Article Figures & Data
Figures
- Figure 1.
Network plot.
- Figure 2.
Ranked forest plots.
CAU = care as usual; RR = relative risk; SMD = standardized mean difference.
Tables
All Studiesa n (%) Psy vs CAU n (%) Psy vs Pha n (%) Pha vs Comb n (%) Psy vs WL n (%) Patients Screening Yes 19 (30.6) 12 (30.8) 7 (41.2) 3 (60.0) 0 (0) No 43 (69.4) 27 (69.2) 10 (58.8) 2 (40.0) 6 (100.0) Target group Adults 50 (80.6) 31 (79.5) 13 (76.5) 4 (80.0) 6 (100.0) Specific groupb 12 (19.4) 8 (20.5) 4 (23.5) 1 (20.0) 0 (0) Psychotherapy Type CBT 32 (51.6) 22 (56.4) 3 (17.6) 2 (40.0) 5 (83.3) IPT 6 (9.7) 3 (7.7) 4 (23.5) 1 (20.0) 0 (0) PST 8 (12.9) 2 (5.1) 6 (35.3) 1 (20.0) 0 (0) Supportive 5 (8.1) 3 (7.7) 3 (17.6) 0 (0) 0 (0) Other 11 (17.7) 9 (23.1) 1 (5.9) 1 (20.0) 1 (16.7) Format Individual 39 (62.9) 24 (61.5) 13 (76.5) 4 (80.0) 2 (33.3) Group/GSH mixed 23 (37.1) 15 (38.5) 4 (23.5) 1 (20.0) 4 (66.7) Adequate 28 (45.2) 22 (56.4) 4 (23.5) 3 (60.0) 1 (16.7) Pharmacotherapy Type SSRI 7 (11.3) 0 (0) 6 (35.3) 2 (40.0) 0 (0) Other 9 (14.5) 0 (0) 7 (41.2) 3 (60.0) 0 (0) None 46 (74.2) 0 (0) 4 (23.5) 0 (0) 0 (0) Adequate 9 (56.3)c 0 (0) 8 (47.1) 2 (40.0) 0 (0) General study characteristics Country North America 9 (14.5) 6 (15.4) 4 (23.5) 1 (20.0) 0 (0) Europe 40 (64.5) 24 (61.5) 11 (64.7) 4 (80.0) 6 (100.0) Other 13 (21.0) 9 (23.1) 2 (11.8) 0 (0) 0 (0) Risk of bias Low 28 (45.2) 15 (38.5) 8 (47.1) 4 (80.0) 2 (33.3) At least some 34 (54.8) 24 (61.5) 9 (52.9) 1 (20.0) 4 (67.7) Total 62 (100.0) 39 (100.0) 17 (100.0) 5 (100.0) 6 (100.0) CAU = care as usual; CBT = cognitive behavior therapy; Comb = combined treatment; GSH = guided self-help; IPT = interpersonal psychotherapy; Pha = pharmacotherapy; PST = problem-solving therapy; Psy = psychotherapy; SSRI = selective serotonin reuptake inhibitor; WL = waitlist.
↵a Includes all 62 comparisons.
↵b Specific groups refer to older adults (García-Peña, 2015; Joling, 2011; Laidlaw, 2008; Serfaty, 2009; Scogin, 2018; Williams, 2000),44-49 women with postpartum depression (Chibanda, 2014; Sharp, 2010),50-51 minorities (Dwight-Johnson, 2011; Gater, 2010),52-53 and patients with comorbid headache/migraine.54 See Supplemental Appendix 4 for complete references for all studies.
↵c This is 56.3% of the 16 studies that included pharmacotherapy.
- Table 2.
