Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-05-16T04:06:26.129Z Has data issue: false hasContentIssue false

What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression

Published online by Cambridge University Press:  19 February 2007

Department of Nursing, Midwifery and Health Visiting, University of Manchester, UK
National Primary Care Research and Development Centre, University of Manchester, UK
Department of Health Sciences, University of York, UK
Department of Health Sciences, University of York, UK
Department of Health Sciences, University of York, UK
Department of Nursing, Midwifery and Health Visiting, University of Manchester, UK
*Address for correspondence: Dr Peter Bower, National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL, UK. (Email:



Although self-help interventions are effective in treating depression, less is known about the factors that determine effectiveness (i.e. moderators of effect). This study sought to determine whether the content of self-help interventions, the study populations or aspects of study design were the most important moderators.


Randomized trials of the effectiveness of self-help interventions versus controls in the treatment of depressive symptoms were identified using previous reviews and electronic database searches. Data on moderators (i.e. patient populations, study design, intervention content) and outcomes were extracted and analysed using meta-regression.


Thirty-four studies were identified with 39 comparisons. Study design factors associated with greater effectiveness were unclear allocation concealment, observer-rated outcome measures and waiting-list control groups. Greater effectiveness was also associated with recruitment in non-clinical settings, patients with existing depression (rather than those ‘at risk’), contact with a therapist (i.e. guided self-help) and the use of cognitive behavioural therapy (CBT) techniques. However, only guided self-help remained significant in the multivariate analysis [regression coefficient 0·36, 95% confidence interval (CI) 0·05–0·68, p=0·03]. In the subset of guided studies, there were no significant associations between outcomes and the session length, content, delivery mode or therapist background.


The results provide some insights into moderators of self-help interventions, which might assist in the design of future interventions. However, the present study did not provide a comprehensive description, and other research methods might be required to identify factors associated with the effectiveness of self-help.

Invited Review
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)



