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PRISMA flow diagram

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Figure 3
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Figure 4. Funnel plot of comparison 1: Any psychological therapy versus any non‐therapy comparator, Outcome 1: Depressive Symptomatology, Follow‐up: End‐of‐intervention.

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Figure 4

Figure 4. Funnel plot of comparison 1: Any psychological therapy versus any non‐therapy comparator, Outcome 1: Depressive Symptomatology, Follow‐up: End‐of‐intervention.

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Comparison 1: Any psychological therapy versus any non‐therapy comparator, Outcome 1: Depressive symptomatology

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Analysis 1.1

Comparison 1: Any psychological therapy versus any non‐therapy comparator, Outcome 1: Depressive symptomatology

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Comparison 1: Any psychological therapy versus any non‐therapy comparator, Outcome 2: Treatment non‐acceptability

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Analysis 1.2

Comparison 1: Any psychological therapy versus any non‐therapy comparator, Outcome 2: Treatment non‐acceptability

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Comparison 1: Any psychological therapy versus any non‐therapy comparator, Outcome 3: Quality of life and psychological well‐being

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Analysis 1.3

Comparison 1: Any psychological therapy versus any non‐therapy comparator, Outcome 3: Quality of life and psychological well‐being

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Comparison 1: Any psychological therapy versus any non‐therapy comparator, Outcome 4: Anxious symptomatology

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Analysis 1.4

Comparison 1: Any psychological therapy versus any non‐therapy comparator, Outcome 4: Anxious symptomatology

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Comparison 2: Subgroup 1: baseline depression severity: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology (end‐of‐intervention)

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Analysis 2.1

Comparison 2: Subgroup 1: baseline depression severity: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology (end‐of‐intervention)

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Comparison 3: Subgroup 2: type of psychological therapy: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology (end‐of‐intervention)

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Analysis 3.1

Comparison 3: Subgroup 2: type of psychological therapy: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology (end‐of‐intervention)

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Comparison 4: Subgroup 3: type of non‐therapy comparator: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology (end‐of‐intervention)

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Analysis 4.1

Comparison 4: Subgroup 3: type of non‐therapy comparator: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology (end‐of‐intervention)

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Comparison 5: Subgroup 4: level of cognitive function: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology (end‐of‐intervention)

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Analysis 5.1

Comparison 5: Subgroup 4: level of cognitive function: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology (end‐of‐intervention)

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Comparison 6: Subgroup 5: long‐term care facility staff involvement in therapy: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology (end‐of‐intervention)

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Analysis 6.1

Comparison 6: Subgroup 5: long‐term care facility staff involvement in therapy: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology (end‐of‐intervention)

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Comparison 7: Subgroup 6: therapeutic contact: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology, therapeutic contact (weeks)

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Analysis 7.1

Comparison 7: Subgroup 6: therapeutic contact: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology, therapeutic contact (weeks)

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Comparison 7: Subgroup 6: therapeutic contact: psychological therapies versus non‐therapy comparators, Outcome 2: Depressive symptomatology, therapeutic contact (number of sessions)

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Analysis 7.2

Comparison 7: Subgroup 6: therapeutic contact: psychological therapies versus non‐therapy comparators, Outcome 2: Depressive symptomatology, therapeutic contact (number of sessions)

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Comparison 7: Subgroup 6: therapeutic contact: psychological therapies versus non‐therapy comparators, Outcome 3: Depressive symptomatology, therapeutic contact (total treatment dose)

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Analysis 7.3

Comparison 7: Subgroup 6: therapeutic contact: psychological therapies versus non‐therapy comparators, Outcome 3: Depressive symptomatology, therapeutic contact (total treatment dose)

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Comparison 8: Sensitivity analysis 1: missing data: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology (end‐of‐intervention)

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Analysis 8.1

Comparison 8: Sensitivity analysis 1: missing data: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology (end‐of‐intervention)

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Comparison 9: Sensitivity analysis 2: treatment fidelity: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology (end‐of‐intervention)

