Psychotherapies for depression in low‐ and middle‐income countries: a meta‐analysis

Cuijpers, Pim; Karyotaki, Eirini; Reijnders, Mirjam; Purgato, Marianna; Barbui, Corrado

doi:10.1002/wps.20493

Cited by 108 publications

(92 citation statements)

References 66 publications

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“…Findings from this paper clearly show that combined treatment is the best option in moderate depression, and in routine clinical care it would be better to consider psychotherapy as the first choice when only one treatment is offered to a patient. The National Health Service in the UK and other health care systems in the world, including low and middle income countries, should model themselves accordingly and invest more resources in non‐pharmacological interventions for depression.…”

Section: Discussionmentioning

confidence: 99%

A network meta‐analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression

et al. 2020

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No network meta‐analysis has examined the relative effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression, while this is a very important clinical issue. We conducted systematic searches in bibliographical databases to identify randomized trials in which a psychotherapy and a pharmacotherapy for the acute or long‐term treatment of depression were compared with each other, or in which the combination of a psychotherapy and a pharmacotherapy was compared with either one alone. The main outcome was treatment response (50% improvement between baseline and endpoint). Remission and acceptability (defined as study drop‐out for any reason) were also examined. Possible moderators that were assessed included chronic and treatment‐resistant depression and baseline severity of depression. Data were pooled as relative risk (RR) using a random‐effects model. A total of 101 studies with 11,910 patients were included. Depression in most studies was moderate to severe. In the network meta‐analysis, combined treatment was more effective than psychotherapy alone (RR=1.27; 95% CI: 1.14‐1.39) and pharmacotherapy alone (RR=1.25; 95% CI: 1.14‐1.37) in achieving response at the end of treatment. No significant difference was found between psychotherapy alone and pharmacotherapy alone (RR=0.99; 95% CI: 0.92‐1.08). Similar results were found for remission. Combined treatment (RR=1.23; 95% CI: 1.05‐1.45) and psychotherapy alone (RR=1.17; 95% CI: 1.02‐1.32) were more acceptable than pharmacotherapy. Results were similar for chronic and treatment‐resistant depression. The combination of psychotherapy and pharmacotherapy seems to be the best choice for patients with moderate depression. More research is needed on long‐term effects of treatments (including cost‐effectiveness), on the impact of specific pharmacological and non‐pharmacological approaches, and on the effects in specific populations of patients.

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Section: Discussionmentioning

confidence: 99%

A network meta‐analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression

et al. 2020

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“…The full search string for one database (PubMed) is given in Appendix A. We also searched a number of bibliographical databases to identify trials in non-Western countries (Cuijpers, Karyotaki, Reijnders, Purgato, & Barbui, 2018), because the number of trials on psychological treatments in these countries is growing rapidly. Furthermore, we checked the references of earlier metaanalyses on psychological treatments of depression.…”

Section: Identification and Selection Of Studiesmentioning

confidence: 99%

The effects of fifteen evidence-supported therapies for adult depression: A meta-analytic review

Cuijpers

Karyotaki

Wit

et al. 2019

Psychotherapy Research

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Objective: In the past decades, many different types of psychotherapy for adult depression have been developed. Method: In this meta-analysis we examined the effects of 15 different types of psychotherapy using 385 comparisons between a therapy and a control condition: Acceptance and commitment therapy, mindfulness-based cognitive behavior therapy (CBT), guided self-help using a self-help book from David Burns, Beck's CBT, the "Coping with Depression" course, two subtypes of behavioral activation, extended and brief problem-solving therapy, self-examination therapy, brief psychodynamic therapy, non-directive counseling, full and brief interpersonal psychotherapy, and life review therapy. Results: The effect sizes ranged from g = 0.38 for the "Coping with Depression" course to g = 1.10 for life review therapy. There was significant publication bias for most therapies. In 70% of the trials there was at least some risk of bias. After adjusting studies with low risk of bias for publication bias, only two types of therapy remained significant (the "Coping with Depression" course, and self-examination therapy). Conclusions: We conclude that the 15 types of psychotherapy may be effective in the treatment of depression. However, the evidence is not conclusive because of high levels of heterogeneity, publication bias, and the risk of bias in the majority of studies.

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“…Cultural adaptation research has increased over the past decade. Meta-analytic evidence has provided mixed results, with two studies showing that culturally adapted evidence-based psychological interventions are more effective than unadapted ones (Benish et al, 2011;Hall et al, 2016), and one meta-analysis providing contrary evidence (Cuijpers et al, 2018). There is also little evidence about what specific aspects have to be adapted, and to what extent.…”

Section: Discussionmentioning

confidence: 99%

“…Six of these studies have assessed functional impairment, showing large pre-post and pre-follow-up effect sizes (g = 0.73 and 0.97, respectively). And a recent systematic review and meta-analysis including 32 randomized controlled trials (RCTs) of depression treatments in low-and middle-income countries found a large effect size (g = 1.10) when comparing psychotherapy with a control condition, using Western symptom assessments such as the Beck Depression Inventory or the Hamilton Rating Scale for Depression (Cuijpers, Karyotaki, Reijnders, Purgato, & Barbui, 2018). Functional disability was not addressed as an outcome in this review.…”

Section: Culture Context and Psychological Interventionsmentioning

confidence: 97%

“…In addition, one meta-analysis including 21 direct comparison studies showed that adaptation of illness concepts was the sole moderator of superior outcomes of culturally adapted psychotherapy (Benish et al, 2011). However, a more recent meta-analysis looked at psychological interventions for the treatment of depression in low-and middle-income countries (Cuijpers et al, 2018). This study found that whether the intervention was culturally adapted or not was not a moderator of the effect size.…”

Section: Cultural Adaptation Of Scalable Interventionsmentioning

confidence: 99%

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Cultural Clinical Psychology and PTSD

Heim¹,

Kirmayer²,

Maercker³

2018

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, is one of the world-leading experts in psychological trauma consequences and post-traumatic stress disorder. He has directed several basic and treatment research programs on traumatized populations in Germany and Switzerland. His research and clinical practice focuses on trauma survivors from different periods of life, traumatic experience of man-made or disaster origins, and from different countries or continents. From 2011 to 2018 he chaired the working group "Specifically Stress-Associated Disorders" for the revision of ICD-11 by World Health Organization.

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Psychotherapies for depression in low‐ and middle‐income countries: a meta‐analysis

Cited by 108 publications

References 66 publications

A network meta‐analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression

A network meta‐analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression

The effects of fifteen evidence-supported therapies for adult depression: A meta-analytic review

Cultural Clinical Psychology and PTSD

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