Levels Of Service Use Research Articles

Identifying complex emotional and relational needs of service users in Later Life CMHTs within the Greater Manchester Mental Health NHS Foundation Trust

The Community Mental Health Transformation Agenda places a focus on supporting adults and older adults with severe and enduring mental health difficulties, including care for older adults with complex emotional and relational needs (CERN). Current research has paid little attention to CERN in later life. Studies suggest that older adults with CERN present differently to younger adults. This means services may not be identifying and meeting the needs of these individuals. The aim of this scoping exercise was to understand the prevalence of CERN in older adult community mental health services in Greater Manchester. Data was collected on 347 service users under the Care Programme Approach with later life community mental health teams in Greater Manchester. Data was gathered from the Trust electronic record system and interviews with care co-ordinators. Findings revealed that services users had high levels of complex need, including high levels of service use and high levels of risk, especially for self-neglect. Findings aligned with scoping exercises conducted in other Trusts and provided a better understanding of the needs of this population.

Campus Support Program Service Use by Students Who Experienced Foster Care, Relative Care, or Homelessness

Campus support programs (CSPs) in higher education institutions seek to address the barriers encountered by students who experienced foster care or homelessness (SEFC/H). This mixed methods study of a CSP at Florida State University examined the SEFC/H’s service use and students’ perceptions of the CSP to better understand student experiences. Study participants included 54 CSP students who graduated between 2015 and 2020. They completed surveys at graduation and six months and one year post-graduation. Students reported service use and perceptions of the services’ helpfulness. They described what they valued in the CSP and what the CSP could have done to better prepare them for life after graduation. Findings show a high level of service use and perceptions of helpfulness. Students reported valuing the support; resources; physical space; sense of belonging, community, family, and home; growth and motivation; and success because of their CSP involvement. Areas where students believed the CSP could better prepare them for life after graduation included finances, graduate school, career planning, life skills, and connections. Implications for CSP include assisting SEFC/H with (a) planning and life skills, (b) financial literacy and money, and (c) mentors and connections.

The practice and determinants of ambulance service utilization in pre-hospital settings, Jimma City, Ethiopia

BackgroundIn pre-hospital setting, ambulance provides emergency care and means of transport to arrive at appropriate health centers are as vital as in-hospital care, especially, in developing countries. Accordingly, Ethiopia has made several efforts to improve accessibility of ambulances services in prehospital care system that improves the quality of basic emergency care. Yet, being a recent phenomenon in Ethiopia, empirical studies are inadequate with regard to the practice and determinants of ambulance service utilization in pre-hospital settings. Hence, this study aimed to assess the ambulance service utilization and its determinants among patients admitted to the Emergency Departments (EDs) within the context of pre-hospital care system in public hospitals of Jimma City.MethodA cross-sectional study design was used to capture quantitative data in the study area from June to July 2022. A systematic sampling technique was used to select 451 participants. Interviewer-administered questionnaire was used to collect data. Data analysis was done using SPSS version 26.0; descriptive and logistic regressions were done, where statistical significance was determined at p < 0.05.ResultsAmbulance service was rendered to bring about 39.5% (of total sample, 451) patients to hospitals. The distribution of service by severity of illnesses was 48.7% among high, and 39.4% among moderately acute cases. The major determinants of ambulance service utilization were: service time (with AOR, 0.35, 95%CI, 0.2-0.6 for those admitted to ED in the morning, and AOR, 2.36, 95%CI, 1.3-4.4 for those at night); referral source (with AOR, 0.2, 95%CI, 0.1-0.4 among the self-referrals); mental status (with AOR, 1.9, 95%CI, 1-3.5 where change in the level of consciousness is observed); first responder (AOR, 6.3 95%CI, 1.5-26 where first responders were the police, and AOR, 3.4, 95%C1, 1.7-6.6 in case of bystanders); distance to hospital (with AOR,0.37, 95%CI, 0.2-0.7 among the patients within ≤15km radius); and prior experience in ambulance use (with AOR, 4.1,95%CI, 2.4-7).ConclusionAlthough the utilization of ambulance in pre-hospital settings was, generally, good in Jimma City; lower levels of service use among patients in more acute health conditions is problematic. Community-based emergency care should be enhanced to improve the knowledge and use of ambulance services.

