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The effect of psychotherapy for depression on improvements in social functioning: a meta-analysis

  • F. Renner (a1), P. Cuijpers (a2) and M. J. H. Huibers (a1) (a2)
Abstract
Background

Patients with depression often report impairments in social functioning. From a patient perspective, improvements in social functioning might be an important outcome in psychotherapy for depression. Therefore, it is important to examine the effects of psychotherapy on social functioning in patients with depression.

Method

We conducted a meta-analysis on studies of psychotherapy for depression that reported results for social functioning at post-treatment. Only studies that compared psychotherapy to a control condition were included (31 studies with 2956 patients).

Results

The effect size of psychotherapy on social functioning was small to moderate, before [Hedges' g = 0.46, 95% confidence interval (CI) 0.32–0.60] and after adjusting for publication bias (g = 0.40, 95% CI 0.25–0.55). Univariate moderator analyses revealed that studies using care as usual as a control group versus other control groups yielded lower effect sizes, whereas studies conducted in the USA versus other countries and studies that used clinician-rated instruments versus self-report yielded higher effect sizes. Higher quality studies yielded lower effect sizes whereas the number of treatment sessions and the effect size of depressive symptoms were positively related to the effect size of social functioning. When controlling for these and additional characteristics simultaneously in multivariate meta-regression, the effect size of depressive symptoms, treatment format and number of sessions were significant predictors. The effect size of social functioning remained marginally significant, indicating that improvements in social functioning are not fully explained by improvements in depressive symptoms.

Conclusions

Psychotherapy for depression results in small to moderate improvements in social functioning. These improvements are strongly associated with, but not fully explained by, improvements in depressive symptoms.

