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Brief Psychotherapy for Depression in Primary Care: A Systematic Review of the Evidence

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Principal Investigators: Jason A. Nieuwsma, Ph.D.; Co-Investigators: Ranak B. Trivedi, Ph.D.; Jennifer McDuffie, Ph.D.; Ian Kronish, M.D.; Dinesh Benjamin, M.D.; John W. Williams Jr., M.D., M.H.Sc.; Medical Editor: Liz Wing, M.A.

Evidence-based Synthesis Program (ESP) Center, Durham VA Medical Center, Durham, NC

Washington (DC): Department of Veterans Affairs; February 2011

Download PDF: Complete Report, Executive Summary, Report, Appendices

Summary / Overview

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. Thus, we conducted a systematic review of the peer-reviewed literature to answer the following key questions:

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?

See also

A Synthesis of the Evidence: Brief Psychotherapy for Depression in Primary Care (VA HSR&D Management e-Brief)

Cyber Seminar on Brief Psychotherapy for Depression in Primary Care: A Systematic Review of the Evidence