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Analysis 9.1

Comparison 9: Sensitivity analysis 2: treatment fidelity: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology (end‐of‐intervention)

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Comparison 10: Sensitivity analysis 3: bias: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology

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Analysis 10.1

Comparison 10: Sensitivity analysis 3: bias: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology

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Comparison 11: Sensitivity analysis 4: attrition: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology

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Analysis 11.1

Comparison 11: Sensitivity analysis 4: attrition: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology

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Comparison 12: Sensitivity analysis 5: omit Luo 2020: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology

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Analysis 12.1

Comparison 12: Sensitivity analysis 5: omit Luo 2020: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology

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Comparison 12: Sensitivity analysis 5: omit Luo 2020: psychological therapies versus non‐therapy comparators, Outcome 2: Quality of life and psychological well‐being

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Analysis 12.2

Comparison 12: Sensitivity analysis 5: omit Luo 2020: psychological therapies versus non‐therapy comparators, Outcome 2: Quality of life and psychological well‐being

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Comparison 13: Sensitivity analysis 6: omit Tsai 2008: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology

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Analysis 13.1

Comparison 13: Sensitivity analysis 6: omit Tsai 2008: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology

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Comparison 14: Sensitivity analysis 7: omit Daleo 1999: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology

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Analysis 14.1

Comparison 14: Sensitivity analysis 7: omit Daleo 1999: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology

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Comparison 15: Funnel plot: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology

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Analysis 15.1

Comparison 15: Funnel plot: psychological therapies versus non‐therapy comparators, Outcome 1: Depressive symptomatology

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Summary of findings 1. Any psychological therapy versus any non‐therapy comparator: end‐of‐intervention and short‐term follow‐up

Psychological therapies compared with non‐therapy comparators

Patient or population: older people with depression

Setting: long‐term care facilities

Intervention: psychological therapy

Comparison: non‐therapy comparator (treatment as usual, non‐specific attentional control, or wait list)

Outcomes

Anticipated absolute effects (95% CI)

Number of participants (studies)

Certainty of the evidence (GRADE)

Comments

Depressive symptomatology (lower = less depressive symptomatology): end‐of‐intervention follow‐up (2 to 24 weeks)

The mean score for the psychological therapy group was 1.04 standard deviations lower (95% CI 1.49 to 0.58 lower) than for non‐therapy comparators

644 (18 RCTs)

⊕⊝⊝⊝

Very lowa,b

Measured with GDS‐12, GDS‐15, GDS‐30, SDS, BDI, HAM‐D, CSDD, and CES‐D. The effect observed was large.c

At short‐term follow‐up (up to 3 months), the mean score for the psychological therapy group was 1.03 standard deviations lower (95% CI 1.49 lower to 0.56 lower) than for non‐therapy comparators, based on a sample of 512 participants (16 RCTs); very low‐certainty evidencea,b, large effect sizec.

Treatment non‐acceptability (higher = greater non‐acceptability): end‐of‐intervention follow‐up (4 to 13 weeks)

The odds of treatment non‐acceptability for psychological therapies was 3.44 times higher (95% CI 1.19 to 9.93 higher) than for non‐therapy comparators

313 (5 RCTs)

⊕⊝⊝⊝

Very lowb,d

While 12 RCTs reported attrition data, only 5 RCTs contributed to the effect estimate as 7 RCTs reported 0 events in both groups. Caution is advised in interpreting this finding.

There was a paucity of attrition data at short‐term follow‐up.

Depression remission (presence or absence of MDD):end‐of‐intervention follow‐up (10 weeks)

The net difference in change in prevalence was 54.2% (i.e. psychological therapy led to a 4.2% reduction in prevalence of MDD, whereas the non‐therapy comparator led to a 50.0% increased prevalence)

82 (1 RCT)

⊕⊝⊝⊝

Very lowb,d

Assessed using the SCID‐IV. Data were from 1 RCT only.

