The Effectiveness of Problem-Solving Therapy for Primary Care Patients' Depressive and/or Anxiety Disorders: A Systematic Review and Meta-Analysis

J Am Board Fam Med. Jan-Feb 2018;31(1):139-150. doi: 10.3122/jabfm.2018.01.170270.

Abstract

Background: There is increasing demand for managing depressive and/or anxiety disorders among primary care patients. Problem-solving therapy (PST) is a brief evidence- and strength-based psychotherapy that has received increasing support for its effectiveness in managing depression and anxiety among primary care patients.

Methods: We conducted a systematic review and meta-analysis of clinical trials examining PST for patients with depression and/or anxiety in primary care as identified by searches for published literature across 6 databases and manual searching. A weighted average of treatment effect size estimates per study was used for meta-analysis and moderator analysis.

Results: From an initial pool of 153 primary studies, 11 studies (with 2072 participants) met inclusion criteria for synthesis. PST reported an overall significant treatment effect for primary care depression and/or anxiety (d = 0.673; P < .001). Participants' age and sex moderated treatment effects. Physician-involved PST in primary care, despite a significantly smaller treatment effect size than mental health provider only PST, reported an overall statistically significant effect (d = 0.35; P = .029).

Conclusions: Results from the study supported PST's effectiveness for primary care depression and/or anxiety. Our preliminary results also indicated that physician-involved PST offers meaningful improvements for primary care patients' depression and/or anxiety.

Keywords: Anxiety Disorders; Depressive Disorder; Mental Health; Primary Health Care; Problem Solving; Psychotherapy.

Publication types

  • Evaluation Study
  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Anxiety Disorders / therapy*
  • Cognitive Behavioral Therapy / methods*
  • Depressive Disorder / therapy*
  • Humans
  • Primary Health Care / methods*
  • Problem Solving*
  • Treatment Outcome