Psychotherapy For Adult Depression Research Articles

Psychotherapy for adult depression in low- and middle-income countries: an updated systematic review and meta-analysis.

Previous meta-analyses on psychotherapy for adult depression have found a larger treatment effect in non-Western trials compared to Western trials (i.e. North America, Europe, and Australia). However, factors contributing to this difference remain unclear. This study investigated different study characteristics between Western and non-Western trials and examined their association with effect size estimates. We systematically searched PubMed, PsycINFO, Embase, and Cochrane Library (01-09-2022). We included randomized-controlled trials (RCTs) that compared psychotherapy with a control condition. The validity of included RCTs was assessed by the Cochrane risk of bias assessment tool (RoB 1). Effect sizes were pooled using the random-effects model. Subgroup analyses and meta-regressions were also conducted. We identified 405 eligible trials, among which 105 trials (117 comparisons, 16 304 participants) were from non-Western countries. We confirmed that non-Western trials had a larger treatment effect (g = 1.10, 95% CI 0.90-1.31) than Western trials (g = 0.57, 95% CI 0.52-0.62). Trials from non-Western countries also had more usual care controls, higher risk of bias, larger sample sizes, lower mean ages, younger adults, more group-based interventions, and other recruitment methods (e.g. systematic screening; p < 0.05). The larger effect sizes found in non-Western trials were related to the presence of wait-list controls, high risk of bias, cognitive-behavioral therapy, and clinician-diagnosed depression (p < 0.05). The larger treatment effects observed in non-Western trials may result from the high heterogeneous study design and relatively low validity. Further research on long-term effects, adolescent groups, and individual-level data are still needed.

Treatment efficacy and effectiveness in adults with major depressive disorder and childhood trauma history: a systematic review and meta-analysis

Childhood trauma is a common and potent risk factor for developing major depressive disorder in adulthood, associated with earlier onset, more chronic or recurrent symptoms, and greater probability of having comorbidities. Some studies indicate that evidence-based pharmacotherapies and psychotherapies for adult depression might be less efficacious in patients with a history of childhood trauma than patients without childhood trauma, but findings are inconsistent. Therefore, we examined whether individuals with major depressive disorder, including chronic forms of depression, and a reported history of childhood trauma, had more severe depressive symptoms before treatment, had more unfavourable treatment outcomes following active treatments, and were less likely to benefit from active treatments relative to a control condition, compared with individuals with depression without childhood trauma. We did a comprehensive meta-analysis (PROSPERO CRD42020220139). Study selection combined the search of bibliographical databases (PubMed, PsycINFO, and Embase) from Nov 21, 2013, to March 16, 2020, and full-text randomised clinical trials (RCTs) identified from several sources (1966 up to 2016-19) to identify articles in English. RCTs and open trials comparing the efficacy or effectiveness of evidence-based pharmacotherapy, psychotherapy, or combination intervention for adult patients with depressive disorders and the presence or absence of childhood trauma were included. Two independent researchers extracted study characteristics. Group data for effect-size calculations were requested from study authors. The primary outcome was depression severity change from baseline to the end of the acute treatment phase, expressed as standardised effect size (Hedges' g). Meta-analyses were done using random-effects models. From 10 505 publications, 54 trials met the inclusion criteria, of which 29 (20 RCTs and nine open trials) contributed data of a maximum of 6830 participants (age range 18-85 years, male and female individuals and specific ethnicity data unavailable). More than half (4268 [62%] of 6830) of patients with major depressive disorder reported a history of childhood trauma. Despite having more severe depression at baseline (g=0·202, 95% CI 0·145 to 0·258, I2=0%), patients with childhood trauma benefitted from active treatment similarly to patients without childhood trauma history (treatment effect difference between groups g=0·016, -0·094 to 0·125, I2=44·3%), with no significant difference in active treatment effects (vs control condition) between individuals with and without childhood trauma (childhood trauma g=0·605, 0·294 to 0·916, I2=58·0%; no childhood trauma g=0·178, -0·195 to 0·552, I2=67·5%; between-group difference p=0·051), and similar dropout rates (risk ratio 1·063, 0·945 to 1·195, I2=0%). Findings did not significantly differ by childhood trauma type, study design, depression diagnosis, assessment method of childhood trauma, study quality, year, or treatment type or length, but differed by country (North American studies showed larger treatment effects for patients with childhood trauma; false discovery rate corrected p=0·0080). Most studies had a moderate to high risk of bias (21 [72%] of 29), but the sensitivity analysis in low-bias studies yielded similar findings to when all studies were included. Contrary to previous studies, we found evidence that the symptoms of patients with major depressive disorder and childhood trauma significantly improve after pharmacological and psychotherapeutic treatments, notwithstanding their higher severity of depressive symptoms. Evidence-based psychotherapy and pharmacotherapy should be offered to patients with major depressive disorder regardless of childhood trauma status. None.

