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Marital therapy for depression.

Abstract

BACKGROUND

Marital therapy for depression has the two-fold aim of modifying negative interaction patterns and increasing mutually supportive aspects of couple relationships, thus changing the interpersonal context linked to depression.

OBJECTIVES

1. To conduct a meta-analysis of all intervention studies comparing marital therapy to other psychosocial and pharmacological treatments, or to non-active treatments. 2. To conduct an assessment of the internal validity and external validity. 3. To assess the overall effectiveness of marital therapy as a treatment for depression. 4. To identify mediating variables through which marital therapy is effective in depression treatment.

SEARCH STRATEGY

CCDANCTR-Studies was searched on 5-9-2005, Relevant journals and reference lists were checked.

SELECTION CRITERIA

Randomised controlled trials examining the effectiveness of marital therapy versus individual psychotherapy, drug therapy or waiting list/no treatment/minimal treatment for depression were included in the review. Quasi-randomised controlled trials were also included.

DATA COLLECTION AND ANALYSIS

Data were extracted using a standardised spreadsheet. Where data were not included in published papers, two attempts were made to obtain the data from the authors. Data were synthesised using Review Manager software. Dichotomous data were pooled using the relative risk (RR), and continuous data were pooled using the standardised mean difference (SMD), and 95% confidence intervals (CIs) were calculated. The random effects model was employed for all comparisons. A formal test for heterogeneity, the natural approximate chi-squared test, was also calculated.

MAIN RESULTS

Eight studies were included in the review. No significant difference in effect was found between marital therapy and individual psychotherapy, either for the continuous outcome of depressive symptoms, based on six studies: SMD -0.12 (95% CI -0.56 to 0.32), or the dichotomous outcome of proportion of subjects remaining at caseness level, based on three studies: RR 0.84 (95% CI 0.32 to 2.22). In comparison with drug therapy, a lower drop-out rate was found for marital therapy: RR 0.31 (95% CI 0.15 to 0.61), but this result was greatly influenced by a single study. The comparison with no/minimal treatment, showed a large significant effect in favour of marital therapy for depressive symptoms, based on two studies: SMD -1.28 (95% CI -1.85 to -0.72) and a smaller significant effect for persistence of depression, based on one study only. The findings were weakened by methodological problems affecting most studies, such as the small number of cases available for analysis in almost all comparisons, and the significant heterogeneity among studies.

AUTHORS' CONCLUSIONS

There is no evidence to suggest that marital therapy is more or less effective than individual psychotherapy or drug therapy in the treatment of depression. Improvement of relations in distressed couples might be expected from marital therapy. Future trials should test whether marital therapy is superior to other interventions for distressed couples with a depressed partner, especially considering the role of potential effect moderators in the improvement of depression.

Authors+Show Affiliations

Istituto di Ricerche Farmacologiche "Mario Negri", Unit of Epidemiology and Social Psychiatry, Via Eritrea 62, Milano, Italy. barbato@marionegri.itNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

16625597

Citation

Barbato, A, and B D'Avanzo. "Marital Therapy for Depression." The Cochrane Database of Systematic Reviews, 2006, p. CD004188.
Barbato A, D'Avanzo B. Marital therapy for depression. Cochrane Database Syst Rev. 2006.
Barbato, A., & D'Avanzo, B. (2006). Marital therapy for depression. The Cochrane Database of Systematic Reviews, (2), CD004188.
Barbato A, D'Avanzo B. Marital Therapy for Depression. Cochrane Database Syst Rev. 2006 Apr 19;(2)CD004188. PubMed PMID: 16625597.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Marital therapy for depression. AU - Barbato,A, AU - D'Avanzo,B, Y1 - 2006/04/19/ PY - 2006/4/21/pubmed PY - 2006/6/16/medline PY - 2006/4/21/entrez SP - CD004188 EP - CD004188 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 2 N2 - BACKGROUND: Marital therapy for depression has the two-fold aim of modifying negative interaction patterns and increasing mutually supportive aspects of couple relationships, thus changing the interpersonal context linked to depression. OBJECTIVES: 1. To conduct a meta-analysis of all intervention studies comparing marital therapy to other psychosocial and pharmacological treatments, or to non-active treatments. 2. To conduct an assessment of the internal validity and external validity. 3. To assess the overall effectiveness of marital therapy as a treatment for depression. 4. To identify mediating variables through which marital therapy is effective in depression treatment. SEARCH STRATEGY: CCDANCTR-Studies was searched on 5-9-2005, Relevant journals and reference lists were checked. SELECTION CRITERIA: Randomised controlled trials examining the effectiveness of marital therapy versus individual psychotherapy, drug therapy or waiting list/no treatment/minimal treatment for depression were included in the review. Quasi-randomised controlled trials were also included. DATA COLLECTION AND ANALYSIS: Data were extracted using a standardised spreadsheet. Where data were not included in published papers, two attempts were made to obtain the data from the authors. Data were synthesised using Review Manager software. Dichotomous data were pooled using the relative risk (RR), and continuous data were pooled using the standardised mean difference (SMD), and 95% confidence intervals (CIs) were calculated. The random effects model was employed for all comparisons. A formal test for heterogeneity, the natural approximate chi-squared test, was also calculated. MAIN RESULTS: Eight studies were included in the review. No significant difference in effect was found between marital therapy and individual psychotherapy, either for the continuous outcome of depressive symptoms, based on six studies: SMD -0.12 (95% CI -0.56 to 0.32), or the dichotomous outcome of proportion of subjects remaining at caseness level, based on three studies: RR 0.84 (95% CI 0.32 to 2.22). In comparison with drug therapy, a lower drop-out rate was found for marital therapy: RR 0.31 (95% CI 0.15 to 0.61), but this result was greatly influenced by a single study. The comparison with no/minimal treatment, showed a large significant effect in favour of marital therapy for depressive symptoms, based on two studies: SMD -1.28 (95% CI -1.85 to -0.72) and a smaller significant effect for persistence of depression, based on one study only. The findings were weakened by methodological problems affecting most studies, such as the small number of cases available for analysis in almost all comparisons, and the significant heterogeneity among studies. AUTHORS' CONCLUSIONS: There is no evidence to suggest that marital therapy is more or less effective than individual psychotherapy or drug therapy in the treatment of depression. Improvement of relations in distressed couples might be expected from marital therapy. Future trials should test whether marital therapy is superior to other interventions for distressed couples with a depressed partner, especially considering the role of potential effect moderators in the improvement of depression. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/16625597/Marital_therapy_for_depression_ L2 - https://doi.org/10.1002/14651858.CD004188.pub2 DB - PRIME DP - Unbound Medicine ER -