E-Connect: Linking probation youth at risk for suicide to behavioral health services.

Youth involved in the justice system (YIJ) have higher rates of suicidal thoughts and behaviors (STB) and associated behavioral health (BH) problems, yet lower levels of service use compared to youth in the general population. This study examined the efficacy of e-Connect, a digital clinical decision support system (CDSS), at improving STB risk identification, referral, and linkage to BH services by probation officers. As the intervention spanned pre- and post-COVID-19 shutdown periods, we also examined the disruption in public agencies' service provision on study outcomes. Administrative record data (1,488 youth, ages 10-18 years, 56% male, 56% White) allowed examination of differences between care-as-usual (baseline) and e-Connect in screening, identification of STB and BH problems, referral, and treatment initiation. Compared to care-as-usual, probation officers using e-Connect were over five times as likely to identify YIJ with STB (adjusted odds ratio [aOR] = 5.86; 95% confidence interval, CI [3.24, 11.7]) and over 11 times more likely to refer YIJ in need of BH services to treatment (aOR = 11.04; 95% CI [6.54, 19.43]). In turn, youth referred to treatment via e-Connect were nearly 17 times more likely to initiate (aOR = 16.92; 95% CI [9.17, 32.60]). Results remained unchanged during the pre- and post-COVID-19 shutdown periods. e-Connect is one of the first digital STB screening, referral, and linkage-to-service systems that use CDSS technology to successfully assist probation officers in linking youth on their caseload to treatment. Such an approach may support identification of STB and cross-systems linkage in other youth-serving organizations, such as schools, that increasingly manage youth BH problems with minimal clinical support. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

From population numbers to population needs: Incorporating epidemiological change into health service planning in Australia

BackgroundIn the face of rapidly ageing populations and increasing costs of health care provision, questions continue to be raised about the long-term sustainability of publicly funded health care programmes around the world. But despite increasing evidence of dynamic changes in epidemiology, most official health service planning models continue to rely on the implicit assumption that age-specific requirements for services (and by implication age-specific needs for care) will remain constant across future years (‘constant-use models'). ObjectivesIn this paper, we discuss the advantage of dynamic ‘changing needs’ planning models, compared to ‘constant-use’ planning models, and consider a framework that integrates population needs directly into health service planning. Using Australian survey data, we empirically illustrate the difference between static health service planning approaches to dynamic needs-driven planning models. MethodsWe use data from the Household, Income and Labour Dynamics Survey in Australia (HILDA) to explore trends in health needs from 2001 to 2020. We subsequently simulate a ‘changing-needs' planning model where changes in health needs by birth-cohorts are incorporated into official government estimates from the Australian Intergenerational Reports (IGR) to understand the potential impact on future health care requirements. ResultsOur results show that healthy ageing trends are being observed for successive birth-cohorts with these trends greatest in older age groups, the age groups for which health care expenditures are largest. Adjusting for these changes in needs using Australian data leads to reductions in the expenditures required for future years ranging from 1.5 (2.50%) to 3 billion (5.25%) 2019 AUD. ConclusionWe conclude that ‘constant-use’ planning models based on the expected future numbers of people in different age groups applied to current levels of service use by age groups without any consideration given to changing age-specific needs for health care lead to inefficient resource planning.

Predictors of amounts of child and adolescent mental health service use

The aim of this study was to build evidence about how to tailor services to meet the individual needs of young people by identifying predictors of amounts of child and adolescent mental health service use. We conducted a secondary analysis of a large administrative dataset from services in England was conducted using the Mental Health Services Data Set (years 2016–17 and 2017–18). The final sample included N = 27,362 episodes of care (periods of service use consisting of at least two attended care contacts and less than 180 days between care contacts) from 39 services. There were 50–10,855 episodes per service. The descriptive statistics for episodes of care were: Mage = 13 years, SDage = 4.71, range = 0–25 years; 13,785 or 50% male. Overall, there were high levels of heterogeneity in number of care contacts within episodes of care: M = 11.12, SD = 28.28, range = 2–1529. Certain characteristics predicted differential patterns of service use. For example, young people with substance use (beta = 6.29, 95% CI = 5.06–7.53) or eating disorders (beta = 4.30, 95% CI = 3.29–5.30) were particularly more likely to have higher levels of service use. To build on this, evidence is needed about predictors of child and adolescent mental health treatment outcome and whether the same characteristics predict levels of improvement as well as levels of service use.

