Abstract
The treatment of depression in patients with somatic disorders is crucial, given its negative impact on quality of life (QoL), functioning, and even on the somatic disease prognosis. We aimed to examine the most updated evidence on the effects of psychotherapy in patients with depression and somatic disorders, including HIV, oncological, cardiometabolic, and neurological disorders. We conducted a meta-analysis of 75 randomized trials (8209 participants) of psychotherapy for adults with somatic disorders and a diagnosis or elevated symptoms of depression. Outcomes included depression, QoL, somatic health-related outcomes, and mortality. Psychotherapy significantly reduced the severity of depression at post-treatment across all categories of somatic disorders (Hedges'g = 0.65; 95% CI 0.52-0.79), with sustained effects at 6-11 months (g = 0.38; 95% CI 0.22-0.53) and at 12 months follow-up or longer (g = 0.13; 95% CI 0.04-0.21). Psychotherapy also showed significant effects on QoL (g = 0.26; 95% CI 0.17-0.35), maintained up to 11 months follow-up (g = 0.25; 95% CI 0.16-0.34). No significant effects were observed on the most frequently reported somatic health-related outcomes (glycemic control, pain), and neither on mortality. Heterogeneity in most analyses was very high, and only 29 (38%) trials were rated at low risk of bias (RoB). Psychotherapy may be an effective treatment option for patients with depression and somatic disorders, with long-term effects on depression severity and QoL. However, these results should be interpreted with caution due to heterogeneity and RoB.
Highlights
Individuals with somatic disorders have an increased risk of experiencing depression (Egede, 2007; Moussavi et al, 2007)
We used the most recent version of an existing database of randomized trials on psychotherapies for depression. This database was developed through systematic searches in PubMed, PsycINFO, Embase, and Cochrane, by combining index and free terms indicative of depression and psychotherapies
Psychotherapy reduced the severity of depression across all main categories of somatic diseases, with variable effects: neurological (g = 0.96, 95% confidence interval (CI) 0.53–1.38), oncological (g = 0.85, 95% CI 0.46–1.25), cardiometabolic (g = 0.75, 95% CI 0.51–0.99), HIV/AIDS (g = 0.34, 95% CI 0.19–0.50), and other somatic disorders (g = 0.48, 95% CI 0.23–0.74)
Summary
Individuals with somatic disorders have an increased risk of experiencing depression (Egede, 2007; Moussavi et al, 2007). In patients with comorbid depression and somatic disorders, previous meta-analytical studies have suggested that psychotherapy is an effective treatment option (Rizzo, Creed, Goldberg, Meader, & Pilling, 2011; van Straten, Geraedts, Verdonck-de Leeuw, Andersson, & Cuijpers, 2010). Psychotherapy significantly reduced the severity of depression at post-treatment across all categories of somatic disorders (Hedges’g = 0.65; 95% CI 0.52–0.79), with sustained effects at 6–11 months (g = 0.38; 95% CI 0.22–0.53) and at 12 months follow-up or longer (g = 0.13; 95% CI 0.04–0.21). Psychotherapy may be an effective treatment option for patients with depression and somatic disorders, with long-term effects on depression severity and QoL. These results should be interpreted with caution due to heterogeneity and RoB
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