Psychosocial interventions for improving mental health outcomes in patients with multimorbidity

Study «Smith SM, Wallace E, O'Dowd T ym. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev 2016;(3):CD006560 »1

Cochrane review included 18 RCTs for multimorbid patients, who receive care in a primary or community care setting. Nine studies focused on defined comorbid conditions with an emphasis on depression, diabetes and cardiovascular disease. The remaining studies focused on multimorbidity, generally in older people.

Population

In total, 1212 multimorbid patients with depression, diabetes and/or cardiovascular disease (5 studies) or depression and headache (1 study). Average age varied from 41 to 68 years.

Intervention

– Intervention duration varied from 2 weeks to 12 months.

– In four studies of six case managers coordinated collaborative care. Psychiatrist and/or psychologist was team member in three studies and in one study intervention was held by psychologist alone

– Interventions have personalised/individualised goal setting, care plans and support for self-care/self-management. Three studies emphasis psychological aspects and two of them offer therapy

Comparison

Control group patients had usual care and in one study enhanced primary care.

Outcome

Forest plot for depression scores were pooled from Hospital Anxiety and Depression Scale (HADS), Center for Epidemiologic Studies depression scale (CES), symptom checklist (SCL-D13), the Hopkins Symptom Checklist 20 (SCL 20) and Beck's Depression Inventory (BDI) scores from six studies.

– The standardised mean difference for depression scores was -0.41 (95% CI -0.63 to -0.20, I²=61%)

• Applicability: Good
• Study quality: High
• Comment: Quality of evidence is downgraded by the heterogeneity of interventions and control care in original trials. Case manager may improve the management of the treatment.

Study «Xie J, Deng W. Psychosocial intervention for patients with type 2 diabetes mellitus and comorbid depression: a meta-analysis of randomized controlled trials. Neuropsychiatr Dis Treat 2017;13:2681-90 »2

Population

Meta-analysis was conducted in patients with type 2 diabetes mellitus (T2DM) and comorbid depression. In total, 31 RCTs composed of 2,616 patients, average age of patients in the intervention group was approximately 43 years, however, the average age of patients in most studies was between 50 and 70 years old

Intervention

– The treatment time ranged from 2 to 16 weeks

– All RCT studies included some elements of psychosocial support

– Group psychotherapy 11 studies

– Cognitive therapy 7 studies

– Psychological counselling 6 studies

– Individual psychotherapy 5 studies

– Relaxation therapy 2 studies

– In addition 6 studies included health education

Comparison

Conventional treatment

Outcome

The depression scores were Hamilton Depression Rating Scale (HDRS) or Self-Rating Depression Scale (SDS)

– depression symptoms with pooled standardized mean difference (SMD) of -1.50 (95% CI -1.83 to -1.18)

• Applicability: Modest while 26 of 31 RCT studies were conducted in China.
• Study quality: High
• Comment: Quality of evidence is downgraded by the heterogeneity of interventions and control care in original trials.

References

1. Smith SM, Wallace E, O'Dowd T ym. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev 2016;(3):CD006560 «PMID: 26976529»PubMed
2. Xie J, Deng W. Psychosocial intervention for patients with type 2 diabetes mellitus and comorbid depression: a meta-analysis of randomized controlled trials. Neuropsychiatr Dis Treat 2017;13:2681-90 «PMID: 29123401»PubMed