The effectiveness of unguided self-help psychological interventions for obsessive-compulsive disorder: A meta-analysis of randomized controlled trials.

BACKGROUND: Evidence-based psychological interventions exist for individuals with obsessive-compulsive disorder (OCD), but many individuals with OCD are unable to access them because of barriers, such as geographical isolation, treatment cost, and stigma etc. Unguided self-help psychological intervention has emerged as a potential solution to this problem. However, there is limited research on its overall effectiveness. This study aimed to address this gap. METHODS: Comprehensive searches from inception to 1st Jan 2023 were conducted in both international (PubMed, Embase, PsycINFO, International clinical trials registry platform of WHO) and Chinese (China National Knowledge Infrastructure, WeiPu, WanFang, Chinese Clinical Trial Registry) databases. The registered protocol is accessible at https://doi.org/10.17605/OSF.IO/FKB5W. We included randomized controlled trials (RCTs) comparing unguided self-help psychological interventions to control groups for individuals with OCD. The primary outcome was OCD symptom severity, with Hedges' g calculated post-intervention. Heterogeneity was deemed to be low, moderate, and high if the I2 value was quantified 25%, 50%, and 75% respectively. Relative Risks (RRs) was calculated for dropout rates post-intervention. Random-effects models were used for all analyses. RESULTS: 12 RCTs comparing unguided self-help psychological interventions to control groups were identified, with a total of 20 comparisons and 769 OCD patients. Overall, unguided self-help psychological interventions demonstrated a significant moderate effect on reducing OCD symptom severity (g = -0.42; 95% CI [-0.69; -0.14]) compared to control groups, with a moderate heterogeneity (I2 = 59%; 95% CI [22.73; 78.38]). This finding remained significant in sensitivity analyses for the self-rated Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; k = 7, g = -0.46; 95% CI [-0.71; -0.2]) and after removing an outlier (g = -0.37; 95% CI [-0.55; -0.19]), but not for the clinician-rated Y-BOCS (k = 4, g = -0.78; 95% CI [-2.75; 1.19]) and Obsessive Compulsive Inventory-Revised (k = 6, g = -0.26; 95% CI [-0.53; 0]). Subgroup analyses revealed a significant difference in effect size between studies conducting intention-to-treat and completers-only analyses (p = .01). The completers-only analyses demonstrated a moderate significant effect (g = -0.65; 95% CI [-1.08; -0.21]), whereas the effect of the intention-to-treat analyses was not significant (g = -0.18; 95% CI [-0.36; 0]). Participants in the unguided self-help groups exhibited a significantly higher dropout rate (RR = 2.08; 95% CI [1.53; 2.81]) compared to control groups. Furthermore, participants recruited from the community had a higher likelihood of dropping out compared to those recruited from clinical settings (p < .001). Additionally, participants who received cognitive-behavioural therapy intervention were more likely to drop out than those who received other types of intervention (p < .001). Most trials (92%) were rated at a high risk of bias. CONCLUSION: Unguided self-help psychological interventions demonstrate potential effectiveness in alleviating OCD symptom severity post-intervention. However, caution should be exercised when interpreting the results due to high risk of bias across trials and the relatively small sample size. And the considerable dropout rate might hinder treatment effects. Future studies with strict methodology should investigate the long-term effectiveness of unguided self-help psychological interventions for OCD, explore the reasons for high dropout rates, and improve intervention adherence.

Transdiagnostic treatment of depression and anxiety: a meta-analysis.

