Early Adverse Stress and Depressive and Bipolar Disorders: A Systematic Review and Meta-Analysis of Treatment Interventions

Introduction: A significant proportion of adults with depressive or bipolar disorders exposed to early adverse stressors do not adequately respond to standard treatments. This review aimed at synthesizing the evidence on the effectiveness of treatment interventions for depressive or bipolar disorders in adult individuals (aged 18 years or more) exposed to adverse stress early in life.Methods: Systematic review and meta-analysis including experimental and quasi-experimental published studies indexed in CINAHL, EMBASE, PubMed, and Web of Science databases and/or in reference lists. Data management and critical appraisal (with the Study Quality Assessment Tools) was conducted independently by multiple researchers. A quality-effects model for meta-analysis was used for data synthesis and publication bias was assessed using the Doi plot and LFK index. The main outcome was short-term reductions in depressive symptoms.Results: Eight randomized controlled trials, three controlled before-and-after (pre-post) studies, and three uncontrolled before-and-after studies were included. Studies lacked bipolar disorder patients. Unclear randomization procedures and reporting of blinded outcome assessor, and limited use of intention-to-treat analysis, were relevant potential sources of bias. Meta-analyses indicated that psychological, pharmacological, and combined interventions were effective in reducing depressive symptoms in the short- (Cohen's d = −0.55, 95% CI −0.75 to −0.36, I2 = 0%) and mid-term (Cohen's d = −0.66, 95% CI −1.07 to −0.25, I2 = 65.0%). However, a high risk of publication bias was detected for these outcomes. A small number of studies, with mixed results, reported interventions with long-term improvements in depressive symptomatology, and short- and mid-term response to treatment and remission.Conclusion: Despite the well-documented long-lasting, negative, and costly impact of early adverse stressors on adult psychopathology, evidence on treatment alternatives remains scant. Trauma-focused treatment interventions—whether psychological interventions alone or in combination with pharmacotherapy—may have the potential to reduce the severity of depressive symptom in adults who were exposed to early adverse stress. Findings must be interpreted with considerable caution, as important study and outcome-level limitations were observed and gray literature was not considered in this systematic review and meta-analysis.

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Prevalence of depression and depressive symptoms among outpatients: a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2017-017173 ◽

2017 ◽

Vol 7 (8) ◽

pp. e017173 ◽

Cited By ~ 83

Author(s):

Jinghui Wang ◽

Xiaohang Wu ◽

Weiyi Lai ◽

Erping Long ◽

Xiayin Zhang ◽

...

Keyword(s):