The same results occurred at short‐term follow‐up (up to 3 months).

Quality of life or psychological well‐being (higher = higher quality of life or psychological well‐being): end‐of‐intervention follow‐up (4 to 24 weeks)

The mean score for the psychological therapy group was 0.40 standard deviations higher (95% CI 0.02 lower to 0.82 higher) than for non‐therapy comparators

195 (6 RCTs)

⊕⊝⊝⊝

Very lowb,d

Measured with LSI, QOL‐AD, QOL‐AD‐NH, WHOQOL‐BREF, and PGCMS. The effect observed was small.c

At short‐term follow‐up (up to 3 months), the mean score for the psychological therapy group was 0.51 standard deviations higher (95% CI 0.19 to 0.82 higher) than for non‐therapy comparators, based on a sample of 170 participants (5 RCTs); very low certaintyb,d, medium effect sizec.

Anxious symptomatology (lower = less anxious symptomatology): end‐of‐intervention follow‐up (4 to 13 weeks)

The mean score for the psychological therapy group was 0.68 standard deviations lower (95% CI 2.50 lower to 1.14 higher) than for non‐therapy comparators.

115 (2 RCTs)

⊕⊝⊝⊝

Very lowa,b,d

Measured with HADS‐A and DASS. The effect observed was medium.c

There was a paucity of data at short‐term follow‐up.

BDI: Beck Depression Inventory; CES‐D: Center for Epidemiologic Studies Depression Scale; CI: confidence interval; CSDD: Cornell Scale for Depression in Dementia; DASS: Depression, Anxiety and Stress Scales; GDS‐12, GDS‐15, GDS‐30: Geriatric Depression Scale – 12, 15, and 30 items; HADS‐A: Hospital Anxiety and Depression Scale – Anxiety; HAM‐D: Hamilton Depression Rating Scale; LSI: Life Satisfaction Index; MDD: major depressive disorder; PGCMS: Philadelphia Geriatric Centre Morale Scale; QOL‐AD: Quality of Life in Alzheimer's Disease; QOL‐AD‐NH: Quality of Life in Alzheimer's Disease – Nursing Home version; RCT: randomized controlled trial, including cluster‐randomized controlled trial; SCID‐IV: Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; SDS: Zung Self‐Rating Depression Scale.

GRADE Working Group grades of evidence

High certainty: we are very confident that the true effect lies close to that of the estimate of the effect.

Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.

Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect.

Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of the effect.

aThe estimate indicated substantial‐to‐considerable statistical heterogeneity. Downgraded one level for inconsistency.
bAll RCTs had a high risk of bias for at least one category. Downgraded two levels for risk of bias.
cBased on the following interpretations of SMD per Cohen: 0.2 = small effect, 0.5 = medium effect, 0.8 = large effect.
dThe estimate was based on a collectively small sample size. Downgraded one level for imprecision.

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Summary of findings 1. Any psychological therapy versus any non‐therapy comparator: end‐of‐intervention and short‐term follow‐up
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Table 1. Additional summary of findings. Baseline depression severity: end‐of‐intervention follow‐up

Psychological therapies compared with non‐therapy comparators for high and low baseline depression severity

Patient or population: older people with depression

Setting: long‐term care facilities

Intervention: psychological therapy

Comparison: non‐therapy comparator (treatment as usual, non‐specific attentional control, or wait list)

Outcomes

Anticipated absolute effects (95% CI)

Number of participants (studies)

Certainty of the evidence (GRADE)

Comments

HIGH BASELINE SEVERITY (> 54.8 points on a standardized 100‐point scale)

Depressive symptomatology (lower = less depressive symptomatology): end‐of‐intervention follow‐up

The mean score for the psychological therapy group was 1.31 standard deviations lower (95% CI 2.08 to 0.53 lower) than for non‐therapy comparators

273 (9 RCTs)

⊕⊝⊝⊝

Very lowa,b,c

Measured with GDS‐15, GDS‐30, and BDI. The effect observed was large.d

LOW BASELINE SEVERITY (< 54.8 points on a standardized 100‐point scale)