BACKGROUND: In the past 10 years an increasing number of randomised trials have examined the effects of transdiagnostic treatments of patients with depression or anxiety. We conducted the first comprehensive meta-analysis of the outcomes of this emerging field. METHODS: We used the searches in PubMed, PsychINFO, Embase and the Cochrane library of an existing database of randomised trials of psychological interventions for depression to identify studies comparing a transdiagnostic treatment of patients with depression or anxiety with a control group (deadline 1 January 2022). We conducted random-effects meta-analyses and examined the effects on depression and anxiety at the short and longer term. RESULTS: We included 45 randomised controlled trials with 51 comparisons between a psychotherapy and a control group and 5530 participants. Thirty-five (78%) studies were conducted in the last 10 years. The overall effect size was g = 0.54 (95% CI 0.40-0.69; NNT = 5.87), with high heterogeneity (I2 = 78; 95% CI 71-83), and a broad PI (-0.31-1.39). The effects remained significant in a series of sensitivity analyses, including exclusion of outliers, adjustment for publication bias, for studies with low risk of bias, and in multilevel analyses. The results were comparable for depression and anxiety separately. At 6 months after randomisation the main effects were still significant, but not at 12 months, although the number of studies was small. CONCLUSIONS: Transdiagnostic treatments of patients with depression or anxiety are increasingly examined and are probably effective at the short term.

Psychotherapy for comorbid depression and somatic disorders: a systematic review and meta-analysis.

BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Impact of climate events, pollution, and green spaces on mental health: an umbrella review of meta-analyses.

Climate change may affect mental health. We conducted an umbrella review of meta-analyses examining the association between mental health and climate events related to climate change, pollution and green spaces. We searched major bibliographic databases and included meta-analyses with at least five primary studies. Results were summarized narratively. We included 24 meta-analyses on mental health and climate events (n = 13), pollution (n = 11), and green spaces (n = 2) (two meta-analyses provided data on two categories). The quality was suboptimal. According to AMSTAR-2, the overall confidence in the results was high for none of the studies, for three it was moderate, and for the other studies the confidence was low to critically low. The meta-analyses on climate events suggested an increased prevalence of symptoms of post-traumatic stress, depression, and anxiety associated with the exposure to various types of climate events, although the effect sizes differed considerably across study and not all were significant. The meta-analyses on pollution suggested that there may be a small but significant association between PM2.5, PM10, NO2, SO2, CO and mental health, especially depression and suicide, as well as autism spectrum disorders after exposure during pregnancy, but the resulting effect sizes varied considerably. Serious methodological flaws make it difficult to draw credible conclusions. We found reasonable evidence for an association between climate events and mental health and some evidence for an association between pollution and mental disorders. More high-quality research is needed to verify these associations.

Psychological treatment of perinatal depression: a meta-analysis.

BACKGROUND: Depression during pregnancy and after the birth of a child is highly prevalent and an important public health problem. Psychological interventions are the first-line treatment and, although a considerable number of randomized trials have been conducted, no recent comprehensive meta-analysis has evaluated treatment effects. METHODS: We used an existing database of randomized controlled trials of psychotherapies for adult depression and included studies aimed at perinatal depression. Random effects models were used in all analyses. We examined the effects of the interventions in the short and long term, and also examined secondary outcomes. RESULTS: Forty-three studies with 49 comparisons and 6270 participants between an intervention and control group were included. The overall effect size was g = 0.67 [95% confidence interval (CI) 0.45~0.89; numbers needed-to-be-treated = 4.39] with high heterogeneity (I2 = 80%; 95% CI 75~85). This effect size remained largely unchanged and significant in a series of sensitivity analyses, although some publication bias was found. The effects remained significant at 6-12 months follow-up. Significant effects were also found for social support, anxiety, functional limitations, parental stress and marital stress, although the number of studies for each outcome was low. All results should be considered with caution because of the high levels of heterogeneity in most analyses. CONCLUSIONS: Psychological interventions are probably effective in the treatment of perinatal depression, with effects that last at least up to 6-12 months and probably also have effects on social support, anxiety, functional impairment, parental stress, and marital stress.

The effects of psychological treatments of depression in children and adolescents on response, reliable change, and deterioration: a systematic review and meta-analysis.

