Effects of psychological treatment for depression among people not actively seeking help: a meta-analysis

Abstract

Although psychological treatments have been found to be effective for depression in adults, many individuals with depression do not actively seek help. It is currently unclear whether psychological treatments are effective among those not actively seeking help. Besides, little is known about the proportion of patients who completed a screening questionnaire who end up in a clinical trial. Therefore, we conducted a meta-analysis of 52 randomized trials comparing psychotherapies for adults with a diagnosis or elevated symptoms of depression against control conditions (care-as-usual, waiting list, and other inactive treatment). Only studies recruiting participants who do not actively seek help (participants who have been recruited through screening instead of advertisements and clinical referrals) were included. To obtain an overall effect estimate of psychotherapy, we pooled all post-test differences with a random-effects model. We found that psychological treatments had a moderate to high effect on reducing depressive symptoms compared to control groups [g = 0.55; 95% confidence interval (CI) 0.41–0.69]. Heterogeneity was high (I2 = 75%; 95% CI 68–80). At 12 months' follow-up, the effects were small but significant (6–8 months: g = 0.33; 95% CI 0.14–0.52; 9–12 months: g = 0.24; 95% CI 0.11–0.37). As a secondary outcome, we found that 13% of patients who completed a screening questionnaire met the inclusion criteria for depression and agreed to be randomized in the trial. Based on the current evidence, psychological treatments for depression might be effective for depressed patients who are not actively seeking help.

Efficacy of an Unguided, Digital Single-Session Intervention for Internalizing Symptoms in Web-Based Workers: Randomized Controlled Trial

“…We did not recruit participants seeking help in routine care and instead provided treatment to individuals with mental health problems. However, Zhao et al [ 61 ] recently reported that psychological interventions can be effective, even when individuals are not seeking treatment. In addition, although Prolific is renowned for its data quality [ 62 ] and we reviewed participants’ responses for data quality, we have no way of confirming that respondents honestly engaged with the material after the intervention was completed.…”

The role of religiosity on seeking help

“…Although the merits of help seeking are considerable (Chu et al, 2011; Mueller & Kamdar, 2011; Zhao et al, 2022), previous research has shown that people in need may not ask for help because of a wide variety of concerns (e.g., help seeking could undermine perceptions toward the help seeker's competence. See Rosette et al (2015)).…”