Factors associated with professional mental health service use among adults with suicidal ideation

BackgroundThe uptake of professional mental health services among people with suicidal ideation remains low, yet few community-based studies have characterised modifiable individual barriers to service use. Our aims were (1) to identify factors associated with use of professional mental health services among people experiencing suicidal ideation, and (2) to distinguish subgroups with varying levels of service use. Methods1462 Australian adults (78.8% female) were recruited online to participate in a cross-sectional survey. Logistic regression analysis was used to identify factors associated with professional service use. A decision tree model was used to identify subgroups with varying rates of professional service use. ResultsMost participants (62%) had used professional services for mental health concerns in the past 12 months. Greater rates of service use were observed in participants who were middle aged, spoke English, disclosed to informal sources or helplines, met criteria for a mental health disorder, had higher levels of entrapment, psychological distress, and disinhibition, and lower levels of detachment and antagonism. At the terminal nodes of the decision tree analysis, service use ranged from 21% to 94%. The most important determinants of service use were meeting criteria for a mental disorder and disclosure of suicidal ideation to family/friends and helplines. ConclusionThese findings suggest that interventions to support the safe disclosure of suicidal ideation may assist in increasing service use. There is also the need for services that meet the needs of individuals who do not meet criteria for a mental health condition.

Patient Service Utilization Among Individuals with Co-occurring Disorders: A Comparison of Two Models of Care Coordination.

Healthcare systems have increasingly adopted integrated care models with demonstrated effectiveness. However, few studies examine integrated care for individuals with co-morbid mental illness and medical conditions. This quasi-experimental study compared service use for two integrated care models for patients with co-occurring conditions. We used hierarchical negative binomial and logistic regressions with random effects to test the relationship between integration and service use. Patients treated at co-located agencies had significantly higher odds of inpatient hospitalization compared to those in fully integrated settings. Additionally, some comorbidities had significantly different levels of service use. Patients at co-located agencies had more outpatient and emergency visits, but was not statistically significant. Our findings provide evidence that the model of care may impact service use for patients experiencing co-occurring conditions, however, variations in service use for specific co-morbid conditions highlight the need to examine the specific needs and characteristics of this population.

A utilisation profile of publicly financed oral examinations in the Republic of Ireland.

To develop a utilisation profile for oral examinations performed under the remit of publicly financed dental services in the Republic of Ireland as a proxy for the overall level of service use. Collation of data from multiple administrative datasets for 2018, and generation of an age-specific oral examination utilisation profile. Age-specific oral examination rates per 1,000 population. A total of 1,163,399 publicly financed oral examinations were performed. Comparably low population-adjusted oral examination rates were observed in the 0-15, 16-24 and 75+ age cohorts. The National Oral Health Policy in Ireland aims to improve access to oral healthcare services across the life-course. Young children and older adults are highlighted as population subgroups with low levels of service eligibility and engagement, respectively. These results reinforce the need to focus on these age cohorts.

Mental Health Services Data Dashboards for Reporting to Australian Governments during COVID-19.

The Australian Institute of Health and Welfare (AIHW) has been providing support to the Australian Government Department of Health to report on mental health-related data to Australian governments on a frequent basis since April 2020 in the form of COVID-19 mental health services data dashboards. These dashboards feature extensive use of data visualizations which illustrate the change in mental health service use over time as well as comparisons with pre-pandemic levels of service use. Data are included from the Medicare Benefits Schedule (MBS), Pharmaceutical Benefits Scheme (PBS/RPBS), Australian Government-funded crisis and support organizations, and key findings from emerging research. Demand for telehealth, crisis and support organizations and online mental health information services, in particular, have increased during the pandemic. The dashboards incorporate both new and existing data sources and represent an innovative way of reporting mental health services data to Australian governments. The reporting has enabled timely, targeted adjustments to mental health service delivery during the pandemic with improved cooperative data sharing arrangements having the potential to yield ongoing benefits.

