Academic journal article Indian Journal of Psychiatry

Group Psychotherapies for Depression in Persons with HIV: A Systematic Review

Academic journal article Indian Journal of Psychiatry

Group Psychotherapies for Depression in Persons with HIV: A Systematic Review

Article excerpt

Byline: Abhijit. Honagodu, Murali. Krishna, Rajesh. Sundarachar, Peter. Lepping

Studies investigating effectiveness of group psychotherapy intervention in depression in persons with HIV have showed varying results with differing effect sizes. A systematic review of randomized controlled trials of group psychotherapy in depression in persons with HIV has been conducted to present the best available evidence in relation to its effect on depressive symptomatology. Electronic databases were searched to identify randomized controlled trials. Selected studies were quality assessed and data extracted by two reviewers. If feasible, it was planned to conduct a meta-analysis to obtain a pooled effect size of group psychotherapeutic interventions on depressive symptoms. Odds ratio for drop out from group was calculated. The studies were assessed for their quality using the Quality Rating Scale and other parameters for quality assessment set out by COCHRANE. The quality of reporting of the trials was compared against the Consolidated Standards of Reporting Trials (CONSORT) checklist for non-pharmacological studies (CONSORT-NPT). Four studies met the full inclusion criteria for systematic review. The trials included in the review examined group interventions based on the Cognitive behavioral therapy model against other therapeutic interventions or waiting list controls. In all four studies, group psychotherapy was an effective intervention for reducing depressive symptoms in persons with HIV in comparison to waiting list controls. The reported benefits from the group psychotherapy in comparison to active controls were less impressive. There were no statistically significant differences in drop outs at post treatments across group psychotherapy, wait list control, and other active interventions. The methodological quality of the studies varied. The quality of reporting of the studies was sub-optimal. The results of this systematic review support that group psychological interventions for depression in persons with HIV have a significant effect on depressive symptomatology. This review also indicates that group cognitive behavioral therapies are an acceptable psychological intervention for persons with HIV and comorbid depression.

Introduction

Depression is highly prevalent in individuals with HIV. [sup][1] Depression increases HIV-related morbidity and mortality including those from suicide. [sup][2] Depression also delays initiation of anti-retroviral treatment, [sup][3] affects adherence to treatment and reduces important self-care behaviors [sup][4],[5] in individuals with HIV.

Treatment for depression improves HIV-related outcomes. [sup][6],[7] Antidepressants though efficacious in depression associated with HIV, they are associated with high dropout rates and are expensive. [sup][8],[9] Drug interactions with anti-retroviral agents and sexual dysfunction after antidepressant use are additional concerns. [sup][10],[11]

Psychotherapeutic interventions have also been used to alleviate psychosocial, interpersonal difficulties, and distress associated with HIV. Several randomized controlled trial studies have investigated the efficacy of group therapy techniques to decrease psychological distress, decrease social isolation, and improve coping among HIV-infected people. [sup][12],[13],[14],[15],[16],[17] The number of psychotherapists is often limited in clinical practice with long waiting lists preventing timely delivery of psychotherapeutic interventions and implementation of guidelines. One possible solution would be to provide group-based rather than individual psychotherapy. Steuer et al. suggested that group therapy works effectively because it offers peer support, mitigates social isolation, encourages shared empathy, and provides a context for peer feedback and patients have the opportunity to help one. It may also be cost effective. [sup][18] Group interventions are well suited to meet the needs of an HIV-positive individuals with depression as depression is often accompanied by social isolation, physical disability, and bereavement. …

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