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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

A systematic review of help-seeking interventions for depression, anxiety and general psychological distress

A Gulliver, KM Griffiths, H Christensen, and JL Brewer.

Review published: 2012.

CRD summary

This review found mental health literacy interventions to be promising in encouraging help-seeking attitudes among participants with depression, anxiety and general psychological distress. Further research was needed to evaluate interventions to increase help-seeking behaviour. Conclusions should be treated with caution due to some methodological concerns and the weighting of the study samples to young people (particularly university students).

Authors' objectives

To assess the effectiveness of interventions designed to increase professional help-seeking for depression, anxiety and general psychological distress.

Searching

The authors searched The Cochrane Library, PubMed and PsycINFO in November 2011 for papers published in English. Search terms were provided. Reference lists of key papers were searched.

Study selection

Eligible studies needed to be randomised controlled trials (RCTs) of at least one intervention. Trials needed to provide extractable data on outcomes related to help-seeking attitudes, help-seeking intentions or behaviour for depression, anxiety or general psychological distress. Studies of other disorders (such as substance use) were excluded.

Studies were conducted in Australia, USA and Taiwan. Participant ages ranged from 17 to 79 years of age. Most of the studies were conducted with young people (particularly University students) with a mean age of less than 25 years. All trials except one used universal rather than targeted interventions. Most included a component of information targeting mental health literacy as part of their content. Most of the interventions were conducted in person; others were conducted online or by telephone. In-person interventions ranged from five to 10 minutes to 40 minutes over one session. Online interventions were delivered over three or six weeks. Interventions were delivered by researchers or interviewers. Outcome measures of help seeking varied.

It appeared that one researcher selected studies for the review.

Assessment of study quality

Study quality was assessed using the nine-item Cochrane Effective Practice and Organisation of Care (EPOC) risk of bias tool to rate studies from zero to 9 based on randomisation, allocation concealment, comparability of groups at baseline, missing data, researcher knowledge of allocated interventions, contamination between treatment conditions, selective outcome reporting and any other risk of bias.

Studies were quality assessed by two researchers independently using a predesigned form. Discrepancies were resolved by discussion.

Data extraction

Only data on help-seeking from professional sources was extracted. Study authors were contacted where necessary. Between-group effect sizes were calculated for post-test and follow-up where provided.

Data were extracted by two researchers independently using a predesigned form. Discrepancies were resolved by discussion.

Methods of synthesis

Trials were synthesised narratively due to the diverse outcome measures.

Results of the review

Six trials were included in the review (1,499 participants, range 80 to 525). Three trials provided follow-up data at two weeks, four weeks or six months; other trials measured outcomes at post-test only. Study quality scores ranged from 5 to 9. One study scored 9, three scored 6 and two scored 5. Two of the included trials involved members of the review team.

All six trials found interventions to be significantly better than controls at post-test on at least one help-seeking measure. All five trials that measured attitudes, willingness or beliefs found a significant improvement in help-seeking attitudes at post-test of an intervention compared to control. Effect sizes ranged from 0.12 to 0.53. One of three trials that measured behaviour found a significant difference between intervention and control for help-seeking behaviour at post-test (d=0.24). The only study to measure help-seeking intentions at post-test found no significant difference between treatments. Two of the three studies that provided follow-up data found a significant improvement in help-seeking attitudes (at two or four weeks) and one did not (at six months).

Interventions with mental health literacy content were effective at improving help-seeking attitudes in five out of six studies but had no effect on help-seeking behaviour in any of the three studies that assessed this outcome. Evidence was more sparse for other types of intervention.

Authors' conclusions

Mental health literacy interventions were a promising way to encourage help-seeking attitudes but little was known about interventions to increase help-seeking behaviour and further research was needed.

CRD commentary

This review was based on defined inclusion criteria and underpinned by a search of three databases and associated references. The exclusion of unpublished material opened up the possibility of publication bias where studies with significant outcomes were more likely to be published. The restriction to studies in English may have led to papers being missed. Quality was assessed but use of scores is not recommended when investigating bias. Study details were provided.

A narrative synthesis appeared appropriate given the diversity of the studies. Data extraction and quality assessment were performed by two reviewers independently; it was unclear what methods were used to minimise bias in the selection of studies for the review.

The conclusions should be treated with some caution for the stated reasons and given that the trial populations did not fully reflect those who might receive the intervention in practice.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated a need for further research to assess the efficacy of individual content components and develop effective behaviour change interventions. Research needed to investigate longer-term effects of help-seeking interventions. Future research should address and report biases relating to randomisation and allocation concealment and address all outcome data. Researchers should continue to use attention controls. There was a need for research on age groups other than young people. Research targeted at people with symptoms universal should be performed. Online interventions needed further investigation. Further research needed to be underpinned by models of help-seeking.

Funding

Australian Institute of Sport.

Bibliographic details

Gulliver A, Griffiths KM, Christensen H, Brewer JL. A systematic review of help-seeking interventions for depression, anxiety and general psychological distress. BMC Psychiatry 2012; 12: 81. [PMC free article: PMC3464688] [PubMed: 22799879]

PubMedID

22799879

Indexing Status

Subject indexing assigned by NLM

MeSH

Anxiety Disorders /psychology /therapy; Depressive Disorder /psychology /therapy; Health Literacy; Humans; Mental Health; Patient Acceptance of Health Care; Psychotherapy; Stress, Psychological /psychology /therapy

AccessionNumber

12012044570

Date bibliographic record published

29/10/2012

Date abstract record published

10/01/2013

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 22799879

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