Feasibility, acceptability, concerns, and challenges of implementing supervised injection services at a specialty HIV hospital in Toronto, Canada: perspectives of people living with HIV

BackgroundSubstance use significantly impacts health and healthcare of people living with HIV/AIDS (PLHIV), especially their ability to remain in hospital following admission. Supervised injection services (SIS) reduce overdoses and drug-related harms, but are not often provided within hospitals/outpatient programs. Leading us to question, what are PLHIV’s perceptions of hospital-based SIS?MethodsThis mixed-methods study explored feasibility and acceptability of implementing SIS at Casey House, a Toronto-based specialty HIV hospital, from the perspective of its in/outpatient clients. We conducted a survey, examining clients’ (n = 92) demand for, and acceptability of, hospital-based SIS. Following this, we hosted two focus groups (n = 14) and one-on-one interviews (n = 8) with clients which explored benefits/drawbacks of in-hospital SIS, wherein participants experienced guided tours of a demonstration SIS space and/or presentations of evidence about impacts of SIS. Data were analysed using descriptive statistics and thematic analysis.ResultsAmong survey participants, 76.1% (n = 70) identified as cis-male and over half (n = 49;54.4%) had been a hospital client for 2 years or less. Nearly half (48.8%) knew about clients injecting in/near Casey House, while 23.6% witnessed it. Survey participants were more supportive of SIS for inpatients (76.1%) than for outpatients (68.5%); most (74.7%) reported SIS implementation would not impact their level of service use at Casey House, while some predicted coming more often (16.1%) and others less often (9.2%). Most focus group/interview participants, believed SIS would enhance safety by reducing health harms (e.g. overdose), increasing transparency between clients and clinicians about substance use, and helping retain clients in care. Debate arose about who (e.g., in/outpatients vs. non-clients) should have access to hospital-based SIS and how implementation may shift organizational priorities/resources away from services not specific to drug use.ConclusionsOur data showed widespread support of, and need for, hospital-based SIS among client stakeholders; however, attempts to reduce negative impacts on non-drug using clients need to be considered in the balance of implementation plans. Given the increased risks of morbidity and mortality for PLHIV who inject drugs as well as the problems in retaining them in care in a hospital setting, SIS is a key component of improving care for this marginalized group.

Uncovering spatial variation in maternal healthcare service use at subnational level in Jimma Zone, Ethiopia

BackgroundAnalysis of disaggregated national data suggest uneven access to essential maternal healthcare services within countries. This is of concern as it hinders equitable progress in health outcomes. Mounting an effective response requires identification of subnational areas that may be lagging behind. This paper aims to explore spatial variation in maternal healthcare service use at health centre catchment, village and household levels. Spatial correlations of service use with household wealth and women’s education levels were also assessed.MethodsUsing survey data from 3758 households enrolled in a cluster randomized trial geographical variation in the use of maternity waiting homes (MWH), antenatal care (ANC), delivery care and postnatal care (PNC) was investigated in three districts in Jimma Zone. Correlations of service use with education and wealth levels were also explored among 24 health centre catchment areas using choropleth maps. Global spatial autocorrelation was assessed using Moran’s I. Cluster analyses were performed at village and household levels using Getis Ord Gi* and Kulldorf spatial scan statistics to identify cluster locations.ResultsSignificant global spatial autocorrelation was present in ANC use (Moran’s I = 0.15, p value = 0.025), delivery care (Moran’s I = 0.17, p value = 0.01) and PNC use (Moran’s I = 0.31, p value < 0.01), but not MWH use (Moran’s I = -0.005, p value = 0.94) suggesting clustering of villages with similarly high (hot spots) and/or low (cold spots) service use. Hot spots were detected in health centre catchments in Gomma district while Kersa district had cold spots. High poverty or low education catchments generally had low levels of service use, but there were exceptions. At village level, hot and cold spots were detected for ANC, delivery care and PNC use. Household-level analyses revealed a primary cluster of elevated MWH-use not detected previously. Further investigation of spatial heterogeneity is warranted.ConclusionsSub-national variation in maternal healthcare services exists in Jimma Zone. There was relatively higher poverty and lower education in areas where service use cold spots were identified. Re-directing resources to vulnerable sub-groups and locations lagging behind will be necessary to ensure equitable progress in maternal health.

