Non-pharmacological interventions for depression among survivors of adverse childhood experiences: A meta-analysis

Abstract

Adverse childhood experiences (ACEs) are associated with various mental health problems such as depression, anxiety, drug abuse, and suicide-related behaviors. Yet, it is largely unknown if non-pharmacological interventions are beneficial in improving mental health among ACEs survivors. The purposes of the current meta-analysis were to: (1) evaluate the efficacy of non-pharmacological interventions in reducing depressive symptom severity among those exposed to ACEs, and, (2) estimate the pooled effect size of these interventions. We searched PubMed, CINAHL, and PsycINFO for randomized controlled trials of psychological interventions for depression among ACEs survivors. Two reviewers independently extracted article data and evaluated the quality of studies using the Cochrane risk-of-bias criteria. We estimated the pooled effect sizes using a random-effects model. We also performed sensitivity tests using a meta-regression and sub-group analyses. Using the pooled data of 1624 individuals from 20 unique RCTs, we found that non-pharmacological intervention had a medium to large effect size in reducing depressive symptom severity compared to control conditions (Hedges’ g = 0.714, 95% CI [0.46, 0.97]). Such efficacy was sustained over the shorter-term follow-up (0 to 6 months; Hedges’ g = 0.23, 95% CI [0.04, 0.49]). Although there was an indication that the efficacy may be sustained in the longer term (12 months or more; Hedges’ g = 0.53, 95% CI: [−0.17, 1.22]), this finding was not statistically significant. Cognitive approaches had a larger effect size than noncognitive interventions. In conclusion, non-pharmacological interventions are efficacious options for treating depression among individuals with a history of adverse childhood experiences.