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Meta-Analysis
. 2011 Sep 7;2011(9):CD001025.
doi: 10.1002/14651858.CD001025.pub3.

Counselling for mental health and psychosocial problems in primary care

Peter Bower  1 , Sarah Knowles, Peter A Coventry, Nancy Rowland
Affiliations
Meta-Analysis

Counselling for mental health and psychosocial problems in primary care

Peter Bower et al. Cochrane Database Syst Rev. .

Abstract

Background: The prevalence of mental health and psychosocial problems in primary care is high. Counselling is a potential treatment for these patients, but there is a lack of consensus over the effectiveness of this treatment in primary care.

Objectives: To assess the effectiveness and cost effectiveness of counselling for patients with mental health and psychosocial problems in primary care.

Search strategy: To update the review, the following electronic databases were searched: the Cochrane Collaboration Depression, Anxiety and Neurosis (CCDAN) trials registers (to December 2010), MEDLINE, EMBASE, PsycINFO and the Cochrane Central Register of Controlled Trials (to May 2011).

Selection criteria: Randomised controlled trials of counselling for mental health and psychosocial problems in primary care.

Data collection and analysis: Data were extracted using a standardised data extraction sheet by two reviewers. Trials were rated for quality by two reviewers using Cochrane risk of bias criteria, to assess the extent to which their design and conduct were likely to have prevented systematic error. Continuous measures of outcome were combined using standardised mean differences. An overall effect size was calculated for each outcome with 95% confidence intervals (CI). Continuous data from different measuring instruments were transformed into a standard effect size by dividing mean values by standard deviations. Sensitivity analyses were undertaken to test the robustness of the results. Economic analyses were summarised in narrative form. There was no assessment of adverse events.

Main results: Nine trials were included in the review, involving 1384 randomised participants. Studies varied in risk of bias, although two studies were identified as being at high risk of selection bias because of problems with concealment of allocation. All studies were from primary care in the United Kingdom and thus comparability was high. The analysis found significantly greater clinical effectiveness in the counselling group compared with usual care in terms of mental health outcomes in the short-term (standardised mean difference -0.28, 95% CI -0.43 to -0.13, n = 772, 6 trials) but not in the long-term (standardised mean difference -0.09, 95% CI -0.27 to 0.10, n = 475, 4 trials), nor on measures of social function (standardised mean difference -0.09, 95% CI -0.29 to 0.11, n = 386, 3 trials). Levels of satisfaction with counselling were high. There was some evidence that the overall costs of counselling and usual care were similar. There were limited comparisons between counselling and other psychological therapies, medication, or other psychosocial interventions.

Authors' conclusions: Counselling is associated with significantly greater clinical effectiveness in short-term mental health outcomes compared to usual care, but provides no additional advantages in the long-term. Participants were satisfied with counselling. Although some types of health care utilisation may be reduced, counselling does not seem to reduce overall healthcare costs. The generalisability of these findings to settings outside the United Kingdom is unclear.

PubMed Disclaimer

Conflict of interest statement

NR is Director of Research, Policy and Professional Practice at the British Association of Counselling and Psychotherapy

PB is a paid scientific consultant for the British Association of Counselling and Psychotherapy

Figures

1
1
Study flow diagram for 2011 update of searches
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Counselling compared with usual GP care (short term), Outcome 1 Mental health.
1.2
1.2. Analysis
Comparison 1 Counselling compared with usual GP care (short term), Outcome 2 Social function.
2.1
2.1. Analysis
Comparison 2 Counselling compared with usual GP care (long term), Outcome 1 Mental health.
2.2
2.2. Analysis
Comparison 2 Counselling compared with usual GP care (long term), Outcome 2 Social function.
3.1
3.1. Analysis
Comparison 3 Counselling compared with usual GP care (very long term), Outcome 1 Mental health.
3.2
3.2. Analysis
Comparison 3 Counselling compared with usual GP care (very long term), Outcome 2 Social function.
4.1
4.1. Analysis
Comparison 4 Counselling compared with GP antidepressant treatment (short term), Outcome 1 Mental health.
5.1
5.1. Analysis
Comparison 5 Counselling compared with GP antidepressant treatment (long term), Outcome 1 Mental health.
6.1
6.1. Analysis
Comparison 6 Counselling compared with CBT (short term, depressed patients), Outcome 1 Mental health.
7.1
7.1. Analysis
Comparison 7 Counselling compared with CBT (long term, depressed patients), Outcome 1 Mental health.
8.1
8.1. Analysis
Comparison 8 Counselling compared with CBT (short term, anxious patients), Outcome 1 Mental health.
9.1
9.1. Analysis
Comparison 9 Counselling compared with CBT (long term, anxious patients), Outcome 1 Mental health.
10.1
10.1. Analysis
Comparison 10 Counselling compared with CBT (very long term, anxious patients), Outcome 1 Mental health.
See this image and copyright information in PMC

Update of

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References to other published versions of this review

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