Self-help interventions for symptoms of depression, anxiety and psychological distress in patients with physical illnesses: A systematic review and meta-analysis

Abstract

Psychological distress, depression and anxiety are common in most physical diseases, and self-help interventions, if effective, might be an important approach to improve outcomes as they are inexpensive to provide to large numbers of patients. The primary aim of this review was to assess randomised controlled trials examining the impact of self-help interventions on symptoms of depression, anxiety and psychological distress in patients with physical illness. Systematic searches of electronic databases resulted in twenty-five eligible studies for meta-analysis (n=4211). The results of the primary meta-analyses revealed a significant improvement in depression symptoms, in favour of the intervention group (SMD=-0.13, 95% CI: -0.25, -0.02, p=0.02, I(2)=50%). There were no significant differences in symptoms of anxiety (SMD=-0.10, 95% CI: -0.24, 0.05, p=0.20, I(2)=63%) or psychological distress (SMD=-0.14, 95% CI: -0.40, 0.12, p=0.30, I(2)=72%) between intervention and control conditions. Several subgroup and sensitivity analyses improved effect sizes, suggesting that optimal mental health outcomes may be obtained in patients without neurological conditions, and with interventions based on a therapeutic model (such as cognitive behavioural therapy), and with stress management components. This review demonstrates that with appropriate design and implementation, self-help interventions may potentially improve symptoms of depression in patients with physical conditions.

Medical student depression, anxiety and distress outside North America: a systematic review

“…Tools not validated to assess ‘caseness’ but nonetheless including an assessment of sadness, anxiety and other negative mood states were included under the heading ‘psychological distress’. This categorisation, which provides an inclusive concept of distress, has been used elsewhere …”

Supported cognitive-behavioural self-help versus treatment-as-usual for depressed informal carers of stroke survivors (CEDArS): study protocol for a feasibility randomized controlled trial

“…Additionally, although CBTsh appears effective for common mental health difficulties, reviews of CBTsh interventions for people with physical health conditions are less promising [30-32]. This raises the possibility that benefits demonstrated in general CBTsh interventions for adult depression may not generalize to medical populations that have depression as a secondary comorbidity or informal carers of people with physical health conditions.…”

Tailored Therapist-Guided Internet-Based Cognitive Behavioral Treatment for Psoriasis: A Randomized Controlled Trial

“…These problems may also negatively impact upon skin status, disease course, adherence, and dermatological treatment success [7,8,9,10,11]. Patients with a psychological profile of elevated levels of distress (an estimated 30-40%) are known to be at risk for long-term adjustment problems [3,12] and might benefit from cognitive behavioral therapy (CBT), as it has shown to improve physical and psychological functioning in patients with chronic somatic conditions [13,14,15,16], including dermatological conditions [17,18,19,20]. Over the last decade, CBT has increasingly been offered online, which may facilitate intervention reach, increase cost-effectiveness and time-efficiency, and reduce possible barriers to following a psychological intervention [21,22].…”