Systematic Review ◽

Depressive Symptoms ◽

Meta Analysis ◽

Significant Proportion ◽

Depression Scale ◽

Developed Countries ◽

Self Report ◽

Cochrane Library ◽

Significant Heterogeneity ◽

Prevalence Of Depression

ObjectivesDepression and depressive symptoms are common mental disorders that have a considerable effect on patients’ health-related quality of life and satisfaction with medical care, but the prevalence of these conditions varies substantially between published studies. The aim of this study is to conduct a systematic review and meta-analysis to provide a precise estimate of the prevalence of depression or depressive symptoms among outpatients in different clinical specialties.DesignSystematic review and meta-analysis.Data sources and eligibility criteriaThe PubMed and PsycINFO, EMBASE and Cochrane Library databases were searched to identify observational studies that contained information on the prevalence of depression and depressive symptoms in outpatients. All studies included were published before January 2016. Data characteristics were extracted independently by two investigators. The point prevalence of depression or depressive symptoms was measured using validated self-report questionnaires or structured interviews. Assessments were pooled using a random-effects model. Differences in study-level characteristics were estimated by meta-regression analysis. Heterogeneity was assessed using standard χ2tests and the I2statistic. The study protocol has been registered with PROSPERO under number CRD42017054738.ResultsEighty-three cross-sectional studies involving 41 344 individuals were included in this study. The overall pooled prevalence of depression or depressive symptoms was 27.0% (10 943/41 344 individuals; 95% CI 24.0% to 29.0%), with significant heterogeneity between studies (p<0.0001, τ2=0.3742, I2=96.7%). Notably, a significantly higher prevalence of depression and depressive symptoms was observed in outpatients than in the healthy controls (OR 3.16, 95% CI 2.66 to 3.76, I2=72.0%, χ2=25.33). The highest depression/depressive symptom prevalence estimates occurred in studies of outpatients from otolaryngology clinics (53.0%), followed by dermatology clinics (39.0%) and neurology clinics (35.0%). Subgroup analyses showed that the prevalence of depression and depressive symptoms in different specialties varied from 17.0% to 53.0%. The prevalence of depression and depressive symptoms was higher among outpatients in developing countries than in outpatients from developed countries. Moreover, the prevalence of depression and depressive symptoms in outpatients slightly decreased from 1996 to 2010. Regarding screening instruments, the Beck Depression Inventory led to a higher estimate of the prevalence of depression and depressive symptoms (1316/4702, 36.0%, 95% CI 29.0% to 44.0%, I2=94.8%) than the Hospital Anxiety and Depression Scale (1003/2025, 22.0%, 95% CI 12.0% to 35.0%, I2=96.6%).ConclusionOur study provides evidence that a significant proportion of outpatients experience depression or depressive symptoms, highlighting the importance of developing effective management strategies for the early identification and treatment of these conditions among outpatients in clinical practice. The substantial heterogeneity between studies was not fully explained by the variables examined.

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The Effects of Self-Management Interventions on Depressive Symptoms In Adults With Chronic Physical Disease(S) Experiencing Depressive Symptomatology: A Systematic Review And Meta-Analysis

10.21203/rs.3.rs-228613/v1 ◽

2021 ◽

Author(s):

Lydia Ould Brahim ◽

Sylvie Lambert ◽

Nancy Feeley ◽

Chelsea Coumoundouros ◽

Jamie Schaffler ◽

...

Keyword(s):

Systematic Review ◽

Depressive Symptoms ◽

Chronic Disease ◽

Glycemic Control ◽

Depressive Symptomatology ◽

Meta Analysis ◽

Self Management ◽

Control Group ◽

Physical Disease ◽

Management Interventions

Abstract Background: Chronic diseases are the leading cause of death worldwide. It is estimated that 20% of adults with chronic physical diseases experience concomitant depression, increasing their risk of morbidity and mortality. Low intensity psychosocial interventions, such as self-management (SM), are part of recommended treatment; however, no systematic review has evaluated the effects of depression SM interventions for this population. Objectives: The primary objective was to examine the effect of SM interventions on reducing depressive symptomatology in adults with chronic disease(s) and co-occurring depressive symptoms. Secondary objectives were to evaluate the effect of these interventions on improving other psychosocial and physiological outcomes (e.g., anxiety, glycemic control) and to assess potential differential effect based on key participant and intervention characteristics (e.g., chronic disease, provider). Methods: Studies comparing depression SM interventions to a control group were identified through a) systematic searches of databases to June 2018 [MEDLINE (1946 -), EMBASE (1996 -), PsycINFO (1967 -), CINAHL (1984 -)] and b) secondary ‘snowball’ search strategies. The methodological quality of included studies was critically reviewed. Screening of all titles, abstracts, and full texts for eligibility was assessed independently by two authors. Data were extracted by one author and verified by a second. Results: Fifteen studies were retained: 12 for meta-analysis and three for descriptive review. In total, these trials included 2064 participants and most commonly evaluated interventions for people with cancer (n = 7) or diabetes (n = 4). From baseline to < 6 months (T1), the pooled mean effect size was -0.47 [95% CI -0.73, -0.21] as compared to control groups for the primary outcome of depression and -0.53 [95% CI -0.91, -0.15] at ≥ 6-months (T2). Results were also significant for anxiety (T1 and T2) and glycemic control (T2). SM skills of decision-making and taking action were significant moderators of depression at T1. Conclusion: SM interventions show promise in improving depression and anxiety in those with concomitant chronic physical disease. The findings may contribute to the development of future SM interventions and delivering evidence-based care to this population. Further high-quality RCTs are needed to identify sources of heterogeneity and investigate key intervention components. Prospero registration: CRD42019132215