Meta-analyses show that psychotherapies are effective in the treatment of depression in children and adolescents. However, these effects are usually reported in terms of effect sizes. For patients and clinicians, it is important to know whether patients achieve a clinically significant improvement or deterioration. We conducted such a meta-analysis to examine response, clinically significant change, clinically significant deterioration and recovery as outcomes. We searched four bibliographic databases and included 40 randomised trials comparing psychotherapy for youth depression against control conditions. We used a validated method to estimate outcome rates, based on means, standard deviation and N at baseline and post-test. We also calculated numbers-need-to- treat (NNT). The overall response rate in psychotherapies at 2 (±1) months after baseline was 39% (95% CI: 34-45) and 24% (95% CI: 0.19-28) in control conditions (NNT: 6.2). The difference between therapy and control was still significant at 6-12 months after baseline (NNT=7.8). Clinically significant improvement was found in 54% of youth in therapy, compared with 32% in control groups (NNT=5.3); clinically significant deterioration was 6% in therapy, 13% in controls (NNT=5.1); recovery was 58% in therapy, 36% in controls (NNT=3.3). Smaller effects were found in studies with low risk of bias. Psychotherapies for depression in youth are effective compared to control conditions, but more than 60% of youth receiving therapy do not respond. More effective treatments and treatment strategies are clearly needed. Trial registration https://osf.io/84xka.

Psychological treatment of depression with other comorbid mental disorders: systematic review and meta-analysis.

Most people with a mental disorder meet criteria for multiple disorders. We conducted a systematic review and meta-analysis of randomized trials comparing psychotherapies for people with depression and comorbid other mental disorders with non-active control conditions. We identified studies through an existing database of randomized trials on psychotherapies for depression. Thirty-five trials (3,157 patients) met inclusion criteria. Twenty-seven of the 41 interventions in the 35 trials (66%) were based on CBT. The overall effect on depression was large (g = 0.65; 95% CI: 0.40 ~ 0.90), with high heterogeneity (I2 = 78%; 95% CI: 70 ~ 83). The ten studies in comorbid anxiety showed large effects on depression (g = 0.90; 95% CI: 0.30 ~ 1.51) and anxiety (g = 1.01; 95% CI: 0.28 ~ 1.74). For comorbid insomnia (11 comparisons) a large and significant effect on depression (g = 0.99; 95% CI: 0.16 ~ 1.82) and insomnia (g = 1.38; 95% CI: 0.38 ~ 2.38) were found. For comorbid substance use problems (12 comparisons) effects on depression (g = 0.25; 95% CI: 0.06 ~ 0.43) and on substance use problems (g = 0.25; 95% CI: 0.01 ~ 0.50) were significant. Most effects were no longer significant after adjustment for publication bias and when limited to studies with low risk of bias. Therapies are probably effective in the treatment of depression with comorbid anxiety, insomnia, and substance use problems.

The effects of psychotherapies for depression on response, remission, reliable change, and deterioration: A meta-analysis.

OBJECTIVE: Meta-analyses of psychotherapies usually report effects sizes, while clinicians and patients need to know the proportion of patients who benefit from therapy. We conducted a meta-analysis of therapies for depression reporting the rates of response (50% symptom reduction), remission (HAM-D <7), clinical significant deterioration for psychotherapy, and control conditions (CAU, waitlist, and pill placebo), as well as the relative risk of these outcomes and the numbers-needed-to-be-treated (NNTs). METHODS: We searched bibliographic databases and included 228 randomized trials comparing psychotherapy for depression against control conditions (75 with low risk of bias). Only therapies with at least 10 trials were included. We extracted outcomes from the studies, and for those studies not reporting the outcomes, we used a validated method to estimate the rates. RESULTS: The overall response rate in psychotherapies at 2 (±1) months after baseline was 41% (95% CI: 38~43), 17% (15~20) for usual care (CAU), and 16% (95% CI: 14~18) for waitlist. No significant differences between types of therapy were found. The NNT for therapy versus CAU was 5.3 and versus waitlist 3.9. About one third of patients remitted after therapy compared with 7%-13% in control conditions. The rates of deterioration were 5% versus 12%-13%, respectively. Most sensitivity analyses supported the general findings. CONCLUSION: Psychotherapies for depression may be effective compared with control conditions, but more than half of patients receiving therapy do not respond and only one third remitted. More effective treatments and treatment strategies such as sequencing and combining treatments are clearly needed.

