scholarly journals Economic evaluation of cognitive behavioural therapy for insomnia (CBT‐I) in adult population: A systematic review

2019 ◽  
Vol 28 (S1) ◽  
BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032176 ◽  
Author(s):  
Andrea Natalie Natsky ◽  
Andrew Vakulin ◽  
Ching Li Chai-Coetzer ◽  
Leon Lack ◽  
R. Doug McEvoy ◽  
...  

IntroductionInsomnia is associated with a number of adverse consequences that place a substantial economic burden on individuals and society. Cognitive behavioural therapy for insomnia (CBT-I) is a promising intervention that can improve outcomes in people who suffer from insomnia. However, evidence of its cost-effectiveness remains unclear. In this study, we will systematically review studies that report on economic evaluations of CBT-I and investigate the potential economic benefit of CBT-I as a treatment for insomnia.Methods and analysisThe search will include studies that use full economic evaluation methods (ie, cost-effectiveness, cost-utility, cost-benefit, cost-consequences and cost-minimisation analysis) and those that apply partial economic evaluation approaches (ie, cost description, cost-outcome description and cost analysis). We will conduct a preliminary search in MEDLINE, Google Scholar, MedNar and ProQuest dissertation and theses to build the searching terms. A full search strategy using all identified keywords and index terms will then be undertaken in several databases including MEDLINE, Psychinfo, Proquest, Cochrane, Scopus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science and EMBASE. We will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for protocol guidelines in this review. Only articles in the English language and those reporting on adult populations will be included. We will use standardised data extraction tools for economic evaluations to retrieve and synthesise information from selected studies into themes and summarised in a Joanna Briggs Institute dominance ranking matrix.Ethics and disseminationNo formal ethics approval will be required as we will not be collecting primary data. Review findings will be disseminated through a peer-reviewed publication, workshops, conference presentations and a media release.PROSPERO registration numberCRD42019133554.


Author(s):  
Harry Banyard ◽  
Alex J. Behn ◽  
Jaime Delgadillo

Abstract Background Previous reviews indicate that depressed patients with a comorbid personality disorder (PD) tend to benefit less from psychotherapies for depression and thus personality pathology needs to be the primary focus of treatment. This review specifically focused on studies of Cognitive Behavioural Therapy (CBT) for depression examining the influence of comorbid PD on post-treatment depression outcomes. Methods This was a systematic review and meta-analysis of studies identified through PubMed, PsychINFO, Web of Science, and Scopus. A review protocol was pre-registered in the PROSPERO database (CRD42019128590). Results Eleven eligible studies (N = 769) were included in a narrative synthesis, and ten (N = 690) provided sufficient data for inclusion in random effects meta-analysis. All studies were rated as having “low” or “moderate” risk of bias and there was no significant evidence of publication bias. A small pooled effect size indicated that patients with PD had marginally higher depression severity after CBT compared to patients without PD (g = 0.26, [95% CI: 0.10, 0.43], p = .002), but the effect was not significant in controlled trials (p = .075), studies with low risk of bias (p = .107) and studies that adjusted for intake severity (p = .827). Furthermore, PD cases showed symptomatic improvements across studies, particularly those with longer treatment durations (16–20 sessions). Conclusions The apparent effect of PD on depression outcomes is likely explained by higher intake severity rather than treatment resistance. Excluding these patients from evidence-based care for depression is unjustified, and adequately lengthy CBT should be routinely offered.


2021 ◽  
Vol 7 (5) ◽  
pp. 520-544

To date, the impact of traditional cognitive behavioural therapy (CBT) on anhedonia in major depressive disorder (MDD) has yet been systematically evaluated. This systematic review aims to examine the efficacy of traditional CBT for depressed adults with anhedonia. A literature search for randomised controlled trials of traditional CBT in adults with MDD from inception to July 2020 was conducted in 8 databases. The primary outcome was the levels of anhedonia. Ten studies with adults with MDD met the eligibility criteria. Our results indicate that traditional CBT is as effective as euthymic therapy, positive psychology therapy, self-system therapy,and medications for anhedonia in depression. Besides, our data provide further support for the development of augmented CBT to optimise treatment outcome for depressed adults with anhedonia. Received 11th June 2021; Revised 2nd September 2021; Accepted 20th September 2021


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