Care-as-usual control groups across different settings in randomized trials on psychotherapy for adult depression: a meta-analysis.

Care-as-usual (CAU) is often used as a control condition in psychotherapy research, but it may vary considerably what that entails, ranging from no treatment, to routine treatment in primary care, general medical care, perinatal care, and specialized mental health care. We conducted a meta-analysis of trials comparing psychotherapy for depression to CAU, with a focus on the different categories of CAU and countries where the studies were conducted. We used an existing database of randomized trials on psychotherapy for depression that is updated every year. A total of 140 studies with 15 419 patients were included. We found no significant differences in effects between categories of CAU (effect sizes ranging from g = 0.43 for CAU in primary care to g = 0.73 for no treatment), but heterogeneity was high in all CAU categories. After stratifying effects across specific countries (within CAU categories) we found that heterogeneity was considerably lower and there were several significant differences between countries. Overall, effects were larger in non-Western countries (g = 0.84 to 1.28) compared to those in Western countries (g = 0.52; p for difference = 0.002). Effects were smaller in studies with risk of bias (p = 0.01). There are no significant differences between major categories of CAU when compared to psychotherapy conditions in randomized trials. However, effects of psychotherapy differ considerably across CAU conditions in specific countries. CAU therefore is a heterogeneous control condition in psychotherapy research.

"Factors to consider in the interpretation of trial results in psychotherapy for depression in adults, with reference to suicidal behaviour"

"Factors to consider in the interpretation of trial results in psychotherapy for depression in adults, with reference to suicidal behaviour"

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. …

Psychotherapies for adult depression: recent developments.

Much has been learned from the 400 randomized trials on psychotherapies for adult depression that have been conducted, but much is also still unknown. In this study some recent attempts to further reduce the disease burden of depression through psychotherapies are reviewed. In the past, many new psychotherapies have promised to be more effective than existing treatments, usually without success. We describe recent research on two new therapies, acceptance and commitment therapy and cognitive bias modification, and conclude that both have also not shown to be more effective than existing therapies. A growing number of studies have also focused on therapies that may be successful in further reducing the disease burden, such as treatments for chronic depression and relapse prevention. Other studies are aimed at scaling up psychological services, such as the training of lay health counselors in low-income and middle-income countries, telephone-based, and internet-based therapies. Psychotherapies are essential tools in the treatment of adult depression. Randomized trials have shown that these treatments are effective, and by focusing on key issues, such as chronic depression, relapse, and scaling them up, psychotherapies contribute more and more to the reduction of the disease burden of depression.

