Counselling for mental health and psychosocial problems in primary care

Peter Bower; Sarah Knowles; Peter A Coventry; Nancy Rowland

doi:10.1002/14651858.CD001025.pub3

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Figure 1

Study flow diagram for 2011 update of searches

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Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Analysis 1.1

Comparison 1 Counselling compared with usual GP care (short term), Outcome 1 Mental health.

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Analysis 1.2

Comparison 1 Counselling compared with usual GP care (short term), Outcome 2 Social function.

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Analysis 2.1

Comparison 2 Counselling compared with usual GP care (long term), Outcome 1 Mental health.

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Analysis 2.2

Comparison 2 Counselling compared with usual GP care (long term), Outcome 2 Social function.

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Analysis 3.1

Comparison 3 Counselling compared with usual GP care (very long term), Outcome 1 Mental health.

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Analysis 3.2

Comparison 3 Counselling compared with usual GP care (very long term), Outcome 2 Social function.

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Analysis 4.1

Comparison 4 Counselling compared with GP antidepressant treatment (short term), Outcome 1 Mental health.

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Analysis 5.1

Comparison 5 Counselling compared with GP antidepressant treatment (long term), Outcome 1 Mental health.

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Analysis 6.1

Comparison 6 Counselling compared with CBT (short term, depressed patients), Outcome 1 Mental health.

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Analysis 7.1

Comparison 7 Counselling compared with CBT (long term, depressed patients), Outcome 1 Mental health.

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Analysis 8.1

Comparison 8 Counselling compared with CBT (short term, anxious patients), Outcome 1 Mental health.

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Analysis 9.1

Comparison 9 Counselling compared with CBT (long term, anxious patients), Outcome 1 Mental health.

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Analysis 10.1

Comparison 10 Counselling compared with CBT (very long term, anxious patients), Outcome 1 Mental health.

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Table 1. Sensitivity analyses

Comparison number	Comparison	Sensititivity analysis	Outcome	Studies	Participants	Effect estimate [95% CI] Test for heterogeneity, I²
1.1.1	Counselling compared with usual GP care (short term)	Quality – removing studies with inadequate concealment	Mental health	4	510	‐0.27 [‐0.45, ‐0.09] Chi²=6.31 df=3 p=0.10 I² =52.4%
1.1.2	Counselling compared with all GP care (short term)	Usual care – including study with GP antidepressant arm	Mental health	7	855	‐0.24 [‐0.38, ‐0.10] Chi²=11.29 df=6 p=0.08 I² =46.8%
1.1.3	Counselling compared with usual GP care (short term)	Chronicity – removing the study with patients with chronic conditions	Mental health	5	611	‐0.36 [‐0.53, ‐0.19] Chi²=5.45 df=4 p=0.24 I² =26.6%
1.1.4	Counselling compared with usual GP care (short term)	Quality and chronicity – removing studies with inadequate concealment and study with patients with chronic conditions	Mental health	3	349	‐0.41 [‐0.62, ‐0.19] Chi²=1.87 df=2 p=0.39 I² =0.0%
1.1.5	Counselling compared with usual GP care (short term)	Chronicity – including study with patients with chronic conditions only	Mental health	1	161	0.00 [‐0.31 to 0.31] NA
2.1.1	Counselling compared with usual GP care (long term)	Quality – removing studies with inadequate concealment	Mental health	3	375	‐0.10 [‐0.31, 0.10] Chi²=3.78 df=2 p=0.15 I² =47.0%
2.1.2	Counselling compared with all GP care (long term)	Usual care – including study with GP antidepressant arm	Mental health	5	540	‐0.05 [‐0.23, 0.12] Chi²=4.84 df=4 p=0.30 I² =17.4%
2.1.3	Counselling compared with usual GP care (long term)	Chronicity – removing the study with patients with chronic conditions	Mental health	3	332	‐0.11 [‐0.34, 0.11] Chi²=3.79 df=2 p=0.15 I² =47.2%
2.1.4	Counselling compared with usual GP care (long term)	Quality and chronicity – removing studies with inadequate concealment and study with patients with chronic conditions	Mental health	2	232	‐0.15 [‐0.40, 0.11] Chi²=3.49 df=1 p=0.06 I² =71.4%
2.1.5	Counselling compared with usual GP care (long term)	Chronicity – including study with patients with chronic conditions only	Mental health	1	143	‐0.03 [‐0.36 to 0.30] NA

Table 1. Sensitivity analyses

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Comparison 1. Counselling compared with usual GP care (short term)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mental health Show forest plot	6	772	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.28 [‐0.43, ‐0.13]

2 Social function Show forest plot	3	386	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.09 [‐0.29, 0.11]

Comparison 1. Counselling compared with usual GP care (short term)

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Comparison 2. Counselling compared with usual GP care (long term)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mental health Show forest plot	4	475	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.09 [‐0.27, 0.10]

2 Social function Show forest plot	3	369	Std. Mean Difference (IV, Fixed, 95% CI)	‐0.12 [‐0.33, 0.08]

Comparison 2. Counselling compared with usual GP care (long term)

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Comparison 3. Counselling compared with usual GP care (very long term)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mental health Show forest plot	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

2 Social function Show forest plot	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

Comparison 3. Counselling compared with usual GP care (very long term)

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Comparison 4. Counselling compared with GP antidepressant treatment (short term)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mental health Show forest plot	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

Comparison 4. Counselling compared with GP antidepressant treatment (short term)

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Comparison 5. Counselling compared with GP antidepressant treatment (long term)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mental health Show forest plot	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

Comparison 5. Counselling compared with GP antidepressant treatment (long term)

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Comparison 6. Counselling compared with CBT (short term, depressed patients)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mental health Show forest plot	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

Comparison 6. Counselling compared with CBT (short term, depressed patients)

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Comparison 7. Counselling compared with CBT (long term, depressed patients)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mental health Show forest plot	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

Comparison 7. Counselling compared with CBT (long term, depressed patients)

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Comparison 8. Counselling compared with CBT (short term, anxious patients)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mental health Show forest plot	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

Comparison 8. Counselling compared with CBT (short term, anxious patients)

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Comparison 9. Counselling compared with CBT (long term, anxious patients)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mental health Show forest plot	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

Comparison 9. Counselling compared with CBT (long term, anxious patients)

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Comparison 10. Counselling compared with CBT (very long term, anxious patients)

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Mental health Show forest plot	1		Std. Mean Difference (IV, Fixed, 95% CI)	Subtotals only

Comparison 10. Counselling compared with CBT (very long term, anxious patients)

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