Integrating Healthcare Services for Indigenous Australian Students at Boarding Schools: A Mixed-Methods Sequential Explanatory Study.

Introduction:Many Aboriginal and Torres Strait Islander Australian adolescents from remote communities attend boarding schools, requiring integrated healthcare between home and schools. This study explored students’ health status, healthcare service use and satisfaction.Methodology:A two-phased mixed-methods explanatory design was implemented. 32 Indigenous primary and 188 secondary boarding school students were asked their health status, psychological distress, use of healthcare services in community and boarding school, and service satisfaction. Results were fed back to students, parents and community members, and education and healthcare staff to elicit further explanation and interpretation.Results:In the previous year, 75% of primary and 81% of secondary boarding school students had visited a doctor. More than 90% were satisfied with healthcare services used. Despite 27.1% reporting high psychological distress, students did not perceive distress as reducing their overall health, nor was distress associated with mental healthcare service use.Discussion:Despite high levels of service use and satisfaction, this study highlighted the need for improved healthcare integration for Indigenous adolescents between school-based and remote community services. Further research is needed to identify students’ expectations and models for healthcare integration.Conclusion:With resourcing, schools could play a greater role in facilitating access to healthcare.

An evaluation of the characteristics and outcomes of users of a street triage service: retrospective case note review.

Aims and methodStreet triage services are now common but the population they serve is poorly understood. We aimed to evaluate a local service to determine the characteristics of those using it and their outcomes in the 90 day period following contact. RESULTS: We found that there were high levels of service use and that the vast majority of contacts were via telephone rather than in person. Street triage was used by both existing secondary mental health patients and non-patients. Follow-up rates with secondary services were high in the former and low in the latter case.ImplicationsServices are very busy where they exist and may be replacing traditional crisis services. It is not apparent that they work to increase follow-up among those using them, unless they are already in contact with services. In this service, although there was a joint response model nearly all responses were provided by telephone.Declaration of interestNone.

Paradoxical evidence on ethnic inequities in child welfare: Towards a research agenda

This paper aims to compare developments in theory and evidence about ethnic disparities in the USA with findings from the Child Welfare Inequalities Project in England with a view to identifying key issues for a future research agenda. It has a particular focus on the relevance of the concept of the Hispanic Paradox for disparate intervention rates between ethnic populations in England. Three key theoretical dimensions for explaining such disparities are identified and outlined: artefactual, demand and supply factors. Findings from the study in England are then introduced to explore the relevance of these dimensions in a data set of over 14,000 individual children who were either on child protection plans (with substantiated child abuse or neglect) or who were ‘looked after children: in out-of-home care at the 31st March 2015. While some ethnic populations were experiencing much more difficult average socio-economic circumstances (SEC) than others (using deprivation scores for small neighbourhoods as a proxy measure of family SEC), such factors were only a partial explanation for differential intervention rates between ethnic groups. Overall, large differences in intervention rates were found between ethnic categories and sub-categories which also confounded simply attributing disparities to either cultural differences, such as family patterns, or to individual or institutionalised discrimination. The potential for cost saving if intervention rates could match those ethnic groups with the lowest levels of service use would be considerable. More research is needed to ensure that data is comprehensive, reliable and valid, that there is better understanding of how socio-economic factors affect service demand and what characteristics of different ethnic populations and different approaches o service provision contribute to differential intervention rates.

Identifying Recipients of Electroconvulsive Therapy: Data From Privately Insured Americans.