Depressive symptomatology (lower = less depressive symptomatology): end‐of‐intervention follow‐up

The mean score for the psychological therapy group was 0.81 standard deviations lower (95% CI 1.38 to 0.25 lower) than for non‐therapy comparators

371 (9 RCTs)

⊕⊝⊝⊝

Very lowa,b,c

Measured with GDS‐12, GDS‐15, GDS‐30, SDS, HAM‐D, CSDD, and CES‐D. The effect observed was large.d

BDI: Beck Depression Inventory; CES‐D: Center for Epidemiologic Studies Depression Scale; CI: confidence interval; CSDD: Cornell Scale for Depression in Dementia; GDS‐12, GDS‐15, GDS‐30: Geriatric Depression Scale – 12, 15, and 30 items; HAM‐D: Hamilton Depression Rating Scale; RCT: randomized controlled trials, including cluster‐randomized controlled trial; SDS: Zung Self‐Rating Depression Scale.

GRADE Working Group grades of evidence

High certainty: we are very confident that the true effect lies close to that of the estimate of the effect.

Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.

Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect.

Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of the effect.

aThe estimate indicated substantial‐to‐considerable statistical heterogeneity. Downgraded one level for inconsistency.
bAll RCTs had a high risk of bias for at least one category. Downgraded two levels for risk of bias.
cThe estimate was based on a collectively small sample size. Downgraded one level for imprecision.
dBased on the following interpretations of SMD per Cohen: 0.2 = small effect, 0.5 = medium effect, 0.8 = large effect.

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Table 1. Additional summary of findings. Baseline depression severity: end‐of‐intervention follow‐up
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Table 2. Additional summary of findings. Type of psychological therapy: end‐of‐intervention follow‐up

Cognitive behavioural therapy, behavioural therapy, and reminiscence therapy compared with non‐therapy comparator

Patient or population: older people with depression

Setting: low‐term care facilities

Intervention: cognitive behavioural therapy, behavioural therapy, reminiscence therapy

Comparison: non‐therapy comparator (treatment as usual, non‐specific attentional control, or wait list)

Outcomes

Anticipated absolute effects (95% CI)

Number of participants (studies)

Certainty of the evidence (GRADE)

Comments

COGNITIVE BEHAVIOURAL THERAPY

Depressive symptomatology (lower = less depressive symptomatology): end‐of‐intervention follow‐up

The mean score for the cognitive behavioural therapy group was 1.02 standard deviations lower (95% CI 1.99 to 0.04 lower) than for non‐therapy comparators.

125 (5 RCTs)

⊕⊝⊝⊝

Very lowa,b,c

Measured with GDS‐30, BDI, and HAM‐D. The effect observed was large.d

BEHAVIOURAL THERAPY

Depressive symptomatology (lower = less depressive symptomatology): end‐of‐intervention follow‐up

The mean score for the behavioural therapy group was 0.69 standard deviations lower (95% CI 1.21 to 0.18 lower) than for non‐therapy comparators.

303 (8 RCTs)

⊕⊝⊝⊝

Very lowa,b,c

Measured with GDS‐12, GDS‐15, GDS‐30, SDS, BDI, and CES‐D. The effect observed was medium.d

REMINISCENCE THERAPY

Depressive symptomatology (lower = less depressive symptomatology): end‐of‐intervention follow‐up

The mean score for the reminiscence therapy group was 1.65 standard deviations lower (95% CI 2.83 to 0.47 lower) than for non‐therapy comparators.

203 (6 RCTs)

⊕⊝⊝⊝

Very lowa,b,c

Measured with GDS‐15, GDS‐30, SDS, and CSDD. The effect observed was large.d

BDI: Beck Depression Inventory; CES‐D: Center for Epidemiologic Studies Depression Scale; CI: confidence interval; CSDD: Cornell Scale for Depression in Dementia; GDS‐12, GDS‐15, GDS‐30: Geriatric Depression Scale – 12, 15, and 30 item; HAM‐D: Hamilton Depression Rating Scale; RCT: randomized controlled trial, including cluster‐randomized controlled trial; SDS: Zung Self‐Rating Depression Scale.