Universal prevention of distress aimed at pregnant women: a systematic review and meta-analysis of psychological interventions.

BACKGROUND: There is sufficient meta-analytic evidence that antenatal interventions for women at risk (selective prevention) or for women with severe psychological symptoms (indicated prevention) are effective in reducing postpartum distress. However, women without risk or severe psychological symptoms might also experience distress. This meta-analysis focused on the effectiveness of preventive psychological interventions offered to universal populations of pregnant women on symptoms of depression, anxiety, and general stress. Paternal and infant outcomes were also included. METHOD: We included 12 universal prevention studies in the meta-analysis, incorporating a total of 2559 pregnant women. RESULTS: Overall, ten studies included depression as an outcome measure, five studies included stress, and four studies anxiety. There was a moderate effect of preventive interventions implemented during pregnancy on the combined measure of maternal distress (d = .52), on depressive symptoms (d = .50), and on stress (d = .52). The effect on anxiety (d = .30) was smaller. The effects were not associated with intervention timing, intervention type, intervention delivery mode, timing of post-test, and methodological quality. The number of studies including partner and/or infant outcomes was too low to assess their effectiveness. CONCLUSIONS: This meta-analysis suggests that universal prevention during pregnancy is effective on decreasing symptoms of maternal distress compared to routine care, at least with regard to depression. While promising, the results with regard to anxiety and stress are based on a considerably lower number of studies, and should thus be interpreted with caution. More research is needed on preventing other types of maternal distress beyond depression. Furthermore, there is a lack of research with regard to paternal distress. Also, given the large variety in interventions, more research is needed on which elements of universal prevention work. Finally, as maternal distress symptoms can affect infant development, it is important to investigate whether the positive effects of the preventive interventions extend from mother to infant. SYSTEMATIC REVIEW REGISTRATION NUMBER: International prospective register of systematic reviews (PROSPERO) registration number: CRD42018098861.

Beck depression inventory, second edition, Czech version: demographic correlates, factor structure and comparison with foreign data.

OBJECTIVE: We aimed to examine whether demographic characteristics (i.e., sex, age and education) correlate with total scores of the Czech version of the Beck Depression Inventory (BDI-II), understand the factorial structure of this scale, compare our results with findings of studies conducted in other countries and provide preliminary normative data for use in clinical practice. METHODS: Data of 450 participants were analysed using correlation analysis, non-parametric tests and confirmatory factor analysis (CFA). RESULTS: Women, and participants with lower education, tended to score higher than men, and participants with higher education. There was no significant relationship between age and total scores. CFA confirmed two factors: cognitive-affective and somatic. Czech participants scored lower than participants in other studies. Preliminary normative data are presented in the form of percentile values for the whole sample and stratified according to gender and education level. CONCLUSIONS: We recommend the usage of the BDI-II total score while taking into account also the cognitive-affective and somatic factor subscores. The comparison of our results with other foreign findings shows the need for the development of locally specific normative values for self-reported depression scales. KEY POINTS Women scored higher in the BDI-II than men. Participants with lower education scored higher in the BDI-II than participants with higher education. CFA confirmed two factors: cognitive-affective and somatic. Preliminary normative data for the Czech version of the BDI-II are stratified according to gender and education.

The outcomes of mental health care for depression over time: A meta-regression analysis of response rates in usual care.

