the specific effectiveness of interpersonal psychotherapy and none for cognitive behavior therapy. Superior recovery rates were found for both interpersonal psychotherapy and imipramine plus clinical management, as compared with placebo plus clinical management. On mean scores, however, there were few significant differences in effectiveness among the four treatments in the primary analyses. Secondary analyses, in which patients were dichotomized on intial level of severity of depressive symptoms and impairment of functioning, helped to explain the relative lack of significant findings in the primary analyses. Significant differences among treatments were present only for the subgroup of patients who were more severely depressed and functionally impaired; here, there was some evidence of the effectiveness of interpersonal psychotherapy with these patients and strong evidence of the effectiveness of imipramine plus clinical management. In contrast, there were no significant differences among treatments, including placebo plus clinical management, for the less severely depressed and functionally impaired patients.
Publication bias is the tendency to decide to publish a study based on the results of the study, rather than on the basis of its theoretical or methodological quality. It can arise from selective publication of favorable results, or of statistically significant results. This threatens the validity of conclusions drawn from reviews of published scientific research. Meta-analysis is now used in numerous scientific disciplines, summarizing quantitative evidence from multiple studies. If the literature being synthesised has been affected by publication bias, this in turn biases the meta-analytic results, potentially producing overstated conclusions. Publication Bias in Meta-Analysis examines the different types of publication bias, and presents the methods for estimating and reducing publication bias, or eliminating it altogether. Written by leading experts, adopting a practical and multidisciplinary approach. Provides comprehensive coverage of the topic including: • Different types of publication bias, • Mechanisms that may induce them, • Empirical evidence for their existence, • Statistical methods to address them, • Ways in which they can be avoided. • Features worked examples and common data sets throughout. • Explains and compares all available software used for analysing and reducing publication bias. • Accompanied by a website featuring software, data sets and further material. Publication Bias in Meta-Analysis adopts an inter-disciplinary approach and will make an excellent reference volume for any researchers and graduate students who conduct systematic reviews or meta-analyses. University and medical libraries, as well as pharmaceutical companies and government regulatory agencies, will also find this invaluable.
Background and Objectives: It is well-established that psychological interventions are effective in the treatment of depression. However, it is not yet clear what the optima format is in which psychological treatments should be delivered. Although several studies have examined whether individual and group treatments are equally effective in the treatment of depression, no comprehensive meta-analysis has examined this. Methods: We searched major bibliographical databased and conducted a meta-analysis of 15 studies in which individual and group therapies were compared directly to each other. Results: The mean effect size indicating the difference between individual and group therapies in depressive symptomatology at post-test was 0.20 (95% CI: [0.05 0.35]; p < 0.01), in favor of individual therapies, with a lower drop-out rate in individual interventions (OR = 0.56; 95% CI: [0.37, 0.86]; p < 0.01). At follow-up no significant differences were found. Conclusions: Although individual therapy seems to be somewhat more effective than group therapy at the short term, it is not clear whether this is relevant from a clinical point of view. Because of the small number of studies and the limited quality, more research is needed to examine whether the difference between individual and group treatment is clinically relevant.