Comparative effectiveness and acceptability of psychotherapies for late-life depression: A systematic review and network meta-analysis

Abstract

Background: The purpose of this systematic review and network meta-analysis is to compare the effectiveness and acceptability of psychotherapies for late-life depression.

Methods: We searched PubMed, Embase, PsycINFO, CINAHL, The Cochrane Library, China National Knowledge Infrastructure, WANFANG database, and Chinese Biomedicine literature (CBM) for randomized controlled trials (RCTs) from their respective inception dates to March 30, 2022. Comparative effectiveness and acceptability of these psychological interventions were evaluated by conducting standard pairwise meta-analyses and network meta-analyses. A battery of analyses and assessments, such as the risk of bias and certainty of the evidence were performed.

Results: A total of 68 studies with 4550 participants on six psychotherapies compared with two control groups were included in the final analysis. Notably, there were no statistically significant differences between behavioral activation therapy, cognitive behavior therapy (CBT), cognitive therapy, life review therapy, mindfulness, and combined psychotherapy. Compared with the non-active control group, six psychological interventions were statistically effective in reducing depression symptoms (standardized mean differences (SMDs) range, -1.08 to -0.73). While, only CBT, life review therapy, mindfulness, and combined psychotherapy were more effective than the active control group (SMDs range, -0.85 to -0.74). Life review therapy was ranked as the best option according to effectiveness and acceptability, while behavioral activation therapy was the worst by acceptability. The certainty of the evidence was mostly rated as low to very low.

Conclusions: Despite the scarcity of high-quality evidence, all six psychotherapies were effective for late-life depression, and life review therapy seemed to be the best choice in terms of effectiveness and acceptability. The findings of our review could provide policymakers and service commissioners with evidence-based practice for making decisions among different psychotherapies.

Keywords: Late-life depression; Network meta-analysis; Psychotherapy.