BACKGROUND: Over the past decades dozens of randomized trials have shown that psychological treatments are more effective than care-as-usual (CAU). It could be expected that these treatments are implemented in routine care and that the response rates in usual care improve over time. The aim of the current meta-analysis is to examine if response and remission rates in usual care have improved over time. METHODS: We used an existing meta-analytic database of randomized controlled trials examining the effects of psychological treatments of depression and selected CAU control groups from these trials. We only included CAU conditions in primary care, specialized mental health care, perinatal care and general medical care. The response rate (50 % symptom reduction) was the primary outcome. RESULTS: We included 125 CAU control groups (8542 participants). The response rate for all CAU control groups was 0.22 (95 % CI: 0.19; 0.24) with high heterogeneity (I2 = 83; 95 % CI: 80; 85), with somewhat higher rates in primary care (0.27; 95 % CI: 0.23; 0.31). We found hardly any indications that the outcomes have improved over the years. The meta-regression analysis with publication year as predictor in the full dataset resulted in a coefficient of 0.1 (SE = 0.01; p = 0.0.35). A series of sensitivity analyses supported the main findings. Remission rates and pre-post effect sizes also did not significantly improve over time. CONCLUSIONS: Response and remission rates in usual care are low, with the large majority of patients not responding or remitting, and the outcomes have probably not improved over time.

Non-directive supportive therapy for depression: A meta-analytic review.

BACKGROUND: Non-directive supportive therapy (NDST) is an important treatment of adult depression, but no recent meta-analysis has integrated the randomized trials examining its effects. METHODS: We conducted a meta-analysis comparing NDST to control conditions and to other therapies, by using an existing database of randomized trials of psychological treatments of depression in adults. This database was built through searches in PubMed, PsycINFO, Embase and the Cochrane Library. RESULTS: 48 randomized controlled trials (5075 participants), with 20 comparisons between NDST and a control group and 49 comparisons between NDST and another psychotherapy were included. Random effects meta-analyses found an effect size of NDST compared with control conditions of g = 0.53 (95 % CI, 0.34; 0.72) with moderate heterogeneity (I2 = 51; 95 % CI: 18; 71; PI = -0.02 to 1.09). NDST was less effective than other therapies (g = -0.21; 95 % CI: -0.31; -0.11). The difference with other therapies was significantly larger in studies in which NDST was used as a control group (p = .003). There was no significant difference between NDST and other therapies in which NDST was not used as a control group (k = 14; g = -0.05; 95 % CI: -0.17; 0.07). CONCLUSIONS: NDST probably is an effective treatment of depression. The effects may be somewhat smaller than those of other therapies, but that may also be an artefact, because NDST is often used as a control group and may be designed as an "intent-to-fail" intervention in some studies.

Baseline depression severity as moderator on depression outcomes in psychotherapy and pharmacotherapy.

BACKGROUND: Evidence-based treatments for adult depression include psychotherapy and pharmacotherapy, yet little is known about how baseline depression severity moderates treatment outcome. OBJECTIVES: We aimed to compare the effects of psychotherapy and pharmacotherapy for adult depression and to examine the association between baseline depression severity and treatment outcome, converting multiple baseline depression measures into the scores of the Beck Depression Inventory, second edition (BDI-II). METHODS: We conducted systematic searches in bibliographical databases up to September 2022 to identify randomized controlled trials (RCTs) in which psychotherapy was compared with pharmacotherapy in the treatment of adult depression. Various meta-regressions using the baseline depression severity as predictor of the relative effects of psychotherapy and pharmacotherapy were performed. RESULTS: We identified 65 RCTs including 7250 participants for the meta-analyses and 56 RCTs including 5548 participants for the meta-regression. We found no significant difference between psychotherapy and pharmacotherapy (g = -0.08, 95 % CI: -0.2 to 0.04, p = 0.193) and baseline depression severity was not significantly associated with the relative effects of psychotherapy and pharmacotherapy (B = 0.0032, SE = 0.0096, p = 0.74). Results were similar in several sensitivity analyses. LIMITATIONS: Limitations included the low quality of the included studies, and the omission of long-term effects and within-study variability. CONCLUSIONS: We found no indication for a moderation effect of baseline depression severity on the relative effects of psychotherapy and pharmacotherapy. Thus, other factors such as availability and patients' preference must be considered when deciding for treatment options.