EPA-0174 - Four decades of research on psychotherapy for depression: An overview of meta-analyses

In the past four decades several hundreds of randomized trials have examined the effects of psychotherapy for adult depression. In this presentation the results of a series of meta-analyses of these trials will be presented. These results are based on more than 30 published metaanalyses that have used a meta-analytic database of these trials (www.evidencebasedpsychotherapies.org). First, the results of a meta-analysis of 19 trials on prevention of the incidence of depressive disorders will be presented. This meta-analysis has shown that preventive interventions can significantly reduce the incidence of new cases of depressive disorders with 22%. Studies on psychological treatments of adult depression (N=315) have found relatively large effect sizes (d > 0.6) for these treatments in general. These studies also show that the effects of psychotherapy are comparable with those of pharmacotherapy and that combined treatments are more effective than psychotherapy alone or pharmacotherapy alone. There are no big differences between the different types of psychotherapy. Interpersonal psychotherapy may be somewhat more effective and non-directive supportive therapy may be somewhat less effective than other therapies, but these differences are small and not consistent. Psychotherapies are effective in several more specific target groups, including older adults, women with postpartum depression, and patients with general medical disorders. Effect sizes are smaller in chronic depression and dysthymia, and in inpatients. The effects of psychotherapy are probably overestimated because of the low quality of many studies in this research area, and because of publication bias.

Psychotherapy for Depression in Adults: A Meta-Analysis of Comparative Outcome Studies

Although the subject has been debated and examined for more than 3 decades, it is still not clear whether all psychotherapies are equally efficacious. The authors conducted 7 meta-analyses (with a total of 53 studies) in which 7 major types of psychological treatment for mild to moderate adult depression (cognitive–behavior therapy, nondirective supportive treatment, behavioral activation treatment, psychodynamic treatment, problem-solving therapy, interpersonal psychotherapy, and social skills training) were directly compared with other psychological treatments. Each major type of treatment had been examined in at least 5 randomized comparative trials. There was no indication that 1 of the treatments was more or less efficacious, with the exception of interpersonal psychotherapy (which was somewhat more efficacious; d=0.20) and nondirective supportive treatment (which was somewhat less efficacious than the other treatments; d=−0.13). The drop-out rate was significantly higher in cognitive–behavior therapy than in the other therapies, whereas it was significantly lower in problem-solving therapy. This study suggests that there are no large differences in efficacy between the major psychotherapies for mild to moderate depression. (Reprinted with permission from Journal of Consulting and Clinical Psychology 2008; 76:909–922) Full text of the article available online at http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WY6-4V700P1-1&_user=10&_coverDate=12%2F31%2F2008&_rdoc=1&_fmt=high&_orig=browse&_srch=doc-info(%23toc%237178%232008%23999239993%23788052%23FLP%23display%23Volume)&_cdi=7178&_sort=d&_docanchor=&_ct=18&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=7ca472f5b40e3511cccdde88e17fdcf5

Supplemental Material for Psychotherapy for Depression in Adults: A Meta-Analysis of Comparative Outcome Studies

Supplemental Material for Psychotherapy for Depression in Adults: A Meta-Analysis of Comparative Outcome Studies

Psychotherapy for depression in adults: A meta-analysis of comparative outcome studies.

Although the subject has been debated and examined for more than 3 decades, it is still not clear whether all psychotherapies are equally efficacious. The authors conducted 7 meta-analyses (with a total of 53 studies) in which 7 major types of psychological treatment for mild to moderate adult depression (cognitive-behavior therapy, nondirective supportive treatment, behavioral activation treatment, psychodynamic treatment, problem-solving therapy, interpersonal psychotherapy, and social skills training) were directly compared with other psychological treatments. Each major type of treatment had been examined in at least 5 randomized comparative trials. There was no indication that 1 of the treatments was more or less efficacious, with the exception of interpersonal psychotherapy (which was somewhat more efficacious; d = 0.20) and nondirective supportive treatment (which was somewhat less efficacious than the other treatments; d = -0.13). The drop-out rate was significantly higher in cognitive-behavior therapy than in the other therapies, whereas it was significantly lower in problem-solving therapy. This study suggests that there are no large differences in efficacy between the major psychotherapies for mild to moderate depression.