Copyright
Corresponding author
* Address for correspondence: Mr F. Renner, Department of Clinical Psychological Science, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. (Email: Fritz.Renner@MaastrichtUniversity.nl)
References
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Allart-van Dam E, Hosman CMH, Hoogduin CAL, Schaap CPDR (2003). The coping with depression course: short-term outcomes and mediating effects of a randomized controlled trial in the treatment of subclinical depression. Behavior Therapy 34, 381396.
Barth J, Munder T, Gerger H, Nüesch E, Trelle S, Znoj H, Jüni P, Cuijpers P (2013). Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis. PLoS Medicine 10, e1 001 454.
Battle CL, Uebelacker L, Friedman MA, Cardemil EV, Beevers CG, Miller IW (2010). Treatment goals of depressed outpatients: a qualitative investigation of goals identified by participants in a depression treatment trial. Journal of Psychiatric Practice 16, 425430.
Berger T, Hämmerli K, Gubser N, Andersson G, Caspar F (2011). Internet-based treatment of depression: a randomized controlled trial comparing guided with unguided self-help. Cognitive Behaviour Therapy 40, 251266.
Bosc M (2000). Assessment of social functioning in depression. Comprehensive Psychiatry 41, 6369.
Choi I, Zou J, Titov N, Dear BF, Li S, Johnston L, Andrews G, Hunt C (2012). Culturally attuned internet treatment for depression amongst Chinese Australians: a randomised controlled trial. Journal of Affective Disorders 136, 459468.
Coryell W, Scheftner W, Keller M, Endicott J (1993). The enduring psychosocial consequences of mania and depression. American Journal of Psychiatry 150, 720727.
Cuijpers P, Huibers M, Daniel Ebert D, Koole SL, Andersson G (2013). How much psychotherapy is needed to treat depression? A metaregression analysis. Journal of Affective Disorders 149, 113.
Cuijpers P, Li J, Hofmann SG, Andersson G (2010). Self-reported versus clinician-rated symptoms of depression as outcome measures in psychotherapy research on depression: a meta-analysis. Clinical Psychology Review 30, 768778.
Cuijpers P, van Straten A, Andersson G, van Oppen P (2008 a). Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. Journal of Consulting and Clinical Psychology 76, 909922.
Cuijpers P, van Straten A, Warmerdam L (2008 b). Are individual and group treatments equally effective in the treatment of depression in adults? A meta-analysis. European Journal of Psychiatry 22, 3851.
Cuijpers P, van Straten A, Warmerdam L, Andersson G (2008 c). Psychological treatment of depression: a meta-analytic database of randomized studies. BMC Psychiatry 8, 36.
Cuijpers P, van Straten A, Warmerdam L, Smits N (2008 d). Characteristics of effective psychological treatments of depression: a metaregression analysis. Psychotherapy Research 18, 225236.
Dobkin RD, Menza M, Allen LA, Gara MA, Mark MH, Tiu J, Bienfait KL, Friedman J (2011). Cognitive-behavioral therapy for depression in Parkinson's disease: a randomized, controlled trial. American Journal of Psychiatry 168, 10661074.
Dowrick C, Dunn G, Ayuso-Mateos JL, Dalgard OS, Page H, Lehtinen V, Casey P, Wilkinson C, Vazquez-Barquero JL, Wilkinson G (2000). Problem solving treatment and group psychoeducation for depression: multicentre randomised controlled trial. Outcomes of Depression International Network (ODIN) Group. British Medical Journal 321, 14501454.
Dunn TW, Vittengl JR, Clark LA, Carmody T, Thase ME, Jarrett RB (2012). Change in psychosocial functioning and depressive symptoms during acute-phase cognitive therapy for depression. Psychological Medicine 42, 317326.
Duval S, Tweedie R (2000). Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56, 455463.
Eaton WW, Martins SS, Nestadt G, Bienvenu OJ, Clarke D, Alexandre P (2008). The burden of mental disorders. Epidemiologic Reviews 30, 114.
Ekers D, Richards D, McMillan D, Bland JM, Gilbody S (2011). Behavioural activation delivered by the nonspecialist: Phase II randomised controlled trial. British Journal of Psychiatry 198, 6672.
Faramarzi M, Kheirkhah F, Esmaelzadeh S, Alipour A, Hjiahmadi M, Rahnama J (2008). Is psychotherapy a reliable alternative to pharmacotherapy to promote the mental health of infertile women? A randomized clinical trial. European Journal of Obstetrics, Gynecology, and Reproductive Biology 141, 4953.