The efficacy of cognitive behavioral therapies for depression in China in comparison with the rest of the world: A systematic review and meta-analysis.

OBJECTIVE: There is consistent evidence that cognitive behavioral therapies (CBTs) are effective interventions for adult depression. While some evidence has compared these effects in different countries, no prior systematic review and meta-analysis has compared the efficacy of CBTs between Chinese and people from the rest of the world. The current meta-analysis addressed this gap by a systematic review of eligible studies from Chinese and worldwide databases. METHOD: Hedges' g was calculated using a random-effects model. Subgroup analyses and multilevel meta-analytic models were conducted to examine the relationship among effect sizes and the characteristics in Chinese studies. Metaregression analyses were conducted to explore the difference of the efficacy of CBTs between Chinese studies and non-Chinese studies after controlling for the moderators. RESULTS: A total of 34 (n = 3,710) studies in China and 307 (n = 30,333) studies from the rest of the world were included. The effect size of CBTs on depression for Chinese participants was 1.19 (95% CI [0.86, 1.52]), which was higher (Q = 4.63, p = .03) than the effect size of the rest of the world (0.82, 95% CI [0.74, 0.90]). After controlling for moderators, the effect size of Chinese studies was still higher than non-Chinese studies (ß = 0.351, p = .011). CONCLUSIONS: CBTs are effective interventions for adult depression and deserve more attention in China for depression management. Moderators related to study design, clinical features, and cultural factors need to be considered in the interpretation of the results. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Amount and frequency of psychotherapy as predictors of treatment outcome for adult depression: A meta-regression analysis.

BACKGROUND: It is not clear whether the amount and frequency of psychotherapy is associated with treatment effects for adult depression. We investigated whether a number of indicators of the amount and frequency of psychotherapy were related to the treatment effects in randomized controlled trials (RCTs) comparing individual, face-to-face psychotherapy to a control group (e.g., care-as-usual [CAU] or waitlist condition [WL]). METHODS: Four databases were systematically searched, and meta-regression analyses conducted to assess the relationship between the effect size (Hedges' g) of the treatment and number of sessions, duration of psychotherapy, total contact time with the therapist, and number of sessions per week. RESULTS: We included 176 studies (210 comparisons) with 15,158 participants. We did not find a relationship between the effect size, and number of sessions, or total contact time. There was a small negative association between duration of treatment and the effect size, an additional week of treatment was related to a 0.014 decrease in the effect size. In addition, there was a strong association between number of sessions per week and the effect size, an increase from one to two sessions per week was related to an effect size higher by 0.596. Both associations were no longer significant when controlling for characteristics of studies. LIMITATIONS: The current findings are correlational, future research should thus address this question in an RCT. CONCLUSIONS: We should deliver brief therapies, and thus shorten waiting lists. More sessions, if necessary, should be delivered with higher frequency and over a shorter period of time.

Use of Machine-Learning Algorithms Based on Text, Audio and Video Data in the Prediction of Anxiety and Post-Traumatic Stress in General and Clinical Populations: A Systematic Review.