Ackerson, J., Scogin, F., McKendree-Smith, N. & Lyman, R. (1998). Cognitive bibliotherapy for mild and moderate adolescent depressive symptomatology. Journal of Consulting and Clinical Psychology 66, 685690.CrossRefGoogle ScholarPubMed
Anderson, L., Lewis, G., Araya, R., Elgie, R., Harrison, G., Proudfoot, J., Schmidt, U., Sharp, D., Weightman, A. & Williams, C. (2005). Self-help books for depression: how can practitioners and patients make the right choice? British Journal of General Practice 55, 387392.Google ScholarPubMed
Baron, R. & Kenny, D. (1986). The moderator–mediator distinction in social psychological research: conceptual, strategic and statistical considerations. Journal of Personality and Social Psychology 51, 11731182.CrossRefGoogle ScholarPubMed
Bower, P., Richards, D. & Lovell, K. (2001). The clinical and cost-effectiveness of self-help treatments for anxiety and depressive disorders in primary care: a systematic review. British Journal of General Practice 51, 838845.Google ScholarPubMed
Churchill, R., Hunot, V., Corney, R., Knapp, M., McGuire, H., Tylee, A. & Wessely, S. (2002). A systematic review of controlled trials of the effectiveness and cost-effectiveness of brief psychological treatments for depression. Health Technology Assessment Vol. 5, No. 35.CrossRefGoogle Scholar
Cohen, J. (1988). Statistical Power Analysis for the Behavioural Sciences (2nd edn). Lawrence Erlbaum: New Jersey.Google Scholar
Cook, T. & Campbell, D. (1979). Quasi-Experimentation – Design and Analysis Issues for Field Settings. Rand McNally: Chicago.Google Scholar
Cuijpers, P. (1997). Bibliotherapy in unipolar depression: a meta-analysis. Journal of Behaviour Therapy and Experimental Psychiatry 28, 139147.CrossRefGoogle ScholarPubMed
Den Boer, P., Wiersma, D. & Van Den Bosch, R. (2004). Why is self-help neglected in the treatment of emotional disorders? A meta-analysis. Psychological Medicine 34, 959971.CrossRefGoogle ScholarPubMed
Dickersin, K., Manheimer, E., Wieland, S., Robinson, K., Lefebvre, C., McDonald, S. & CENTRAL Development Group (2002). Development of the Cochrane Collaboration's CENTRAL Register of Controlled Clinical Trials. Evaluation and the Health Professions 25, 3864.Google ScholarPubMed
Egger, M., Davey, Smith G., Schneider, M. & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal 315, 629634.CrossRefGoogle ScholarPubMed
Elliott, R. (1984). A discovery-oriented approach to significant change events in psychological therapies: interpersonal process recall and comprehensive process analysis. In Patterns of Change: Intensive Analysis of Psychological Therapies Process (ed. Rice, L. & Greenberg, L.), pp. 249286. Guilford Press: London.Google Scholar
Elliott, R., Fischer, C. & Rennie, D. (1999). Evolving guidelines for publication of qualitative research studies in psychology and related fields. British Journal of Clinical Psychology 38, 213229.CrossRefGoogle ScholarPubMed
Gotzsche, P. (2000). Why we need a broad perspective on meta-analysis. British Medical Journal 321, 585586.CrossRefGoogle Scholar
Gould, R. & Clum, G. (1993). A meta-analysis of self-help treatment approaches. Clinical Psychology Review 13, 169186.CrossRefGoogle Scholar
Higgins, J. & Thompson, S. (2004). Controlling the risk of spurious findings from meta-regression. Statistics in Medicine 23, 16631682.CrossRefGoogle ScholarPubMed
Higgins, J., Thompson, S., Deeks, J. & Altman, D. (2003). Measuring inconsistency in meta-analyses. British Medical Journal 327, 557560.CrossRefGoogle ScholarPubMed
Hollis, S. & Campbell, F. (1999). What is meant by intention to treat analysis? Survey of published randomised controlled trials. British Medical Journal 319, 670674.CrossRefGoogle ScholarPubMed
Jacobson, N., Dobson, K., Truax, P., Addis, M., Koerner, K., Gollan, J., Gortner, E. & Prince, S. (1996). A component analysis of cognitive-behavioural treatment for depression. Journal of Consulting and Clinical Psychology 64, 295304.CrossRefGoogle Scholar
Lambert, P., Sutton, A., Abrams, K. & Jones, D. (2002). A comparison of summary patient-level covariates in meta-regression with individual patient data meta-analysis. Journal of Clinical Epidemiology 55, 8694.CrossRefGoogle ScholarPubMed
Lipsey, M. (1990). Design Sensitivity: Statistical Power for Experimental Research. Sage: Newbury Park.Google Scholar
Lipsey, M. & Wilson, D. (2001). Practical Meta-Analysis. Sage: Newbury Park.Google ScholarPubMed