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Does retirement trigger depressive symptoms? A systematic review and meta-analysis

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796021000627 ◽

2021 ◽

Vol 30 ◽

Author(s):

A. Odone ◽

V. Gianfredi ◽

G. P. Vigezzi ◽

A. Amerio ◽

C. Ardito ◽

...

Keyword(s):

Mental Health ◽

Systematic Review ◽

Depressive Symptoms ◽

Protective Effect ◽

Meta Analysis ◽

Assessment Tools ◽

Cochrane Library ◽

High Quality ◽

Funnel Plot ◽

Funnel Plot Asymmetry

Abstract Aims Retirement is a major life transition that may improve or worsen mental health, including depression. Existing studies provide contradictory results. We conducted a systematic review with meta-analysis to quantitatively pool available evidence on the association of retirement and depressive symptoms. Methods We applied PRISMA guidelines to conduct a systematic review and meta-analysis to retrieve, quantitatively pool and critically evaluate the association between retirement and both incident and prevalent depression and to understand better the potential role of individual and contextual-level determinants. Relevant original studies were identified by searching PubMed, Embase, PsycINFO and the Cochrane Library, through 4 March 2021. Subgroup and sensitivity meta-analyses were conducted by gender, study design (longitudinal v. cross-sectional studies), study quality score (QS) and considering studies using validated scales to diagnose depression. Heterogeneity between studies was evaluated with I2 statistics. Results Forty-one original studies met our a priori defined inclusion criteria. Meta-analysis on more than half a million subjects (n = 557 111) from 60 datasets suggested a protective effect of retirement on the risk of depression [effect size (ES) = 0.83, 95% confidence interval (CI) = 0.74–0.93], although with high statistical heterogeneity between risk estimates (χ2 = 895.19, df = 59, I2 = 93.41%, p-value < 0.0001). Funnel plot asymmetry and trim and fill method suggested a minor potential publication bias. Results were consistent, confirm their robustness and suggest stronger protective effects when progressively restricting the included studies based on quality criteria: (i) studies with the highest QS [55 datasets, 407 086 subjects, ES = 0.81, 95% CI = 0.71–0.91], (ii) studies with a high QS and using validated assessment tools to diagnose depression (44 datasets, 239 453 subjects, ES = 0.76, 95% CI = 0.65–0.88) and (iii) studies of high quality, using a validated tool and with a longitudinal design (24 datasets, 162 004 subjects, ES = 0.76, 95% CI = 0.64–0.90). We observed a progressive reduction in funnel plot asymmetry. About gender, no statistically significant difference was found (females ES = 0.79, 95% CI = 0.61–1.02 v. men ES = 0.87, 95% CI = 0.68–1.11). Conclusions Pooled data suggested that retirement reduces by nearly 20% the risk of depression; such estimates got stronger when limiting the analysis to longitudinal and high-quality studies, even if results are affected by high heterogeneity. As retirement seems to have an independent and protective effect on mental health and depressive symptoms, greater flexibility in retirement timing should be granted to older workers to reduce their mental burden and avoid the development of severe depression. Retirement may also be identified as a target moment for preventive interventions, particularly primary and secondary prevention, to promote health and wellbeing in older ages, boosting the observed impact.

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Ovarian Reserve after Chemotherapy in Breast Cancer: A Systematic Review and Meta-Analysis

Journal of Personalized Medicine ◽

10.3390/jpm11080704 ◽

2021 ◽

Vol 11 (8) ◽

pp. 704

Author(s):

Alessia Romito ◽

Sonia Bove ◽

Ilaria Romito ◽

Drieda Zace ◽

Ivano Raimondo ◽

...

