[State of knowledge: efficacy of psychosocial interventions for the prevention and treatment of common mental disorders and symptoms]

Bernard S, Brassard J, Proteau-Dupont É, Léveillé S, Lapalme M
Record ID 32018002603
Original Title: État des connaissances - efficacité des interventions psychosociales pour prévenir et traiter les symptômes et troubles mentaux courants
Authors' objectives: Common mental disorders and symptoms, including anxiety and depression, affect a significant proportion of the population. The needs for mental health services are numerous and have increased since the start of the COVID-19 pandemic. The goal of this knowledge synthesis is to document the efficacy of various psychosocial interventions aimed at preventing and treating common mental disorders and symptoms. Four questions were formulated to meet this goal: 1. Which psychosocial interventions are effective in preventing and treating common mental disorders and symptoms? 2. Which characteristics and components of psychosocial interventions have been shown to be effective? 3. How are psychosocial interventions perceived by individuals presenting common mental disorders or related symptoms? 4. What are the moderating variables (characteristics of the individuals and clinical conditions) and mediating variables (therapeutic processes and procedures) associated with the efficacy of psychosocial interventions? In line with ministerial guidelines and the Quebec Program for Mental Disorders, the work focused on interventions that can be offered in local services, by various categories of workers and professionals, and in modalities that promote access to mental health services (e.g., digital interventions, interventions offered in group or hybrid format). Of note, this report does not cover the professional, organizational, economic and ethical dimensions, nor the implementation issues related to the interventions. Furthermore, the efficacy results presented here are based on international studies and thus, are not contextualized to the clinical and professional practice in Quebec. This report covers the efficacy of psychosocial interventions (Question 1); the characteristics and components of effective interventions (Question 2); and the individuals’ experience with these interventions (Question 3). A second report will be produced to document the personal and clinical characteristics of those individuals most likely to respond favourably to these interventions (moderating variables) and to identify active elements associated with their efficacy (mediating variables) (Question 4).
Authors' results and conclusions: RESULTS: KEY RESULTS ON THE EFFICACY OF PSYCHOSOCIAL INTERVENTIONS: (#1: Effective interventions to reduce symptoms of common mental disorders): Unguided self-care based on the principles of cognitive-behavioural therapy, either transdiagnostic or focused on cognitive restructuring, as well as those based on mindfulness positive psychology or on psychological education, are effective in reducing symptoms of depression, anxiety and stress in adults presenting an anxiety, depressive or adjustment disorder or related symptoms. Clinically significant improvement rates reported in the studies ranged from 19% to 53%. (#2: Effective interventions to generate psychosocial benefits): In-presence interventions based on mindfulness, interpersonal therapy, brief psychodynamic therapy, as well as counseling, are effective in reducing symptoms of depression in adults with a depressive disorder or related symptoms. • In-presence interventions based on trauma–focused cognitive-behavioral therapy as well as music therapy are effective in reducing symptoms of stress in adults at risk of presenting or presenting symptoms of stress or a post-traumatic stress disorder. KEY RESULTS ON THE CHARACTERISTICS AND COMPONENTS OF EFFECTIVE INTERVENTIONS: The content analysis conducted on the identified interventions indicates that few characteristics and components clearly distinguish effective interventions from interventions whose efficacy has not been demonstrated. Generally speaking, however, the studies reviewed indicated the following: • effective interventions for reducing symptoms of common mental disorders or producing psychosocial benefits are often brief (less than 7 hours), offered in digital format and include some form of coaching or clinical support. KEY RESULTS ON THE USERS’ EXPERIENCE: The components and relational aspects of self-care and in-presence interventions considered most useful by users are as follows: • self-observation, psychological education, learning to confront one’s fears and harmful thoughts, learning to manage one’s emotions as well as mindfulness activities, including meditation, relaxation and self-compassion exercises; • additional components include the practitioner’s ability to create a warm, caring and respectful supportive relationship in a safe environment; understanding the therapeutic process and playing an active role in it; and shared decision-making. 5 The benefits derived from self-care and in-presence interventions are as follows: • some normalization of the individuals’ condition; a feeling that they are like other people; increased self-knowledge and self-esteem; and a feeling of being more in control and better equipped. The following improvements to self-care and in-presence interventions are suggested: • lighten and clarify content, diversify learning strategies, devise more flexible and customizable intervention methods; • the ability to complete interventions at one’s own pace. CONCLUSION: The results from the primary studies and systematic reviews published in 2019–2020 confirm the relevance of the stepped-care model and the need to use a wide range of interventions, from unguided and guided self-care to in-presence interventions, including psychotherapy, in order to respond to the growing needs of the population. The work carried out is consistent with the 2022–2026 Interministerial Mental Health Action Plan which, among other objectives, aims to continue the implementation of the Quebec Program for Mental Disorders and to introduce innovation through the integration of digital interventions into mental health services. We hope that the results of our review will support the Ministry of Health and Social Services in its response to the needs of people with common mental disorders and related symptoms.
Authors' methods: The literature review is based on a rapid systematic review method where some steps of the systematic review process have been omitted or abridged. The literature selected includes 69 primary studies and 19 systematic reviews published in 2019–2020. These reviews totalize more than 1,000 studies published from 1966 to 2019. An update of the literature search was also carried out in February 2022. A summary of this update, based on the titles and abstracts, is also presented. A narrative synthesis based on effect sizes (using Cohen’s d measure) was conducted. The grading of evidence from primary studies lead to the formulation of 30 statements on the efficacy of psychosocial interventions and 19 statements on the users’ experience. The statements on efficacy were formulated by taking into account the age group, the individuals’ clinical profiles, the type of clinical support offered, the theoretical approach underpinning the interventions and their effects on symptoms of depression, anxiety and stress as well as on individuals’ quality of life, psychological well-being, functioning and personal competencies.
Project Status: Completed
Year Published: 2022
English language abstract: An English language summary is available
Publication Type: Other
Country: Canada
Province: Quebec
MeSH Terms
  • Depression
  • Anxiety
  • Mental Health Services
  • Mental Health
  • Psychosocial Intervention
  • Psychosocial Support Systems
  • Mindfulness
Organisation Name: Institut national d'excellence en sante et en services sociaux
Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369
Contact Name: demande@inesss.qc.ca
Contact Email: demande@inesss.qc.ca
Copyright: Gouvernement du Québec
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.