GRADE Working Group grades of evidence

High certainty: we are very confident that the true effect lies close to that of the estimate of the effect.

Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.

Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect.

Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

aThe estimate indicated substantial to considerable statistical heterogeneity. Downgraded one level for inconsistency.
bAll RCTs had a high risk of bias for at least one category. Downgraded two levels for risk of bias.
cThe estimate was based on a collectively small sample size. Downgraded one level for imprecision.
dBased on the following interpretations of SMD per Cohen: 0.2 = small effect, 0.5 = medium effect, 0.8 = large effect.

Figuras y tablas -
Table 2. Additional summary of findings. Type of psychological therapy: end‐of‐intervention follow‐up
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Table 3. Additional summary of findings. Type of non‐therapy comparator: end‐of‐intervention follow‐up

Psychological therapies compared with treatment as usual and with non‐specific attentional control comparators

Patient or population: older people with depression

Setting: long‐term care facilities

Intervention: psychological therapy

Comparison: treatment as usual and non‐specific attentional control

Outcomes

Anticipated absolute effects (95% CI)

Number of participants (studies)

Certainty of the evidence (GRADE)

Comments

TREATMENT AS USUAL

Depressive symptomatology (lower = less depressive symptomatology): end‐of‐intervention follow‐up

The mean score for the psychological therapy group was 1.47 standard deviations lower (95% CI 2.10 to 0.84 lower) than for the treatment as usual group

430 (12 RCTs)

⊕⊝⊝⊝

Very lowa,b

Measured with GDS‐12, GDS‐15, GDS‐30, BDI, and HAM‐D. The effect observed was large.c

NON‐SPECIFIC ATTENTIONAL CONTROL

Depressive symptomatology (lower = less depressive symptomatology): end‐of‐intervention follow‐up

The mean score for the psychological therapy group was 0.30 standard deviations lower (95% CI 0.83 lower to 0.23 higher) than for non‐specific attentional control group

208 (6 RCTs)

⊕⊝⊝⊝

Very lowb,d

Measured with GDS‐15, GDS‐30, SDS, BDI, CSDD, and CES‐D. The effect observed was small.c

BDI: Beck Depression Inventory; CES‐D: Center for Epidemiologic Studies Depression Scale; CI: confidence interval; CSDD: Cornell Scale for Depression in Dementia; GDS‐12, GDS‐15, GDS‐30: Geriatric Depression Scale – 12, 15, and 30 items; HAM‐D: Hamilton Depression Rating Scale; RCT: randomized controlled trial, including cluster‐randomized controlled trial; SDS: Zung Self‐Rating Depression Scale.

GRADE Working Group grades of evidence

High certainty: we are very confident that the true effect lies close to that of the estimate of the effect.

Moderate certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.

Low certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect.

Very low certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

aThe estimate indicated substantial to considerable statistical heterogeneity. Downgraded one level for inconsistency.
bAll RCTs had a high risk of bias for at least one category. Downgraded two levels for risk of bias.
cBased on the following interpretations of SMD per Cohen: 0.2 = small effect, 0.5 = medium effect, 0.8 = large effect.
dThe estimate was based on a collectively small sample size. Downgraded one level for imprecision.

