TY - JOUR
KW - Cost-Benefit Analysis
KW - Counseling
KW - Family Practice/economics
KW - Female
KW - Humans
KW - Male
KW - Patient Satisfaction
KW - Primary Health Care/economics
KW - Psychotherapy/economics
KW - Randomized Controlled Trials as Topic
AU - P. Bower
AU - S. Knowles
AU - P. A. Coventry
AU - N. Rowland
A1 - 
AB - BACKGROUND: The prevalence of mental health and psychosocial problems in primary care is high. Counselling is a potential treatment for these patients, but there is a lack of consensus over the effectiveness of this treatment in primary care. OBJECTIVES: To assess the effectiveness and cost effectiveness of counselling for patients with mental health and psychosocial problems in primary care. SEARCH STRATEGY: To update the review, the following electronic databases were searched: the Cochrane Collaboration Depression, Anxiety and Neurosis (CCDAN) trials registers (to December 2010), MEDLINE, EMBASE, PsycINFO and the Cochrane Central Register of Controlled Trials (to May 2011). SELECTION CRITERIA: Randomised controlled trials of counselling for mental health and psychosocial problems in primary care. DATA COLLECTION AND ANALYSIS: Data were extracted using a standardised data extraction sheet by two reviewers. Trials were rated for quality by two reviewers using Cochrane risk of bias criteria, to assess the extent to which their design and conduct were likely to have prevented systematic error. Continuous measures of outcome were combined using standardised mean differences. An overall effect size was calculated for each outcome with 95% confidence intervals (CI). Continuous data from different measuring instruments were transformed into a standard effect size by dividing mean values by standard deviations. Sensitivity analyses were undertaken to test the robustness of the results. Economic analyses were summarised in narrative form. There was no assessment of adverse events. MAIN RESULTS: Nine trials were included in the review, involving 1384 randomised participants. Studies varied in risk of bias, although two studies were identified as being at high risk of selection bias because of problems with concealment of allocation. All studies were from primary care in the United Kingdom and thus comparability was high. The analysis found significantly greater clinical effectiveness in the counselling group compared with usual care in terms of mental health outcomes in the short-term (standardised mean difference -0.28, 95% CI -0.43 to -0.13, n = 772, 6 trials) but not in the long-term (standardised mean difference -0.09, 95% CI -0.27 to 0.10, n = 475, 4 trials), nor on measures of social function (standardised mean difference -0.09, 95% CI -0.29 to 0.11, n = 386, 3 trials). Levels of satisfaction with counselling were high. There was some evidence that the overall costs of counselling and usual care were similar. There were limited comparisons between counselling and other psychological therapies, medication, or other psychosocial interventions. AUTHORS' CONCLUSIONS: Counselling is associated with significantly greater clinical effectiveness in short-term mental health outcomes compared to usual care, but provides no additional advantages in the long-term. Participants were satisfied with counselling. Although some types of health care utilisation may be reduced, counselling does not seem to reduce overall healthcare costs. The generalisability of these findings to settings outside the United Kingdom is unclear.
BT - Cochrane database of systematic reviews (Online)
C5 - Financing & Sustainability
CP - 9
CY - England
DO - 10.1002/14651858.CD001025.pub3
IS - 9
JF - Cochrane database of systematic reviews (Online)
N2 - BACKGROUND: The prevalence of mental health and psychosocial problems in primary care is high. Counselling is a potential treatment for these patients, but there is a lack of consensus over the effectiveness of this treatment in primary care. OBJECTIVES: To assess the effectiveness and cost effectiveness of counselling for patients with mental health and psychosocial problems in primary care. SEARCH STRATEGY: To update the review, the following electronic databases were searched: the Cochrane Collaboration Depression, Anxiety and Neurosis (CCDAN) trials registers (to December 2010), MEDLINE, EMBASE, PsycINFO and the Cochrane Central Register of Controlled Trials (to May 2011). SELECTION CRITERIA: Randomised controlled trials of counselling for mental health and psychosocial problems in primary care. DATA COLLECTION AND ANALYSIS: Data were extracted using a standardised data extraction sheet by two reviewers. Trials were rated for quality by two reviewers using Cochrane risk of bias criteria, to assess the extent to which their design and conduct were likely to have prevented systematic error. Continuous measures of outcome were combined using standardised mean differences. An overall effect size was calculated for each outcome with 95% confidence intervals (CI). Continuous data from different measuring instruments were transformed into a standard effect size by dividing mean values by standard deviations. Sensitivity analyses were undertaken to test the robustness of the results. Economic analyses were summarised in narrative form. There was no assessment of adverse events. MAIN RESULTS: Nine trials were included in the review, involving 1384 randomised participants. Studies varied in risk of bias, although two studies were identified as being at high risk of selection bias because of problems with concealment of allocation. All studies were from primary care in the United Kingdom and thus comparability was high. The analysis found significantly greater clinical effectiveness in the counselling group compared with usual care in terms of mental health outcomes in the short-term (standardised mean difference -0.28, 95% CI -0.43 to -0.13, n = 772, 6 trials) but not in the long-term (standardised mean difference -0.09, 95% CI -0.27 to 0.10, n = 475, 4 trials), nor on measures of social function (standardised mean difference -0.09, 95% CI -0.29 to 0.11, n = 386, 3 trials). Levels of satisfaction with counselling were high. There was some evidence that the overall costs of counselling and usual care were similar. There were limited comparisons between counselling and other psychological therapies, medication, or other psychosocial interventions. AUTHORS' CONCLUSIONS: Counselling is associated with significantly greater clinical effectiveness in short-term mental health outcomes compared to usual care, but provides no additional advantages in the long-term. Participants were satisfied with counselling. Although some types of health care utilisation may be reduced, counselling does not seem to reduce overall healthcare costs. The generalisability of these findings to settings outside the United Kingdom is unclear.
PP - England
PY - 2011
SN - 1469-493X; 1361-6137
T1 - Counselling for mental health and psychosocial problems in primary care
T2 - Cochrane database of systematic reviews (Online)
TI - Counselling for mental health and psychosocial problems in primary care
U1 - Financing & Sustainability
U2 - 21901675
U3 - 10.1002/14651858.CD001025.pub3
VL - (9)
VO - 1469-493X; 1361-6137
Y1 - 2011
ER -