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Meta-Analysis
. 2015 Dec 14;2015(12):CD009871.
doi: 10.1002/14651858.CD009871.pub2.

Non-pharmacological interventions for depression in adults and children with traumatic brain injury

Paul Gertler  1 , Robyn L Tate, Ian D Cameron
Affiliations
Meta-Analysis

Non-pharmacological interventions for depression in adults and children with traumatic brain injury

Paul Gertler et al. Cochrane Database Syst Rev. .

Abstract

Background: Following traumatic brain injury (TBI) there is an increased prevalence of depression compared to the general population. It is unknown whether non-pharmacological interventions for depression are effective for people with TBI.

Objectives: To investigate the effectiveness of non-pharmacological interventions for depression in adults and children with TBI at reducing the diagnosis and severity of symptoms of depression.

Search methods: We ran the most recent search on 11 February 2015. We searched the Cochrane Injuries Group Specialised Register, The Cochrane Library, MEDLINE (OvidSP), Embase (OvidSP), three other databases and clinical trials registers. Relevant conference proceedings and journals were handsearched, as were the reference lists of identified studies.

Selection criteria: Randomised controlled trials (RCTs) of non-pharmacological interventions for depression in adults and children who had a TBI.

Data collection and analysis: Two authors independently selected trials from the search results, then assessed risk of bias and extracted data from the included trials. The authors contacted trial investigators to obtain missing information. We rated the overall quality of the evidence of the primary outcomes using the GRADE approach.

Main results: Six studies met the inclusion criteria, with a total of 334 adult participants. We identified no studies that included children as participants. All studies were affected by high risk of bias due to a lack of blinding of participants and personnel; five studies were affected by high risk of bias for lack of blinding of outcome assessors. There was high or unclear risk of biases affecting some studies across all the Cochrane risk of bias measures.Three studies compared a psychological intervention (either cognitive behaviour therapy or mindfulness-based cognitive therapy) with a control intervention. Data regarding depression symptom outcome measures were combined in a meta-analysis, but did not find an effect in favour of treatment (SMD -0.14; 95% CI -0.47 to 0.19; Z = 0.83; P = 0.41). The other comparisons comprised of single studies of depression symptoms and compared; cognitive behaviour therapy versus supportive psychotherapy (SMD -0.09; 95% CI -0.65 to 0.48; Z = 0.30; P = 0.77); repetitive transcranial magnetic stimulation plus tricyclic antidepressant (rTMS + TCA) versus tricyclic antidepressant alone (SMD -0.84; 95% CI -1.36 to -0.32; Z = 3;19, P = 0.001); and a supervised exercise program versus exercise as usual (SMD -0.43; 95% CI -0.88 to 0.03; Z = 1.84; P = 0.07). There was very-low quality evidence, small effect sizes and wide variability of results, suggesting that no comparisons showed a reliable effect for any intervention.Only one study mentioned minor, transient adverse events from repetitive transcranial magnetic stimulation.

Authors' conclusions: The review did not find compelling evidence in favour of any intervention. Future studies should focus on participants with a diagnosed TBI and include only participants who have a diagnosis of depression, or who record scores above a clinical cutoff on a depression measure. There is a need for additional RCTs that include a comparison between an intervention and a control that replicates the effect of the attention given to participants during an active treatment.

PubMed Disclaimer

Conflict of interest statement

PG: None known.

RT: None known.

IC: None known.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies. Six studies are included in this review.
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 CBT versus control, Outcome 1 Major depressive disorder (MDD) on the structured clinical interview for depression (SCID) scale.
1.2
1.2. Analysis
Comparison 1 CBT versus control, Outcome 2 MDD on SCID long term follow up.
1.3
1.3. Analysis
Comparison 1 CBT versus control, Outcome 3 Depression scales.
1.4
1.4. Analysis
Comparison 1 CBT versus control, Outcome 4 Depression scales long term follow up.
1.5
1.5. Analysis
Comparison 1 CBT versus control, Outcome 5 Secondary depression measure ‐ SCL20 or SCL90R.
1.6
1.6. Analysis
Comparison 1 CBT versus control, Outcome 6 SCL20 long term follow up.
1.7
1.7. Analysis
Comparison 1 CBT versus control, Outcome 7 Secondary depression measure ‐ PGI.
1.8
1.8. Analysis
Comparison 1 CBT versus control, Outcome 8 PGI long term follow up.
1.9
1.9. Analysis
Comparison 1 CBT versus control, Outcome 9 Secondary measure ‐ Dissatisfaction with depression care.
1.10
1.10. Analysis
Comparison 1 CBT versus control, Outcome 10 Secondary depression measure ‐ PHQ.
1.11
1.11. Analysis
Comparison 1 CBT versus control, Outcome 11 Beck Hopelessness Scale (BHS).
1.12
1.12. Analysis
Comparison 1 CBT versus control, Outcome 12 Beck Scale for Suicide Ideation.
1.13
1.13. Analysis
Comparison 1 CBT versus control, Outcome 13 Rosenberg Self‐Esteem Scale.
1.14
1.14. Analysis
Comparison 1 CBT versus control, Outcome 14 Treatment drop‐outs.
2.1
2.1. Analysis
Comparison 2 CBT versus SPT, Outcome 1 MDD present on SCID following intervention.
2.2
2.2. Analysis
Comparison 2 CBT versus SPT, Outcome 2 Beck Depression Inventory (BDI).
2.3
2.3. Analysis
Comparison 2 CBT versus SPT, Outcome 3 Life 3 ‐ Quality of Life.
2.4
2.4. Analysis
Comparison 2 CBT versus SPT, Outcome 4 Treatment drop‐outs.
3.1
3.1. Analysis
Comparison 3 Transcranial magnetic stimulation plus TCA versus TCA alone, Outcome 1 Hamilton Rating Scale for Depression (HAM‐D).
3.2
3.2. Analysis
Comparison 3 Transcranial magnetic stimulation plus TCA versus TCA alone, Outcome 2 Mini Mental State Examination (MMSE).
3.3
3.3. Analysis
Comparison 3 Transcranial magnetic stimulation plus TCA versus TCA alone, Outcome 3 Serotonin (5‐HT) levels.
3.4
3.4. Analysis
Comparison 3 Transcranial magnetic stimulation plus TCA versus TCA alone, Outcome 4 Noradrenaline.
3.5
3.5. Analysis
Comparison 3 Transcranial magnetic stimulation plus TCA versus TCA alone, Outcome 5 Treatment dropouts.
4.1
4.1. Analysis
Comparison 4 Supervised exercise versus exercise as usual, Outcome 1 Beck Depression Inventory (BDI).
4.2
4.2. Analysis
Comparison 4 Supervised exercise versus exercise as usual, Outcome 2 Treatment dropouts.
See this image and copyright information in PMC

Update of

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