Psychological treatment of depressive symptoms in patients with medical disorders: A meta-analysis

van Straten, Annemieke; Geraedts, Anna; Verdonck-de Leeuw, Irma; Andersson, Gerhard; Cuijpers, Pim

doi:10.1016/j.jpsychores.2010.01.019

« Previous Next »Journal of Psychosomatic Research
Volume 69, Issue 1 , Pages 23-32, July 2010

Psychological treatment of depressive symptoms in patients with medical disorders: A meta-analysis

Annemieke van Straten
- Department of Clinical Psychology and the EMGO Institute for Health and Care Research, VU University Amsterdam, The Netherlands
- Corresponding author. Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. Tel.: +31 20 598 89 70; fax: +31 20 598 87 58.
Anna Geraedts
- Department of Clinical Psychology and the EMGO Institute for Health and Care Research, VU University Amsterdam, The Netherlands
Irma Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center
Gerhard Andersson
- Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Sweden
- Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
Pim Cuijpers
- Department of Clinical Psychology and the EMGO Institute for Health and Care Research, VU University Amsterdam, The Netherlands

Received 4 June 2009; received in revised form 14 January 2010; accepted 19 January 2010. published online 17 March 2010.

Abstract

Objective

It is widely acknowledged that the prevalence of depression in the general population is high, but that it is even higher for patients with medical disorders. Yet, the effectiveness of psychological treatments in these patient populations has not been firmly established.

Methods

We conducted a meta-analysis of randomized controlled studies examining the effects of psychological treatments in patients with 1 of 10 different medical disorders and elevated levels of depression. Extensive searches were performed in PubMed, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials.

Results

We included 23 studies. The overall effect size of the 15 studies that compared psychological treatments with a waitlist or care-as-usual control group was d=1.00 [95% confidence interval (CI), 0.57–1.44] but declined to d=0.42 (95% CI, 0.27–0.58) after removing two outliers with extremely high effects. We tested the type of disorder, inclusion based on diagnostic criteria or symptoms, type of treatment, treatment format, type of control group, and intention-to-treat or completers analyses, but none of these variables were significantly associated with the effect. The four studies that compared one type of psychotherapy to another showed a positive effect of cognitive behavioral therapy and interpersonal therapy compared to supportive therapy (d=0.42; 95% CI, 0.14–0.69). There were not enough studies (n=3) to draw any conclusions about the comparison of psychotherapy to pharmacotherapy.

Conclusion

We conclude that the effects of psychological treatment of patients with medical disorders are very similar to those found in otherwise healthy patients. Treating this comorbid depression should be one of the priorities in medical care settings.

Keywords: Depression, Psychotherapy, Meta-analysis, Somatic disorders