Abstract
BackgroundGlobally, national guidelines for depression have prioritised evidence from randomised controlled trials and quantitative meta-analyses, omitting qualitative research concerning patient experience of treatments. A review of patient experience research can provide a comprehensive overview of this important form of evidence and thus enable the voices and subjectivities of those affected by depression to have an impact on the treatments and services they are offered. This review aims to seek a comprehensive understanding of patient experiences of psychological therapies for depression using a systematic and rigorous approach to review and synthesis of qualitative research.MethodPsychINFO, PsychARTICLES, MEDLINE, and CINAHL were searched for published articles using a qualitative approach to examine experiences of psychological therapies for depression. All types of psychological therapy were included irrespective of model or modes of delivery (e.g. remote or in person; group or individual). Each article was assessed following guidance provided by the Critical Appraisal Skill Programme tool. Articles were entered in full into NVIVO and themes were extracted and synthesized following inductive thematic analysis.ResultsThirty-seven studies, representing 671 patients were included. Three main themes are described; the role of therapy features and setting; therapy processes and how they impact on outcomes; and therapy outcomes (benefits and limitations). Subthemes are described within these themes and include discussion of what works and what’s unhelpful; issues integrating therapy with real life; patient preferences and individual difference; challenges of undertaking therapy; influence of the therapist; benefits of therapy; limits of therapy and what happens when therapy ends.ConclusionsFindings point to the importance of common factors in psychotherapies; highlight the need to assess negative outcomes; and indicate the need for patients to be more involved in discussions and decisions about therapy, including tailoring therapy to individual needs and taking social and cultural contexts into account.
Highlights
National guidelines for depression have prioritised evidence from randomised controlled trials and quantitative meta-analyses, omitting qualitative research concerning patient experience of treatments
Findings point to the importance of common factors in psychotherapies; highlight the need to assess negative outcomes; and indicate the need for patients to be more involved in discussions and decisions about therapy, including tailoring therapy to individual needs and taking social and cultural contexts into account
In the United Kingdom (UK), United States (US) and other developed economies, evidence based treatment guidelines can influence the varieties of treatments made available to people formally diagnosed with depression, including the UK National Institute for Health and Care Excellence (NICE) guideline on depression [1]; the American Psychiatric Association guideline [2]; the European Psychiatric Association (EPA) guideline on psychotherapies for chronic forms of depression [3]; and the more recent American Psychological Association depression guideline [4]
Summary
National guidelines for depression have prioritised evidence from randomised controlled trials and quantitative meta-analyses, omitting qualitative research concerning patient experience of treatments. In the United Kingdom (UK), United States (US) and other developed economies, evidence based treatment guidelines can influence the varieties of treatments made available to people formally diagnosed with depression, including the UK National Institute for Health and Care Excellence (NICE) guideline on depression [1]; the American Psychiatric Association guideline [2]; the European Psychiatric Association (EPA) guideline on psychotherapies for chronic forms of depression [3]; and the more recent American Psychological Association depression guideline [4] All of these guidelines prioritise Randomised Controlled Trials (RCTs) and quantitative meta-analyses of trials as might be expected, since this is a key feature of the evidence based medicine paradigm. NICE depression guidelines to date have been significantly more complex than other guidelines in terms of the sub-classification of depression, branding of therapies and hierarchical ordering of treatments and prescription of specific combinations
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