The effectiveness of four empirically supported psychotherapies for primary care depression and anxiety: A systematic review and meta-analysis

Anao Zhang; Cynthia Franklin; Shijie Jing; Lindsay A Bornheimer; Audrey Hang Hai; Joseph A Himle; Dexia Kong; Qingying Ji

doi:10.1016/j.jad.2018.12.008

The effectiveness of four empirically supported psychotherapies for primary care depression and anxiety: A systematic review and meta-analysis

J Affect Disord. 2019 Feb 15:245:1168-1186. doi: 10.1016/j.jad.2018.12.008. Epub 2018 Dec 11.

Authors

Anao Zhang¹, Cynthia Franklin², Shijie Jing³, Lindsay A Bornheimer⁴, Audrey Hang Hai², Joseph A Himle⁵, Dexia Kong⁶, Qingying Ji⁷

Affiliations

¹ University of Michigan, School of Social Work, United States; Shanghai Children's Medical Center, China. Electronic address: zhangan@umich.edu.
² The University of Texas at Austin, Steve Hicks School of Social Work, United States.
³ East China University of Political Science and Law, School of Social Development, China.
⁴ University of Michigan, School of Social Work, United States.
⁵ University of Michigan, School of Social Work, United States; University of Michigan, Department of Psychiatry.
⁶ Rutgers, The State University of New Jersey, Institute for Health, Health Care Policy and Aging Research, United States.
⁷ Shanghai Children's Medical Center, China.

PMID: 30699860
DOI: 10.1016/j.jad.2018.12.008

Abstract

Background: Depressive and anxiety disorders are highly prevalent and detrimental in primary care settings. However, there are gaps in the literature concerning effectiveness and generalizability of empirically supported interventions and treatment of both depression and anxiety in primary care settings. The aim of this review is to systematically assess and meta-analyze the effectiveness of brief empirically-supported psychotherapies for treating depression and/or anxiety in primary care.

Methods: Seven electronic databases, five professional websites and manual search of reference lists were searched through April 2017 for randomized controlled trials (RCTs) of four psychotherapies treating primary care depression and anxiety: cognitive-behavior therapy (CBT), problem-solving therapy (PST), motivational interviewing (MI), and solution-focused brief therapy (SFBT).

Results: From an initial pool of 1140 articles, 179 articles were eligible for full-text review and 65 articles were included for final analysis. Sixty-five articles containing 198 effect sizes reported an overall treatment effect size of d = 0.462, p < 0.001. Single-predictor meta-regression indicated that marital status, treatment modality (individual versus group), and treatment composition were significant moderators. Multiple-predictor meta-regression discovered treatment setting (inside versus outside primary care) significantly moderated treatment effect, b = -0.863, p = 0.039 after controlling for other intervention characteristics.

Conclusion: Treatment effects were found for CBT and PST, both for depressive and anxiety disorders. Interventions delivered outside primary care settings were more effective than those within, individual treatment had greater treatment effects compared to group treatment, and both technology-assisted and in-person treatments were found to be effective.

Keywords: Anxiety/anxiety disorders; Depression; Empirical supported treatments; Health services; Primary care.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Anxiety Disorders / therapy*
Cognitive Behavioral Therapy / methods
Depressive Disorder / therapy*
Humans
Motivational Interviewing / methods
Primary Health Care*
Problem Solving
Psychotherapy / methods*
Psychotherapy, Brief / methods