Fledderus M, Bohlmeijer ET, Pieterse ME, Schreurs KMG (2012). Acceptance and commitment therapy as guided self-help for psychological distress and positive mental health: a randomized controlled trial. Psychological Medicine 42, 485495.
Greenberg PE, Kessler RC, Birnbaum HG, Leong SA, Lowe SW, Berglund PA, Corey-Lisle PK (2003). The economic burden of depression in the United States: how did it change between 1990 and 2000? Journal of Clinical Psychiatry 64, 14651475.
Grote NK, Swartz HA, Geibel SL, Zuckoff A, Houck PR, Frank E (2009). A randomized controlled trial of culturally relevant, brief interpersonal psychotherapy for perinatal depression. Psychiatric Services 60, 313321.
Haringsma R, Engels GI, Cuijpers P, Spinhoven P (2006). Effectiveness of the Coping With Depression (CWD) course for older adults provided by the community-based mental health care system in the Netherlands: a randomized controlled field trial. International Psychogeriatrics 18, 307325.
Harley R, Sprich S, Safren S, Jacobo M, Fava M (2008). Adaptation of dialectical behavior therapy skills training group for treatment-resistant depression. Journal of Nervous and Mental Disease 196, 136143.
Hays RD, Wells KB, Sherbourne C, Rogers W, Spritzer K (1995). Functioning and well-being outcomes of patients with depression compared with chronic general medical illnesses. Archives of General Psychiatry 52, 1119.
Hedges LV, Olkin I (1985). Statistical Methods for Meta-Analysis. Academic Press: San Diego, CA.
Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savović J, Schulz KF, Weeks L, Sterne JAC (2011). The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. British Medical Journal 343, d5928.
Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003). Measuring inconsistency in meta-analyses. British Medical Journal 327, 557560.
Hirschfeld RMA, Montgomery SA, Keller MB, Kasper S, Schatzberg AF, Möller H-J, Healy D, Baldwin D, Humble M, Versiani M, Montenegro R, Bourgeois M (2000). Social functioning in depression: a review. Journal of Clinical Psychiatry 61, 268275.
Horowitz LM, Alden LE, Wiggins JS, Pincus AL (2000). Inventory of Interpersonal Problems Manual. Harcourt Assessment, The Psychological Corporation: Oxford, UK.
Judd LL, Akiskal HS, Zeller PJ, Paulus M, Leon AC, Maser JD, Endicott J, Coryell W, Kunovac JL, Mueller TI, Rice JP, Keller MB (2000). Psychosocial disability during the long-term course of unipolar major depressive disorder. Archives of General Psychiatry 57, 375380.
Kazdin AE (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology 3, 127.
Klein MH, Greist JH, Gurman AS, Neimeyer RA, Lesser DP, Bushnell NJ, Smith RE (1985). A comparative outcome study of group psychotherapy vs. exercise treatments for depression. International Journal of Mental Health 13, 148177.
Laidlaw K, Davidson K, Toner H, Jackson G, Clark S, Law J, Howley M, Bowie G, Connery H, Cross S (2008). A randomised controlled trial of cognitive behaviour therapy vs treatment as usual in the treatment of mild to moderate late life depression. International Journal of Geriatric Psychiatry 23, 843850.
Leon AC, Solomon DA, Mueller TI, Turvey CL, Endicott J, Keller MB (1999). The Range of Impaired Functioning Tool (LIFE-RIFT): a brief measure of functional impairment. Psychological Medicine 29, 869878.
Lynch D, Tamburrino M, Nagel R, Smith MK (2004). Telephone-based treatment for family practice patients with mild depression. Psychological Reports 94, 785792.
Lynch DJ, Tamburrino MB, Nagel R (1997). Telephone counseling for patients with minor depression: preliminary findings in a family practice setting. Journal of Family Practice 44, 293298.
Miller L, Weissman M (2002). Interpersonal psychotherapy delivered over the telephone to recurrent depressives : a pilot study. Depression and Anxiety 16, 114117.
Mintz J, Mintz LI, Arruda MJ, Hwang SS (1992). Treatments of depression and the functional capacity to work. Archives of General Psychiatry 49, 761768.
Miranda J, Chung JY, Green BL, Krupnick J, Siddique J, Revicki DA, Belin T (2003). Treating depression in predominantly low-income young minority women: a randomized controlled trial. Journal of the American Medical Association 290, 5765.
Mynors-Wallis LM, Gath DH, Lloyd-Thomas AR, Tomlinson D (1995). Randomised controlled trial comparing problem solving treatment with amitriptyline and placebo for major depression in primary care. British Medical Journal 310, 441445.