Research in machine-learning (ML) algorithms using natural behavior (i.e., text, audio, and video data) suggests that these techniques could contribute to personalization in psychology and psychiatry. However, a systematic review of the current state-of-the-art is missing. Moreover, individual studies often target ML experts, and may overlook potential clinical implications of their findings. In a narrative accessible to mental health professionals, we present a systematic review, conducted in 5 psychology and 2 computer-science databases. We included 128 studies assessing the predictive power of ML algorithms using text, audio, and/or video data in the prediction of anxiety and post-traumatic stress (PTSD). Most studies (n = 87) aimed at predicting anxiety, the remainder (n = 41) focused on PTSD. They were mostly published since 2019, in computer science journals, and tested algorithms using text (n = 72), as opposed to audio or video. They focused mainly on general populations (n = 92), less on laboratory experiments (n = 23) or clinical populations (n = 13). Methodological quality varied, as did reported metrics of the predictive power, hampering comparison across studies. Two thirds of studies, focusing on both disorders, reported acceptable to very good predictive power (including high-quality studies only). Results of 33 studies were uninterpretable, mainly due to missing information. Research into ML algorithms using natural behavior is in its infancy, but shows potential to contribute to diagnostics of mental disorders, such as anxiety and PTSD, in the future, if standardization of methods, reporting of results, and research in clinical populations are improved.

Absolute and relative outcomes of psychotherapies for eight mental disorders: a systematic review and meta-analysis.

Psychotherapies are first-line treatments for most mental disorders, but their absolute outcomes (i.e., response and remission rates) are not well studied, despite the relevance of such information for health care users, providers and policy makers. We aimed to examine absolute and relative outcomes of psychotherapies across eight mental disorders: major depressive disorder (MDD), social anxiety disorder, panic disorder, generalized anxiety disorder (GAD), specific phobia, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and borderline personality disorder (BPD). We used a series of living systematic reviews included in the Metapsy initiative (www.metapsy.org), with a common strategy for literature search, inclusion of studies and extraction of data, and a common format for the analyses. Literature search was conducted in major bibliographical databases (PubMed, PsycINFO, Embase, and the Cochrane Register of Controlled Trials) up to January 1, 2023. We included randomized controlled trials comparing psychotherapies for any of the eight mental disorders, established by a diagnostic interview, with a control group (waitlist, care-as-usual, or pill placebo). We conducted random-effects model pairwise meta-analyses. The main outcome was the absolute rate of response (at least 50% symptom reduction between baseline and post-test) in the treatment and control conditions. Secondary outcomes included the relative risk (RR) of response, and the number needed to treat (NNT). Random-effects meta-analyses of the included 441 trials (33,881 patients) indicated modest response rates for psychotherapies: 0.42 (95% CI: 0.39-0.45) for MDD; 0.38 (95% CI: 0.33-0.43) for PTSD; 0.38 (95% CI: 0.30-0.47) for OCD; 0.38 (95% CI: 0.33-0.43) for panic disorder; 0.36 (95% CI: 0.30-0.42) for GAD; 0.32 (95% CI: 0.29-0.37) for social anxiety disorder; 0.32 (95% CI: 0.23-0.42) for specific phobia; and 0.24 (95% CI: 0.15-0.36) for BPD. Most sensitivity analyses broadly supported these findings. The RRs were significant for all disorders, except BPD. Our conclusion is that most psychotherapies for the eight mental disorders are effective compared with control conditions, but absolute response rates are modest. More effective treatments and interventions for those not responding to a first-line treatment are needed.

Exploring the efficacy of psychotherapies for depression: a multiverse meta-analysis.

