Excerpt

The individual and societal burden of depressive disorders is widely acknowledged, but treating these disorders remains challenging. Clinical guidelines recommend that both pharmacotherapy and psychotherapy should be considered as first-line treatments. Yet, because primary care settings are often the frontline of treatment, pharmacological treatments take precedence. In part, this may be due to the perception that psychotherapy is lengthy and time intensive, with guidelines recommending 12 to 20 1-hour sessions for most evidence-based psychotherapies. However, recent evidence seems to suggest that psychotherapies that are briefer in both duration and intensity may be efficacious in acute-phase treatment. If true, these briefer psychotherapies may be more easily integrated in primary care settings.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • BACKGROUND
  • METHODS
  • RESULTS
  • FUTURE RESEARCH RECOMMENDATIONS
  • CONCLUSIONS
• INTRODUCTION
• METHODS
  • TOPIC DEVELOPMENT
  • OVERALL APPROACH
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • PEER REVIEW
• RESULTS
  • LITERATURE SEARCH AND STUDY CHARACTERISTICS
  • KEY QUESTION 1 For primary care patients with depressive disorders, are brief, evidence-based psychotherapies with durations of up to eight sessions more efficacious than control for depressive symptoms (i.e., on self-report and/or clinician-administered measures) and quality of life (i.e., functional status and/or health-related quality of life)?
  • KEY QUESTION 2 For primary care patients with depressive disorders treated with a brief, evidence-based psychotherapy, is there evidence that treatment effect may vary by the number of sessions delivered?
  • KEY QUESTION 3 For psychotherapies demonstrating clinically significant treatment effects, what are the characteristics of treatment providers (i.e., type of provider and training), and what are the modalities of therapy (i.e., individual/ group, face-to-face/teletherapy/Internet-based)?
  • KEY QUESTION 4 How commonly reported are the key clinical outcomes of quality of life, social functioning, occupational status, patient satisfaction, and adverse treatment effects in randomized trials of psychotherapy?
• DISCUSSION
  • STRENGTHS AND LIMITATIONS
  • CONCLUSIONS
• FUTURE RESEARCH
• REFERENCES
• APPENDIX A SEARCH STRATEGY
• APPENDIX B EVIDENCE TABLES
• APPENDIX C REVIEWER COMMENTS AND RESPONSES
• APPENDIX D EXCLUDED STUDIES
• APPENDIX E ACRONYMS AND ABBREVIATIONS

Medical Editor: Liz Wing, MA

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Durham VA Medical Center, Durham, NC, John W. Williams Jr., MD, MHSc, Director

Suggested citation:

Nieuwsma JA, Trivedi RB, McDuffie J, Kronish I, Benjamin D, Williams JW Jr. Brief Psychotherapy for Depression in Primary Care: A Systematic Review of the Evidence. VA-ESP Project #09-010; 2011

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Durham VA Medical Center, Durham, NC, funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.