Effect of group psychoeducation for major depressive disorder: a systematic review

Abstract

Background: Depression is a common mental disorder and a major contributor to the overall global burden of disease. Healthcare systems struggle to provide effective and acceptable treatment to meet the needs of the growing number of patients suffering from depression. Although there are some known, effective medical treatments for depression, far from all of those affected receive such treatments, and there is a corresponding patient- and stakeholder demand for drug-free alternatives to treat depression. Group psychoeducation is a low threshold, drug-free intervention which has proven to be beneficial in the treatment of other mental disorders and which can be adapted to different populations. Use of group psychoeducation for major depressive disorder (MDD) will increase the availability of treatment, if proven to be effective, because it allows for treating several patients in the same session and meets calls for drug-free treatment. Objective: To systematically review the effectiveness of group psychoeducation for adults with MDD, as sole treatment or in conjunction with treatment as usual (TAU), compared to pharmacological treatment and/or other psychological treatment. Included effect measures are quality of life, depression severity, mortality (suicide), psychosocial functioning, relapse, and compliance. Methods: The review was planned and described in a PROSPERO (CRD42017077110) registered protocol. The search strategy was executed by a search librarian and it was peer reviewed by another librarian. The search included electronic searches in MEDLINE, Embase, the Cochrane Library, PsycINFO, PubMed, CINAHL, Epistemonikos and a hand search of 29 systematic reviews. The search yielded a total of 4219 records, which were screened independently by two reviewers. We assessed eligible studies for risk of bias using the Cochrane risk of bias tool for RCTs. We conducted meta-analyses when studies were sufficiently similar in terms of design, population, intervention, and outcomes. Lastly, we evaluated the certainty of the body of evidence using the GRADE approach. Results: Nine randomized controlled studies (RCTs) with a total of 1249 patients met the inclusion criteria. The meta-analytic results showed that group psychoeducation in conjunction with TAU compared to TAU lead to a reduction in depression at 4-6 weeks, SMD= -0.32 (95% CI: -0.59 to -0.04), and 6 months, SMD= -0.21 (95% CI: -0.38 to -0.04). The effect of psychoeducation in conjunction with TAU was not significant at 12 months follow up, SMD= 0.22 (95% CI:-0.02 to 0.45). Family psychoeducation (groups including patient and caregiver) in conjunction with TAU showed a greater effect on depression than patient group psychoeducation. This was particularly prominent at 3 months follow-up, SMD= -1.21 (95% CI: -1.64 to -0.78). Family psychoeducation in conjunction with TAU also showed greater effect than TAU alone on psychosocial functioning at 3 months follow-up, SMD= 0.98 (95% CI: 0.56 to 1.40). The confidence in the certainty of the evidence varies from high to low. Results for psychosocial functioning was downgraded due to small sample size. Conclusions: While the current body of research on group psychoeducation shows promise for its effects on depression and psychosocial functioning, further evidence on the short- and long-term effects is needed. Family group psychoeducation seems to give better results than patient group psychoeducation. Robust studies to build a solid evidence on the effect of psychoeducation and knowledge on the effects for different patient groups in various socioeconomic- and cultural settings are necessary, prior to a generalised recommendation on this intervention for patients with major depressive disorder.