Figuras y tablas -
Table 3. Additional summary of findings. Type of non‐therapy comparator: end‐of‐intervention follow‐up
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Comparison 1. Any psychological therapy versus any non‐therapy comparator

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1.1 Depressive symptomatology Show forest plot

18

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1.1 End‐of‐intervention

18

644

Std. Mean Difference (IV, Random, 95% CI)

‐1.04 [‐1.49, ‐0.58]

1.1.2 Short‐term

16

512

Std. Mean Difference (IV, Random, 95% CI)

‐1.03 [‐1.49, ‐0.56]

1.1.3 Medium‐term

8

355

Std. Mean Difference (IV, Random, 95% CI)

‐0.43 [‐0.81, ‐0.06]

1.1.4 Long‐term

2

92

Std. Mean Difference (IV, Random, 95% CI)

‐0.16 [‐0.58, 0.27]

1.2 Treatment non‐acceptability Show forest plot

12

585

Odds Ratio (M‐H, Random, 95% CI)

3.44 [1.19, 9.93]

1.2.1 End‐of‐intervention

12

585

Odds Ratio (M‐H, Random, 95% CI)

3.44 [1.19, 9.93]

1.3 Quality of life and psychological well‐being Show forest plot

6

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

1.3.1 End‐of‐intervention

6

195

Std. Mean Difference (IV, Random, 95% CI)

0.40 [‐0.02, 0.82]

1.3.2 Short‐term

5

170

Std. Mean Difference (IV, Random, 95% CI)

0.51 [0.19, 0.82]

1.3.3 Medium‐term

2

68

Std. Mean Difference (IV, Random, 95% CI)

0.26 [‐0.95, 1.48]

1.4 Anxious symptomatology Show forest plot

2

115

Std. Mean Difference (IV, Random, 95% CI)

‐0.68 [‐2.50, 1.14]

1.4.1 End‐of‐intervention

2

115

Std. Mean Difference (IV, Random, 95% CI)

‐0.68 [‐2.50, 1.14]
Figuras y tablas -
Comparison 1. Any psychological therapy versus any non‐therapy comparator
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Comparison 2. Subgroup 1: baseline depression severity: psychological therapies versus non‐therapy comparators

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

2.1 Depressive symptomatology (end‐of‐intervention) Show forest plot

18

644

Std. Mean Difference (IV, Random, 95% CI)

‐1.04 [‐1.49, ‐0.58]

2.1.1 > 54.8 points on a standardised 100‐point scale

9

273

Std. Mean Difference (IV, Random, 95% CI)

‐1.31 [‐2.08, ‐0.53]

2.1.2 < 54.8 points on a standardised 100‐point scale

9

371

Std. Mean Difference (IV, Random, 95% CI)

‐0.81 [‐1.38, ‐0.25]
Figuras y tablas -
Comparison 2. Subgroup 1: baseline depression severity: psychological therapies versus non‐therapy comparators
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Comparison 3. Subgroup 2: type of psychological therapy: psychological therapies versus non‐therapy comparators

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

3.1 Depressive symptomatology (end‐of‐intervention) Show forest plot

18

631

Std. Mean Difference (IV, Random, 95% CI)

‐1.02 [‐1.47, ‐0.57]

3.1.1 CBT

5

125

Std. Mean Difference (IV, Random, 95% CI)

‐1.02 [‐1.99, ‐0.04]

3.1.2 BT

8

303

Std. Mean Difference (IV, Random, 95% CI)

‐0.69 [‐1.21, ‐0.18]

3.1.3 RT

6

203

Std. Mean Difference (IV, Random, 95% CI)

‐1.65 [‐2.83, ‐0.47]
Figuras y tablas -
Comparison 3. Subgroup 2: type of psychological therapy: psychological therapies versus non‐therapy comparators
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Comparison 4. Subgroup 3: type of non‐therapy comparator: psychological therapies versus non‐therapy comparators

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

4.1 Depressive symptomatology (end‐of‐intervention) Show forest plot

18

638

Std. Mean Difference (IV, Random, 95% CI)

‐1.05 [‐1.51, ‐0.58]

4.1.1 Non‐specific attentional control

6

208

Std. Mean Difference (IV, Random, 95% CI)

‐0.30 [‐0.83, 0.23]

4.1.2 Treatment as usual

12

430

Std. Mean Difference (IV, Random, 95% CI)

‐1.47 [‐2.10, ‐0.84]
Figuras y tablas -
Comparison 4. Subgroup 3: type of non‐therapy comparator: psychological therapies versus non‐therapy comparators
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Comparison 5. Subgroup 4: level of cognitive function: psychological therapies versus non‐therapy comparators