Despite the effectiveness of electroconvulsive therapy (ECT), limited epidemiologic research has been conducted to identify rates of ECT use and characteristics of patients who receive ECT. Sociodemographic and clinical characteristics associated with ECT use were examined among patients with mood disorders in the MarketScan commercial insurance claims database. Among individuals with major depressive disorder or bipolar disorder, sociodemographic and clinical characteristics of those who received ECT and those who did not were compared by using bivariate effect size comparisons and multivariate logistic regression. Among unique individuals in the 2014 MarketScan database (N=47,258,528), the ECT utilization rate was 5.56 ECT patients per 100,000 in the population. Of the 969,277 patients with a mood disorder, 2,471 (.25%) received ECT. Those who received ECT had substantially higher rates of additional comorbid psychiatric disorders (risk ratio [RR]=5.70 for any additional psychiatric disorder), numbers of prescription fills for any psychotropic medication (Cohen's d=.77), rates of any substance use disorder (RR=1.97), and total outpatient psychotherapy visits (Cohen's d=.49). The proportion of patients with a mood disorder who received ECT in the West (.19%) was substantially lower than in other U.S. regions (.28%). This difference was almost entirely accounted for by one western state comprising 59.1% of patients in that region. Use of ECT is exceptionally uncommon and limited to patients with extensive multimorbidity and high levels of service use. ECT utilization is most limited in areas of the country where regulatory restrictions are greatest.

Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries.

Anxiety disorders are a major cause of burden of disease. Treatment gaps have been described, but a worldwide evaluation is lacking. We estimated, among individuals with a 12-month DSM-IV (where DSM is Diagnostic Statistical Manual) anxiety disorder in 21 countries, the proportion who (i) perceived a need for treatment; (ii) received any treatment; and (iii) received possibly adequate treatment. Data from 23 community surveys in 21 countries of the World Mental Health (WMH) surveys. DSM-IV mental disorders were assessed (WHO Composite International Diagnostic Interview, CIDI 3.0). DSM-IV included posttraumatic stress disorder among anxiety disorders, while it is not considered so in the DSM-5. We asked if, in the previous 12 months, respondents felt they needed professional treatment and if they obtained professional treatment (specialized/general medical, complementary alternative medical, or nonmedical professional) for "problems with emotions, nerves, mental health, or use of alcohol or drugs." Possibly adequate treatment was defined as receiving pharmacotherapy (1+ months of medication and 4+ visits to a medical doctor) or psychotherapy, complementary alternative medicine or nonmedical care (8+ visits). Of 51,547 respondents (response=71.3%), 9.8% had a 12-month DSM-IV anxiety disorder, 27.6% of whom received any treatment, and only 9.8% received possibly adequate treatment. Of those with 12-month anxiety only 41.3% perceived a need for care. Lower treatment levels were found for lower income countries. Low levels of service use and a high proportion of those receiving services not meeting adequacy standards for anxiety disorders exist worldwide. Results suggest the need for improving recognition of anxiety disorders and the quality of treatment.

Personality disorder services in England: findings from a national survey.

Aims and method We aimed to evaluate the availability and nature of services for people affected by personality disorder in England by conducting a survey of English National Health Service (NHS) mental health trusts and independent organisations.Results In England, 84% of organisations reported having at least one dedicated personality disorder service. This represents a fivefold increase compared with a 2002 survey. However, only 55% of organisations reported that patients had equal access across localities to these dedicated services. Dedicated services commonly had good levels of service use and carer involvement, and engagement in education, research and training. However, a wider multidisciplinary team and a greater number of biopsychosocial interventions were available through generic services.Clinical implications There has been a substantial increase in service provision for people affected by personality disorder, but continued variability in the availability of services is apparent and it remains unclear whether quality of care has improved.

How do hospital doctors manage patients with medically unexplained symptoms: a qualitative study of physicians.