Response, Remission, SMD, and Acceptability for Psychotherapy, Pharmacotherapy, and Combined Treatment Compared With Each Other and Control Conditions (CAU, Waitlist, Placebo)3
Acceptability Response Combined 1.11 (0.65-1.90) 1.00 (0.57-1.76) 0.81 (0.42-1.58) 0.93 (0.52-1.67) 0.84 (0.41-1.72) 1.30 (0.98-1.73) Pharmacotherapy 0.90 (0.69-1.18) 0.73 (0.48-1.11) 0.84 (0.61-1.15) 0.75 (0.44-1.28) 1.35 (1.00-1.81) 1.03 (0.88-1.22) Psychotherapy 0.81 (0.53-1.25) 0.93 (0.78-1.10) 0.83 (0.53-1.31) 1.65 (1.10-2.46) 1.26 (0.94-1.71) 1.22 (0.90-1.66) Pill placebo 1.15 (0.72-1.82) 1.03 (0.55-1.93) 2.15 (1.56-2.97) 1.65 (1.35-2.03) 1.60 (1.40-1.83) 1.31 (0.94-1.81) CAU 0.90 (0.55-1.45) 3.16 (1.91-5.21) 2.43 (1.57-3.74) 2.35 (1.57-3.51) 1.92 (1.16-3.17) 1.47 (0.96-2.23) Waitlist Standardized Mean Difference Remission Combined 0.29 (–0.03 to 0.60) 0.26 (–0.07 to 0.59) 0.54 (0.06-1.02) 0.70 (0.35-1.05) 1.13 (0.64-1.61) 1.25 (0.77-2.04) Pharmacotherapy –0.03 (–0.22 to 0.17) 0.25 (–0.13 to 0.63) 0.41 (0.18-0.64) 0.84 (0.44-1.24) 1.35 (0.81-2.26) 1.08 (0.87-1.34) Psychotherapy 0.28 (–0.10 to 0.66) 0.44 (0.31-0.57) 0.86 (0.51-1.22) 1.74 (0.95-3.20) 1.39 (0.95-2.03) 1.29 (0.88-1.88) Placebo 0.16 (–0.24 to 0.56) 0.59 (0.07-1.10) 2.09 (1.22-3.58) 1.67 (1.28-2.18) 1.55 (1.29-1.85) 1.20 (0.79 to 1.82) CAU 0.43 (0.05-0.80) 3.26 (1.57-6.77) 2.60 (1.48-4.58) 2.41 (1.43-4.06) 1.87 (0.98 to 3.56) 1.56 (0.90-2.70) Waitlist CAU = care as usual; RR = relative risk; SMD = standardized mean difference.
Note: Data are shown as RR (95% CI) (upper panel and lower left of lower panel) or SMD (95% CI) (upper right of lower panel).
a In the lower left triangle of the upper part of the table, RR >1 means that the column-defining intervention increases the event of interest compared with the row-defining intervention. Therefore, the former is more efficacious than the latter. In the upper right triangle, RR >1 means that the row-defining intervention increases the event of interest compared with the column-defining intervention. Therefore, the former is less acceptable than the latter. In the lower left triangle of the lower portion of the table, RR >1 means that the column-defining intervention increases the event of interest compared with the row-defining intervention. In the upper right triangle, SMD >0 means that the row-defining intervention is more effective compared to the column-defining intervention.
Response Remission SMD Acceptability Combined 98.7 92.9 97.7 56.9 Pharmacotherapy 72.5 78.1 66.5 81.6 Psychotherapy 65.2 65.2 71.8 62.8 Placebo 42.3 39.4 39.3 25.8 Care as usual 20.4 22.8 24.1 42.7 Waitlist 0.8 1.7 0.6 30.2 SMD = standardized mean difference.
Supplemental appendixes 1-19
Supplemental appendixes 1-19
- Supplemental data -
PDF file
- Supplemental data -
The Article in Brief
Psychologic Treatment of Depression Compared With Pharmacotherapy and Combined Treatment in Primary Care: A Network Meta-Analysis
Pim Cuijpers , and colleagues
Background Surgical cesarean births can expose new mothers to a range of health complications, including infection, blood clots and hemorrhage. As part of Healthy People 2020 and other maternal health objectives, the state of California exerted pressure to reduce cesarean deliveries, and statewide organizations established quality initiatives in partnership with those goals.
What This Study Found In this study, researchers from Stanford University and the University of Chicago examined unit culture and provider mix differences on hospital and delivery units to identify characteristics of units that successfully reduced their cesarean delivery rates. The mixed-methods study surveyed and interviewed labor and delivery teams from 37 California hospitals that were participating sites in the California Maternal Quality Care Collaborative’s Supporting Vaginal Birth initiative.
Respondents at successful hospitals included more family physicians and midwives, and physicians who had been in practice for less time. The study identified a number of unit culture factors that also predicted success.Implications
- “Family medicine, a discipline that strongly identifies itself as valuing patient-centered care and shared decision-making, may be in a unique position to contribute positively to this aspect of culture change on labor and delivery units.”