BACKGROUND: Hundreds of randomised controlled trials and dozens of meta-analyses have examined psychotherapies for depression-yet not all points in the same direction. Are these discrepancies a result of specific meta-analytical decisions or do most analytical strategies reaching the same conclusion? OBJECTIVE: We aim to solve these discrepancies by conducting a multiverse meta-analysis containing all possible meta-analyses, using all statistical methods. STUDY SELECTION AND ANALYSIS: We searched four bibliographical databases (PubMed, EMBASE, PsycINFO and Cochrane Register of Controlled Trials), including studies published until 1 January 2022. We included all randomised controlled trials comparing psychotherapies with control conditions without restricting the type of psychotherapy, target group, intervention format, control condition and diagnosis. We defined all possible meta-analyses emerging from combinations of these inclusion criteria and estimated the resulting pooled effect sizes with fixed-effect, random-effects, 3-level, robust variance estimation, p-uniform and PET-PEESE (precision-effect test and precision-effect estimate with SE) meta-analysis models. This study was preregistered (https://doi.org/10.1136/bmjopen-2021-050197). FINDINGS: A total of 21 563 records were screened, and 3584 full texts were retrieved; 415 studies met our inclusion criteria containing 1206 effect sizes and 71 454 participants. Based on all possible combinations between inclusion criteria and meta-analytical methods, we calculated 4281 meta-analyses. The average summary effect size for these meta-analyses was Hedges' g mean=0.56, a medium effect size, and ranged from g=-0.66 to 2.51. In total, 90% of these meta-analyses reached a clinically relevant magnitude. CONCLUSIONS AND CLINICAL IMPLICATIONS: The multiverse meta-analysis revealed the overall robustness of the effectiveness of psychotherapies for depression. Notably, meta-analyses that included studies with a high risk of bias, compared the intervention with wait-list control groups, and not correcting for publication bias produced larger effect sizes.

Five decades of research on psychological treatments of depression: A historical and meta-analytic overview.

Since the 1970s, hundreds of randomized trials have examined the effects of psychotherapies for depression, and this number is increasing every year. In this study, we report outcomes from a living systematic review of these studies. We use Poisson regression analyses to examine if the proportions of studies have changed over time across the characteristics of the participants, therapies, and studies. We also present a meta-analysis of the effects across the major types, formats, targets, and age groups. We included 562 randomized controlled trials (669 comparisons; 66,361 patients). Most trials are conducted in adults and the relative proportion of trials in children and adolescents, as well as in older patients is significantly decreasing. The effects in children and adolescents are also significantly smaller than in adults (p = .007). Cognitive behavior therapy (CBT) is by far the best examined type of therapy (52%), but not necessarily more effective than other therapies. Over time, the proportion of studies examining several other types of therapy is significantly decreased compared to CBT. The quality of trials has increased over time, but still, a majority do not meet basic quality criteria, not even in recent years. The effects found in studies with low risk of bias are significantly smaller than in other studies (b = -0.21; SE = 0.05; p < .001). Most trials are conducted in the United States, but the proportion of studies in other parts of the world is rapidly increasing. The evidence that psychotherapies are effective is strong and growing every year. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Does the use of pharmacotherapy interact with the effects of psychotherapy? A meta-analytic review.

BACKGROUND: It is not clear if there is an interaction between psychotherapy and pharmacotherapy. First, there may be no interaction at all, meaning that the effects of both are independent of each other. Second, antidepressants may reduce the effects of psychotherapy, and third, antidepressants may increase the effects of psychotherapy. We examined which of the three is correct. METHODS: We conducted random effects meta-analyses of randomized trials comparing psychotherapies for adult depression with control conditions. The proportion of users of antidepressants was used as a predictor of the effect size in a series of meta-regression analyses, while adjusting for relevant moderators, such as type of control group and baseline severity. RESULTS: We included 300 randomized controlled trials (353 comparisons between treatment and control; 32,852 participants). The main effect size of psychotherapy was g = 0.71 (95% CI: 0.64; 0.79) with high heterogeneity (I2 = 82; 95% CI: 80; 84). We found no significant association between the proportion of antidepressants users and effect size (p = .07). We did find a significant association with some other predictors, including the type of control group and risk of bias. The use of antidepressants was associated with higher response rates within the control conditions, but not with the relative effects of the treatments compared to the control groups. DISCUSSION: We found support for the independent effects of psychotherapy and pharmacotherapy, which is good news from a clinical perspective. Apparently, patients can start with psychotherapy and do not have to be afraid that this will reduce the effects of the therapy.