Neugebauer R, Kline J, Markowitz JC, Bleiberg KL, Baxi L, Rosing MA, Levin B, Keith J (2006). Pilot randomized controlled trial of interpersonal counseling for subsyndromal depression following miscarriage. Journal of Clinical Psychiatry 67, 12991304.
O'Hara MW, Stuart S, Gorman LL, Wenzel A (2000). Efficacy of interpersonal psychotherapy for postpartum depression. Archives of General Psychiatry 57, 10391045.
ONS (2012). Sickness Absence in the Labour Market, April 2012. Office for National Statistics (www.ons.gov.uk/ons/dcp171776_265016.pdf).
Perini S, Titov N, Andrews G (2009). Clinician-assisted internet-based treatment is effective for depression: randomized controlled trial. Australian and New Zealand Journal of Psychiatry 43, 571578.
Propst LR, Ostrom R, Watkins P, Dean T, Mashburn D (1992). Comparative efficacy of religious and nonreligious cognitive-behavioral therapy for the treatment of clinical depression in religious individuals. Journal of Consulting and Clinical Psychology 60, 94103.
Scott J, Teasdale JD, Paykel ES, Johnson AL, Abbott R, Hayhurst H, Moore R, Garland A (2000). Effects of cognitive therapy on psychological symptoms and social functioning in residual depression. British Journal of Psychiatry 177, 440446.
Serfaty MA, Haworth D, Blanchard M, Buszewicz M, Murad S, King M (2009). Clinical effectiveness of individual cognitive behavioral therapy for depressed older people in primary care: a randomized controlled trial. Archives of General Psychiatry 66, 13321340.
Sheehan D (1983). The Anxiety Disease. Scribner's: New York.
Simpson S, Corney R, Fitzgerald P, Beecham J (2003). A randomized controlled trial to evaluate the effectiveness and cost-effectiveness of psychodynamic counselling for general practice patients with chronic depression. Psychological Medicine 33, 229239.
Solomon DA, Leon AC, Endicott J, Mueller TI, Coryell W, Shea MT, Keller MB (2004). Psychosocial impairment and recurrence of major depression. Comprehensive Psychiatry 45, 423430.
Talbot NL, Chaudron LH, Ward EA, Duberstein PR, Conwell Y, O'Hara MW, Tu X, Lu N, He H, Stuart S (2011). A randomized effectiveness trial of interpersonal psychotherapy for depressed women with sexual abuse histories. Psychiatric Services 62, 374380.
van Schaik A, van Marwijk H, Adèr H, van Dyck R, de Haan M, Penninx B, van der Kooij K, van Hout H, Beekman A (2006). Interpersonal psychotherapy for elderly patients in primary care. American Journal of Geriatric Psychiatry 14, 777786.
Vitriol VG, Ballesteros ST, Florenzano RU, Weil KP, Benadof DF (2009). Evaluation of an outpatient intervention for women with severe depression and a history of childhood trauma. Psychiatric Services 60, 936942.
Vittengl JR, Clark LA, Jarrett RB (2004). Improvement in social-interpersonal functioning after cognitive therapy for recurrent depression. Psychological Medicine 34, 643658.
Vittengl JR, Clark LA, Jarrett RB (2009). Deterioration in psychosocial functioning predicts relapse/recurrence after cognitive therapy for depression. Journal of Affective Disorders 112, 135143.
Ward E, King M, Lloyd M, Bower P, Sibbald B, Farrelly S, Gabbay M, Tarrier N, Addington-Hall J (2000). Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy, and usual general practitioner care for patients with depression. I: Clinical effectiveness. British Medical Journal 321, 13831388.
Ware JE Jr., Sherbourne CD (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care 30, 473483.
Watkins JT, Leber WR, Imber SD, Collins JF, Elkin I, Pilkonis PA, Sotsky SM, Shea MT, Glass DR (1993). Temporal course of change of depression. Journal of Consulting and Clinical Psychology 61, 858864.
Watt LM, Cappeliez P (2000). Integrative and instrumental reminiscence therapies for depression in older adults: intervention strategies and treatment effectiveness. Aging and Mental Health 4, 166177.
Weissman M, Markowitz J, Klerman G (2000). Comprehensive Guide to Interpersonal Psychotherapy. Basic Books: New York.
Weissman MM, Prusoff BA, Thompson WD, Harding PS, Myers JK (1978). Social adjustment by self-report in a community sample and in psychiatric outpatients. Journal of Nervous and Mental Disease 166, 317326.
WHO (1948). Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. World Health Organization: Geneva.
Zimmerman M, McGlinchey JB, Posternak MA, Friedman M, Attiullah M, Boerescu D (2006). How should remission from depression be defined? The depressed patient's perspective. American Journal of Psychiatry 163, 148150.
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