Keyword(s):

Breast Cancer ◽

Systematic Review ◽

Publication Bias ◽

Young Women ◽

Ovarian Reserve ◽

Case Reports ◽

Meta Analysis ◽

Case Series ◽

Female Population ◽

Before And After

Background: Worldwide, breast cancer (BC) is the most common malignancy in the female population. In recent years, its diagnosis in young women has increased, together with a growing desire to become pregnant later in life. Although there is evidence about the detrimental effect of chemotherapy (CT) on the menses cycle, a practical tool to measure ovarian reserve is still missing. Recently, anti-Mullerian hormone (AMH) has been considered a good surrogate for ovarian reserve. The main objective of this paper is to evaluate the effect of CT on AMH value. Methods: A systematic review and meta-analysis were conducted on the PubMed and Scopus electronic databases on articles retrieved from inception until February 2021. Trials evaluating ovarian reserves before and after CT in BC were included. We excluded case reports, case-series with fewer than ten patients, reviews (narrative or systematic), communications and perspectives. Studies in languages other than English or with polycystic ovarian syndrome (PCOS) patients were also excluded. AMH reduction was the main endpoint. Egger’s and Begg’s tests were used to assess the risk of publication bias. Results: Eighteen trials were included from the 833 examined. A statistically significant decline in serum AMH concentration was found after CT, persisting even after years, with an overall reduction of −1.97 (95% CI: −3.12, −0.82). No significant differences in ovarian reserve loss were found in the BRCA1/2 mutation carriers compared to wild-type patients. Conclusions: Although this study has some limitations, including publication bias, failure to stratify the results by some important factors and low to medium quality of the studies included, this metanalysis demonstrates that the level of AMH markedly falls after CT in BC patients, corresponding to a reduction in ovarian reserve. These findings should be routinely discussed during oncofertility counseling and used to guide fertility preservation choices in young women before starting treatment.

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Trauma-focused treatments for depression. A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0254778 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254778

Author(s):

Sarah K. Dominguez ◽

Suzy J. M. A. Matthijssen ◽

Christopher William Lee

Keyword(s):

Systematic Review ◽

Depressive Symptoms ◽

Publication Bias ◽

Effect Size ◽

Meta Analysis ◽

Health Condition ◽

Current Evidence ◽

Primary Concern ◽

Imagery Rescripting ◽

The Impact

Background Trauma-focused treatments (TFTs) have demonstrated efficacy at decreasing depressive symptoms in individuals with PTSD. This systematic review and meta-analysis evaluated the effectiveness of TFTs for individuals with depression as their primary concern. Methods A systematic search was conducted for RCTs published before October 2019 in Cochrane CENTRAL, Pubmed, EMBASE, PsycInfo, and additional sources. Trials examining the impact of TFTs on participants with depression were included. Trials focusing on individuals with PTSD or another mental health condition were excluded. The primary outcome was the effect size for depression diagnosis or depressive symptoms. Heterogeneity, study quality, and publication bias were also explored. Results Eleven RCTs were included (n = 567) with ten of these using EMDR as the TFT and one using imagery rescripting. Analysis suggested these TFTs were effective in reducing depressive symptoms post-treatment with a large effect size [d = 1.17 (95% CI: 0.58~ 1.75)]. Removal of an outlier saw the effect size remain large [d = 0.83 (95% CI: 0.48~ 1.17)], while the heterogeneity decreased (I2 = 66%). Analysis of the 10 studies that used EMDR also showed a large effect [d = 1.30 (95% CI: 0.67~1.91)]. EMDR was superior to non trauma-focused CBT [d = 0.66 (95% CI: 0.31~1.02)] and analysis of EMDR and imagery rescripting studies suggest superiority over inactive control conditions [d = 1.19 (95% CI: 0.53~ 1.86)]. Analysis of follow-up data also supported the use of EMDR with this population [d = 0.71 (95% CI: 1.04~0.38)]. No publication bias was identified. Conclusions Current evidence suggests that EMDR can be an effective treatment for depression. There were insufficient RCTs on other trauma-focused interventions to conclude whether TFTs in general were effective for treating depression. Larger studies with robust methodology using EMDR and other trauma-focused interventions are needed to build on these findings.