Objective Medically unexplained symptoms are a common presentation in medical practice and are associated with significant morbidity and high levels of service use. Most research exploring the attitudes and training of doctors in treating patients with unexplained symptoms has been conducted in primary care. This study aims to explore the ways in which doctors working in secondary care approach and manage patients with medically unexplained symptoms. Design A qualitative study using in-depth interviews and thematic analysis. Setting Three hospitals in the North Thames area. Participants Twenty consultant and training-grade physicians working in cardiology, gastroenterology, rheumatology and neurology. Main outcome measure Physicians' approach to patients with medically unexplained symptoms and their views on managing these patients. Results There was considerable variation in how the physicians approached patients who presented with medically unexplained symptoms. Investigations were often ordered without a clear rationale and the explanations given to patients when results of investigations were normal were highly variable, both within and across specialties. The doctor's level of experience appeared to be a more important factor in their investigation and management strategies than their medical specialty. Physicians reported little or no formal training in how to manage such presentations, with no apparent consistency in how they had developed their approach. Doctors described learning from their own experience and from senior role models. Organisational barriers were identified to the effective management of these patients, particularly in terms of continuity of care. Conclusions Given the importance of this topic, there is a need for serious consideration as to how the management of patients with medically unexplained symptoms is included in medical training and in the planning and delivery of services.

Four decades of outcome research on psychotherapies for adult depression: An overview of a series of meta-analyses.

Depressive disorders are highly prevalent (Alonso et al., 2004; Kessler et al., 1994), have a high incidence (Waraich, Goldner, Somers, & Hsu, 2004), and they are associated with a substantial loss of quality of life for patients and their relatives (Saarni et al., 2007; Ustun, Ayuso-Mateos, Chatterji, Mathers, & Murray, 2004). These disorders are also associated with increased mortality rates (Cuijpers, Vogelzangs et al., 2014), high levels of service use, and enormous economic costs (Greenberg & Birnbaum, 2005; Smit et al., 2006). Major depression is currently ranked fourth worldwide in disease burden. Depression is expected to rank first in disease burden in high-income countries by the year 2030 (Mathers & Loncar, 2006). It is not surprising therefore that several treatments of depression have been developed in the past decades and that a considerable body of research has examined the effects of these treatments. There are two main categories of treatments for depression: biological treatments (mostly antidepressant medications) and psychological treatments. Both types have been examined extensively. Since the 1970s about 500 randomized controlled trials have examined the effects of psychological treatments on depression.It is now about 10 years since we started to build a comprehensive database of randomized trials examining the effects of psychological treatments of depression. Since that time we have updated this database every year (Cuijpers, van Straten, Smit, Mihalopoulos, & Beekman, 2008). We have used this database to answer several research questions with meta-analyses. We have published more than 70 of such meta-analyses. We have examined which psychotherapies are effective, whether psychotherapy is as effective as pharmacotherapy, and whether combined treatments are more effective than psychotherapy or pharmacotherapy alone. We have also examined the effects of the therapies in specific target groups, settings and subtypes of depression, as well characteristics of the therapies, such as the format (individual, group, self-help), and the number of sessions. We have examined the quality of the trials and how this affects their outcomes of the therapies, as well as the problem of publication bias. In this article we will give an overview of the results of these meta-analyses. We already provided an overview in an earlier article (Cuijpers, Andersson, Donker, & Van Straten, 2011). However, since then a considerable number of new meta-analyses have been published. This article can be seen as an update of this earlier overview.A Database of Randomized Trials of Psychotherapies for Adult DepressionThe methods used for building the database and the analyses used in the meta-analyses have been published in a methods article (Cuijpers, Van Straten, Smit et al., 2008). The general methods we used in these meta-analyses have been described in a manual that is freely available (Cuijpers, 2016b). In brief, the database was developed through a comprehensive literature search (of works dating from 1966), and is updated every year. We searched major bibliographical databases (PsycINFO, PubMed, Embase, Cochrane Central Register of Controlled Trials). We include all randomized trials in which at least one arm is a psychological treatment for adults (>18 years) with a depressive disorder according to a diagnostic interview or an elevated level of depressive symptomatology (as indicated by a score above a cut-off score on a validated self-report depression scale like the Beck Depression Inventory).We calculate standardized mean effects (Cohen's d or Hedges' g) for each comparison between a psychotherapy and a comparison group, indicating the difference between these groups in terms of standard deviations. Effect sizes of 0.8 can be assumed to be large, while effect sizes of 0.5 are moderate, and effect sizes of 0.2 are small (Cohen, 1988). An effect size is, however, still a statistical concept with no direct indication for clinical relevance. …