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

5.1 Depressive symptomatology (end‐of‐intervention) Show forest plot

12

443

Std. Mean Difference (IV, Random, 95% CI)

‐0.81 [‐1.35, ‐0.26]

5.1.1 High cognitive impairment

5

176

Std. Mean Difference (IV, Random, 95% CI)

‐0.41 [‐0.89, 0.07]

5.1.2 Low cognitive impairment

7

267

Std. Mean Difference (IV, Random, 95% CI)

‐1.30 [‐2.26, ‐0.34]
Figuras y tablas -
Comparison 5. Subgroup 4: level of cognitive function: psychological therapies versus non‐therapy comparators
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Comparison 6. Subgroup 5: long‐term care facility staff involvement in therapy: psychological therapies versus non‐therapy comparators

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

6.1 Depressive symptomatology (end‐of‐intervention) Show forest plot

14

470

Std. Mean Difference (IV, Random, 95% CI)

‐0.93 [‐1.43, ‐0.43]

6.1.1 Professional therapist without LTC staff involvement

5

167

Std. Mean Difference (IV, Random, 95% CI)

‐0.76 [‐1.68, 0.16]

6.1.2 Professional therapist with LTC staff involvement

9

303

Std. Mean Difference (IV, Random, 95% CI)

‐1.02 [‐1.62, ‐0.43]
Figuras y tablas -
Comparison 6. Subgroup 5: long‐term care facility staff involvement in therapy: psychological therapies versus non‐therapy comparators
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Comparison 7. Subgroup 6: therapeutic contact: psychological therapies versus non‐therapy comparators

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

7.1 Depressive symptomatology, therapeutic contact (weeks) Show forest plot

17

619

Std. Mean Difference (IV, Random, 95% CI)

‐0.98 [‐1.45, ‐0.52]

7.1.1 < 8.5 weeks

8

251

Std. Mean Difference (IV, Random, 95% CI)

‐0.74 [‐1.34, ‐0.14]

7.1.2 > 8.5 weeks

9

368

Std. Mean Difference (IV, Random, 95% CI)

‐1.25 [‐1.99, ‐0.51]

7.2 Depressive symptomatology, therapeutic contact (number of sessions) Show forest plot

16

581

Std. Mean Difference (IV, Random, 95% CI)

‐0.87 [‐1.31, ‐0.42]

7.2.1 < 9.5 total sessions

9

310

Std. Mean Difference (IV, Random, 95% CI)

‐1.08 [‐1.86, ‐0.30]

7.2.2 > 9.5 total sessions

7

271

Std. Mean Difference (IV, Random, 95% CI)

‐0.72 [‐1.15, ‐0.28]

7.3 Depressive symptomatology, therapeutic contact (total treatment dose) Show forest plot

12

326

Std. Mean Difference (IV, Random, 95% CI)

‐1.20 [‐1.87, ‐0.54]

7.3.1 < 6.5 total hours

6

192

Std. Mean Difference (IV, Random, 95% CI)

‐0.69 [‐1.48, 0.11]

7.3.2 > 6.5 total hours

6

134

Std. Mean Difference (IV, Random, 95% CI)

‐1.83 [‐2.93, ‐0.73]
Figuras y tablas -
Comparison 7. Subgroup 6: therapeutic contact: psychological therapies versus non‐therapy comparators
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Comparison 8. Sensitivity analysis 1: missing data: psychological therapies versus non‐therapy comparators

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

8.1 Depressive symptomatology (end‐of‐intervention) Show forest plot

12

469

Std. Mean Difference (IV, Random, 95% CI)

‐1.11 [‐1.71, ‐0.51]
Figuras y tablas -
Comparison 8. Sensitivity analysis 1: missing data: psychological therapies versus non‐therapy comparators
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Comparison 9. Sensitivity analysis 2: treatment fidelity: psychological therapies versus non‐therapy comparators