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The relationship of depressive symptoms and functional and structural markers of subclinical atherosclerosis: A systematic review and meta-analysis

European Journal of Preventive Cardiology ◽

10.1177/2047487318764158 ◽

2018 ◽

Vol 25 (7) ◽

pp. 706-716 ◽

Cited By ~ 15

Author(s):

Yupeng Wu ◽

Dandan Sun ◽

Bin Wang ◽

Yanfeng Li ◽

Yi Ma

Keyword(s):

Systematic Review ◽

Sensitivity Analysis ◽

Depressive Symptoms ◽

Publication Bias ◽

Meta Analysis ◽

Subclinical Atherosclerosis ◽

Great Promise ◽

Female Ratio ◽

Relationship Of ◽

The Relationship

Objectives The relationship of depressive symptoms and subclinical atherosclerosis remains controversial. We performed a systematic review and meta-analysis to evaluate the effect of depressive symptoms on the functional and structural markers of subclinical atherosclerosis as measured by carotid intima-media thickness (IMT), pulse wave velocity (PWV) and flow-mediated vasodilation (FMD). Methods A systematic literature search was performed electronically. Studies relating IMT, PWV or FMD to depressive symptoms were included. Standard/weighted mean differences (SMD/WMD) and corresponding 95% confidence intervals (95% CIs) were pooled in overall and subgroup analyses (age, sex, depression diagnosis, region, study design, site measured and sample size). Sensitivity analysis and publication bias were also conducted. Results Thirty-eight articles involving 5947 patients with depressive symptoms and 34,423 controls without depressive symptoms were included. Compared with controls without depressive symptoms, patients with depressive symptoms showed a significantly thicker IMT (SMD (95% CI) = 0.137 (0.047–0.227), p = 0.003), a higher PWV (SMD (95% CI) = 0.216 (0.139–0.293), p < 0.001) and a lower FMD (WMD (95% CI) = –2.554 (–3.709 to –1.399), p < 0.001). When analyzing subgroups with age and female ratio, all results were still significant ( p < 0.05) except IMT and FMD in age < 50 years subgroups ( p > 0.05). There was no statistical significance in sensitivity analysis and publication bias ( p > 0.05). Conclusions Depressive symptoms contributed toward subclinical atherosclerosis, and resulted in impaired functional and structural markers of subclinical atherosclerosis, which holds great promise in early prevention of cardiovascular disease.

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Effect of saffron supplementation on symptoms of depression and anxiety: a systematic review and meta-analysis

Nutrition Reviews ◽

10.1093/nutrit/nuz023 ◽

2019 ◽

Vol 77 (8) ◽

pp. 557-571 ◽

Cited By ~ 13

Author(s):

Wolfgang Marx ◽

Melissa Lane ◽

Tetyana Rocks ◽

Anu Ruusunen ◽

Amy Loughman ◽

...

Keyword(s):

