Self-help interventions for symptoms of depression, anxiety and psychological distress in patients with physical illnesses: A systematic review and meta-analysis

• Published in: Clinical psychology review 2014-03, Vol.34 (2), p.141-157
• Main Authors: Matcham, F., Rayner, L., Hutton, J., Monk, A., Steel, C., Hotopf, M.
• Format: Article
• Language: English
• Subjects: Anxiety - psychology; Anxiety - therapy; Depression - psychology; Depression - therapy; Humans; Mental health; Meta-analysis; Physical illness; Psychotherapy - methods; Randomised controlled trial; Self Care - methods; Self-help; Stress, Psychological - psychology; Stress, Psychological - therapy
• ISSN: 0272-7358; 1873-7811
• DOI: 10.1016/j.cpr.2014.01.005

Psychological distress, depression and anxiety are common in most physical diseases, and self-help interventions, if effective, might be an important approach to improve outcomes as they are inexpensive to provide to large numbers of patients. The primary aim of this review was to assess randomised controlled trials examining the impact of self-help interventions on symptoms of depression, anxiety and psychological distress in patients with physical illness. Systematic searches of electronic databases resulted in twenty-five eligible studies for meta-analysis (n=4211). The results of the primary meta-analyses revealed a significant improvement in depression symptoms, in favour of the intervention group (SMD=−0.13, 95% CI: −0.25, −0.02, p=0.02, I2=50%). There were no significant differences in symptoms of anxiety (SMD=−0.10, 95% CI: −0.24, 0.05, p=0.20, I2=63%) or psychological distress (SMD=−0.14, 95% CI: −0.40, 0.12, p=0.30, I2=72%) between intervention and control conditions. Several subgroup and sensitivity analyses improved effect sizes, suggesting that optimal mental health outcomes may be obtained in patients without neurological conditions, and with interventions based on a therapeutic model (such as cognitive behavioural therapy), and with stress management components. This review demonstrates that with appropriate design and implementation, self-help interventions may potentially improve symptoms of depression in patients with physical conditions. •Systematic review of self-help interventions for distress in physical illness•Overall between-group difference in efficacy for depression symptoms•Maximum efficacy in interventions based on therapeutic models•Larger effect sizes in studies reporting intention-to-treat analysis•Particularly efficacious in patients with cardiac conditions