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

9.1 Depressive symptomatology (end‐of‐intervention) Show forest plot

4

158

Std. Mean Difference (IV, Random, 95% CI)

‐1.06 [‐1.91, ‐0.21]
Figuras y tablas -
Comparison 9. Sensitivity analysis 2: treatment fidelity: psychological therapies versus non‐therapy comparators
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Comparison 10. Sensitivity analysis 3: bias: psychological therapies versus non‐therapy comparators

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

10.1 Depressive symptomatology Show forest plot

6

282

Std. Mean Difference (IV, Random, 95% CI)

‐0.16 [‐0.54, 0.23]
Figuras y tablas -
Comparison 10. Sensitivity analysis 3: bias: psychological therapies versus non‐therapy comparators
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Comparison 11. Sensitivity analysis 4: attrition: psychological therapies versus non‐therapy comparators

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

11.1 Depressive symptomatology Show forest plot

14

499

Std. Mean Difference (IV, Random, 95% CI)

‐1.29 [‐1.83, ‐0.75]
Figuras y tablas -
Comparison 11. Sensitivity analysis 4: attrition: psychological therapies versus non‐therapy comparators
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Comparison 12. Sensitivity analysis 5: omit Luo 2020: psychological therapies versus non‐therapy comparators

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

12.1 Depressive symptomatology Show forest plot

17

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

12.1.1 End‐of‐intervention

17

594

Std. Mean Difference (IV, Random, 95% CI)

‐1.07 [‐1.57, ‐0.58]

12.1.2 Short‐term

15

462

Std. Mean Difference (IV, Random, 95% CI)

‐1.07 [‐1.58, ‐0.56]

12.2 Quality of life and psychological well‐being Show forest plot

5

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

12.2.1 End‐of‐intervention

5

145

Std. Mean Difference (IV, Random, 95% CI)

0.25 [‐0.17, 0.68]

12.2.2 Short‐term

4

120

Std. Mean Difference (IV, Random, 95% CI)

0.35 [‐0.02, 0.72]
Figuras y tablas -
Comparison 12. Sensitivity analysis 5: omit Luo 2020: psychological therapies versus non‐therapy comparators
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Comparison 13. Sensitivity analysis 6: omit Tsai 2008: psychological therapies versus non‐therapy comparators

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

13.1 Depressive symptomatology Show forest plot

17

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

13.1.1 End‐of‐intervention

17

581

Std. Mean Difference (IV, Random, 95% CI)

‐1.13 [‐1.59, ‐0.67]

13.1.2 Short‐term

15

449

Std. Mean Difference (IV, Random, 95% CI)

‐1.12 [‐1.57, ‐0.68]

13.1.3 Medium‐term

7

292

Std. Mean Difference (IV, Random, 95% CI)

‐0.44 [‐0.90, 0.02]
Figuras y tablas -
Comparison 13. Sensitivity analysis 6: omit Tsai 2008: psychological therapies versus non‐therapy comparators
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Comparison 14. Sensitivity analysis 7: omit Daleo 1999: psychological therapies versus non‐therapy comparators

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

14.1 Depressive symptomatology Show forest plot

17

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

14.1.1 End‐of‐intervention

17

619

Std. Mean Difference (IV, Random, 95% CI)

‐0.86 [‐1.26, ‐0.46]

14.1.2 Short‐term

15

487

Std. Mean Difference (IV, Random, 95% CI)

‐0.84 [‐1.22, ‐0.45]
Figuras y tablas -
Comparison 14. Sensitivity analysis 7: omit Daleo 1999: psychological therapies versus non‐therapy comparators
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Comparison 15. Funnel plot: psychological therapies versus non‐therapy comparators

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

15.1 Depressive symptomatology Show forest plot

18

644

Std. Mean Difference (IV, Random, 95% CI)

‐1.04 [‐1.49, ‐0.58]
Figuras y tablas -
Comparison 15. Funnel plot: psychological therapies versus non‐therapy comparators
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