Little, P., Dorward, M., Warner, G., Moore, M., Stephens, K., Senior, J. & Kendrick, T. (2004). Randomised controlled trial of effect of leaflets to empower patients in consultations in primary care. British Medical Journal 328, 441444.CrossRefGoogle ScholarPubMed
Lovell, K. & Richards, D. (2000). Multiple Access Points and Levels of Entry (MAPLE): ensuring choice, accessibility and equity for CBT services. Behavioral and Cognitive Psychotherapy 28, 379391.CrossRefGoogle Scholar
Marrs, R. (1995). A meta-analysis of bibliotherapy studies. American Journal of Community Psychology 23, 843870.CrossRefGoogle ScholarPubMed
McKendree-Smith, N., Floyd, M. & Scogin, F. (2003). Self-administered treatments for depression: a review. Journal of Clinical Psychology 59, 275288.CrossRefGoogle ScholarPubMed
Mead, N., MacDonald, W., Bower, P., Lovell, K., Richards, D. & Bucknall, A. (2005). The clinical effectiveness of guided self-help versus waiting list control in the management of anxiety and depression: a randomised controlled trial. Psychological Medicine 35, 16331643.CrossRefGoogle Scholar
National Collaborating Centre for Mental Health (2005). Depression: Management of Depression in Primary and Secondary Care – NICE Guidance. National Institute for Clinical Excellence ( Accessed 19 January 2005.Google Scholar
Newman, M., Erickson, T., Przeworski, A. & Dzus, E. (2003). Self-help and minimal-contact therapies for anxiety disorders: is human contact necessary for therapeutic efficacy? Journal of Clinical Psychology 59, 251274.CrossRefGoogle Scholar
Proudfoot, J., Ryden, C., Everitt, B., Shapiro, D., Goldberg, D., Mann, A., Tylee, A., Marks, I. & Gray, J. (2004). Clinical efficacy of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomised controlled trial. British Journal of Psychiatry 185, 4654.CrossRefGoogle ScholarPubMed
Rahe, R., Taylor, C., Tolles, R., Newhall, M., Veach, T. & Bryson, S. (2002). A novel stress and coping workplace program reduces illness and healthcare utilization. Psychosomatic Medicine 64, 278286.CrossRefGoogle ScholarPubMed
Reid, M., Glazener, C., Murray, G. & Taylor, G. (2002). A two-centred pragmatic randomised controlled trial of two interventions of postnatal support. British Journal of Obstetrics and Gynaecology 109, 11641170.Google ScholarPubMed
Richards, A., Barkham, M., Cahill, J., Richards, D., Williams, C. & Heywood, P. (2003). PHASE: a randomised, controlled trial of supervised self-help cognitive behavioural therapy in primary care. British Journal of General Practice 53, 764770.Google ScholarPubMed
Rosenthal, R. (1979). The ‘File Drawer Problem’ and tolerance for null results. Psychological Bulletin 86, 638641.CrossRefGoogle Scholar
Royle, P. & Waugh, N. (2005). A simplified search strategy for identifying randomised controlled trials for systematic reviews of health care interventions: a comparison with more exhaustive strategies. BMC Medical Research Methodology 5, 23.CrossRefGoogle Scholar
Schulz, K., Chalmers, I., Hayes, R. & Altman, D. (1995). Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. Journal of the American Medical Association 273, 408412.CrossRefGoogle ScholarPubMed
Schulz, K. & Grimes, D. (2002). Allocation concealment in randomised trials: defending against deciphering. Lancet 359, 614618.CrossRefGoogle ScholarPubMed
Scogin, F., Bynum, J., Stephens, G. & Calhoon, S. (1990). Efficacy of self-administered treatment programs: meta-analytic review. Professional Psychology: Research and Practice 21, 4247.CrossRefGoogle Scholar
Scogin, F., Hanson, A. & Welsh, D. (2003). Self-administered treatment in stepped-care models of depression treatment. Journal of Clinical Psychology 59, 341349.CrossRefGoogle ScholarPubMed
Shadish, W. & Baldwin, S. (2005). Effects of behavioral marital therapy: a meta-analysis of randomized controlled trials. Journal of Consulting and Clinical Psychology 73, 614.CrossRefGoogle ScholarPubMed
Smith, M., Glass, G. & Miller, T. (1980). The Benefits of Psychotherapy. Johns Hopkins University Press: Baltimore.Google Scholar
Sutton, A., Abrams, K., Jones, D., Sheldon, T. & Song, F. (1998). Systematic reviews of trials and other studies. Health Technology Assessment Vol. 2, No. 19.CrossRefGoogle ScholarPubMed
Thompson, S. & Higgins, J. (2002). How should meta-regression analyses be undertaken and interpreted? Statistics in Medicine 21, 15591573.CrossRefGoogle ScholarPubMed
Supplementary material: PDF

Gellatly Supplementary Material


Download Gellatly Supplementary Material(PDF)
PDF 110.4 KB