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Thursday, December 13, 2007

5 Reasons to be Cheerful with Self Help for Depression

The factors that determine effectiveness of self help in the treatment of depression are:

  • Self help interventions have better effect when volunteers enter these form of treatment for depression. Intervention with patients recruited from clinical settings had a smaller effect. The evidence base used for the NICE guideline for self-administered treatments for depression is almost entirely conducted in volunteer populations.

  • Self-help interventions are more effective with actual existing problems. The preventive capacity of self-help treatment can be less efficacious. The capacity of self help in populations at risk may be smaller compared to those with even mild problems. In populations at risk but without symptoms it can be difficult to show additional benefit from any intervention.

  • Self-help interventions should be based on cognitive behavioral therapy principles rather than education.

  • "Guided interventions" are superior to "pure" self-help treatments. Guided here means the presence of therapist contact as part of the intervention. Therapist being either a professional or paraprofessional (no graduate mental health qualification) care taker. The guidance could be by face-to-face or telephone, e-mail and written contact.

  • There was no clear advantage associated with contact that involved supportive guidance beyond monitoring. With monitoring is meant: checking that patients had used the materials, assisting with queries about use, or whether there was a specific statement that therapeutic techniques such as counseling were not used. When the intervention involved more than simple monitoring, which might include advice from the therapist about specific problems, motivation or support.

Implications of this publication:
The appropriate self-help treatment for depression should be based on Cognitive Behavioral Therapy with guidance from a health professional, although the length or nature of that guidance are less clear.

What has been done?
This recently published study is a systematic review of the randomized controlled trial literature to determine intervention, population and study design factors that moderate the treatment effect of self-help interventions for depression.

The researchers found 34 published studies reporting 39 relevant comparison. they included more and more recent studies compared to earlier reviews.

They used complicated statistical methods for their calculations: meta-analysis, meta regression with multivariate and secondary analysis as well as analysis of publication bias. I won't trouble you with the ins- and outs of these complicated statistical methods mostly because I find it difficult to grasp or explain anyway.

These results should be viewed with cautions since they may reflect statistical confounding. The reason why I have written this post about the publication is that their findings sound very rational and recognizable. This is also a well done review worth mentioning in the absence of other comparable meta-analysis.

What is Self-Help for Depression?
In general, the interventions of interest were designed to assist patients in the treatment of their depressive symptoms, using a health technology such as written information, audiotape, videotape or computer presentation. Interventions were designed to be conducted predominantly independent of professional or paraprofessional contact.

Examples of self-help for depression:
Self Help for Depression: Depression Learning Path Recovering from Depression

Article Discussed:
Psychol Med. 2007 Sep;37(9):1217-28. Epub 2007 Feb 19.
What makes self-help interventions effective in the management of depressive
symptoms? Meta-analysis and meta-regression.
Gellatly J, Bower P, Hennessy S, Richards D, Gilbody S, Lovell K.
Blogging on Peer-Reviewed Research

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