Systematic Review ◽

Depressive Symptoms ◽

Publication Bias ◽

Effect Size ◽

Data Extraction ◽

Meta Analysis ◽

Crocus Sativus ◽

Depression And Anxiety ◽

Symptoms Of Depression ◽

Positive Effect

Abstract Context Saffron (Crocus sativus L.) has gained interest as a potential treatment in psychiatry. Objective This systematic review and meta-analysis sought to investigate the effect of saffron supplementation, as both an adjunctive therapy and monotherapy, on symptoms of depression and anxiety in clinical and general populations compared with pharmacotherapy or placebo. Data sources Using the PRISMA guidelines, a systematic literature review of randomized controlled trials was conducted. Data extraction A meta-analysis was conducted to determine treatment effect. Risk of bias was assessed using the Jadad scale. Results Twenty-three studies were included. Saffron had a large positive effect size when compared with placebo for depressive symptoms (g = 0.99, P < 0.001) and anxiety symptoms (g = 0.95, P < 0.006). Saffron also had a large positive effect size when used as an adjunct to antidepressants for depressive symptoms (g = 1.23, P = 0.028). Egger’s regression test found evidence of publication bias. Conclusions Saffron could be an effective intervention for symptoms of depression and anxiety; however, due to evidence of publication bias and lack of regional diversity, further trials are required. PROSPERO registration CRD42017070060.

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Prognostic Value of Frailty for Older Patients with Heart Failure: A Systematic Review and Meta-Analysis of Prospective Studies

BioMed Research International ◽

10.1155/2018/8739058 ◽

2018 ◽

Vol 2018 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Xige Wang ◽

Changli Zhou ◽

Yuewei Li ◽

Huimin Li ◽

Qinqin Cao ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Elderly Patients ◽

Publication Bias ◽

Prospective Studies ◽

Older Patients ◽

Meta Analysis ◽

Assessment Tools ◽

Patients With Heart Failure ◽

All Cause Mortality

Objective. Numerous studies have investigated the prognostic role of frailty in elderly patients with heart failure (HF), but the limited size of the reported studies has resulted in continued uncertainty regarding its prognostic impact. The aim of this study was to integrate the findings of all available studies and estimate the impact of frailty on the prognosis of HF by performing a systematic review and meta-analysis. Methods. PubMed, Embase, Cochrane, and Web of Science databases were searched from inception to November 8th 2017 to identify eligible prospective studies. The Newcastle-Ottawa Scale (NOS) was used to evaluate study quality. The association between frailty and HF outcomes was reviewed. Overall hazard ratios (HRs) for the effects of frailty on all-cause mortality were pooled using a fixed-effect model and publication bias was evaluated using funnel plots. Results. A total of 10 studies involving 3033 elderly patients with HF were included in the systematic review and meta-analysis. All eligible studies indicated that frailty was of prognostic significance for HF patients. The HRs for the effects of frailty on all-cause mortality were 1.70 (95% confidence interval (CI): 1.41–2.04), based on the pooling of six studies that provided related data. However, publication bias was observed among the studies. Conclusions. Frailty has a high prevalence among older patients with HF. Elderly HF patients with frailty have a poorer prognosis than those without frailty. Further studies are now required to implement the use of frailty assessment tools and explore effective interventions for frailty in older HF patients.

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Mind-Body Interventions for Depressive Symptoms in Chronic Pain: A Systematic Review of Meta-Analyses

January 2018 - Pain Physician ◽

10.36076/ppj.2021.24.61-72 ◽

2020 ◽

Vol 1;24 (1;1) ◽

pp. 61-72

Keyword(s):

Systematic Review ◽

Chronic Pain ◽

Depressive Symptoms ◽

Systematic Reviews ◽

Depressive Symptomatology ◽

Meta Analysis ◽

Poor Quality ◽

Mean Differences ◽

Meta Analyses

BACKGROUND: Psychological comorbidities in chronic pain (CP) are common and contribute to adverse health outcomes and poor quality of life. Evidence-based guidance for the management of depressive symptoms in CP is limited, particularly for mind-body interventions. OBJECTIVES: To investigate the effectiveness of mind-body interventions for the management of depressive symptoms in people with CP. STUDY DESIGN: Systematic review (SR) of SRs. SETTING: SRs with meta-analyses of clinical interventions for the management of depressive symptoms in people with CP. METHODS: This SR was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic searches were performed for MEDLINE, EMBASE, PsycINFO, CINAHL, AMED, the Cochrane Database of Systematic Reviews, and the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports from inception to March 14, 2019. Reference lists and overviews were also hand-searched. SRs of mind-body interventions for CP were included if they conducted a meta-analysis of depression outcomes in people with any CP type not including headache. Two independent reviewers screened, extracted, and evaluated the quality of articles found. Quality was assessed using the AMSTAR 2 criteria and data were summarized narratively with standardized mean differences and 95% confidence intervals of the depression outcome. RESULTS: Eleven SRs with 20 distinct meta-analyses demonstrated a small to moderate beneficial effect for mind-body interventions (effect sizes: -0.05 to -0.63). LIMITATIONS: Depressive symptomatology was a subordinate concern compared with other outcomes. The primary literature base was reasonably broad with 33 primary studies, but small when compared with the number of meta-analyses. CONCLUSIONS: Mind-body interventions show consistent small to moderate effects in reducing depressive symptoms in CP. The literature in this area demonstrates understudy and oversynthesis. There is a need for more clinical trials focusing on people with axial pain, people with comorbid major depressive disorder, and with depression as the primary outcome of interest. Full SR registered on PROSPERO: CRD42019131871. KEY WORDS: Mind-body, meditation, yoga, depression, chronic pain, umbrella review

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The effects of self-management interventions on depressive symptoms in adults with chronic physical disease(s) experiencing depressive symptomatology: a systematic review and meta-analysis

BMC Psychiatry ◽

10.1186/s12888-021-03504-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lydia Ould Brahim ◽

Sylvie D. Lambert ◽

Nancy Feeley ◽

Chelsea Coumoundouros ◽

Jamie Schaffler ◽

...

Keyword(s):

Systematic Review ◽

Depressive Symptoms ◽

Chronic Disease ◽

Glycemic Control ◽

Depressive Symptomatology ◽

Meta Analysis ◽

Self Management ◽

Control Group ◽

Physical Disease ◽

Management Interventions

Abstract Background Chronic diseases are the leading cause of death worldwide. It is estimated that 20% of adults with chronic physical diseases experience concomitant depression, increasing their risk of morbidity and mortality. Low intensity psychosocial interventions, such as self-management, are part of recommended treatment; however, no systematic review has evaluated the effects of depression self-management interventions for this population. The primary objective was to examine the effect of self-management interventions on reducing depressive symptomatology in adults with chronic disease(s) and co-occurring depressive symptoms. Secondary objectives were to evaluate the effect of these interventions on improving other psychosocial and physiological outcomes (e.g., anxiety, glycemic control) and to assess potential differential effect based on key participant and intervention characteristics (e.g., chronic disease, provider). Methods Studies comparing depression self-management interventions to a control group were identified through a) systematic searches of databases to June 2018 [MEDLINE (1946 -), EMBASE (1996 -), PsycINFO (1967 -), CINAHL (1984 -)] and b) secondary ‘snowball’ search strategies. The methodological quality of included studies was critically reviewed. Screening of all titles, abstracts, and full texts for eligibility was assessed independently by two authors. Data were extracted by one author and verified by a second. Results Fifteen studies were retained: 12 for meta-analysis and three for descriptive review. In total, these trials included 2064 participants and most commonly evaluated interventions for people with cancer (n = 7) or diabetes (n = 4). From baseline to < 6-months (T1), the pooled mean effect size was − 0.47 [95% CI −0.73, − 0.21] as compared to control groups for the primary outcome of depression and − 0.53 [95% CI −0.91, − 0.15] at ≥ 6-months (T2). Results were also significant for anxiety (T1) and glycemic control (T2). Self-management skills of decision-making and taking action were significant moderators of depression at T1. Conclusion Self-management interventions show promise in improving depression and anxiety in those with concomitant chronic physical disease. The findings may contribute to the development of future Self-management interventions and delivering evidence-based care to this population. Further high-quality RCTs are needed to identify sources of heterogeneity and investigate key intervention components.

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