Adverse effects of psychotherapy: protocol for a systematic review and meta-analysis

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Abstract

Background

While it is well known that psychotherapy is efficacious in the treatment of mental disorders, much less is known about the adverse effects of psychotherapeutic interventions. The aim of this systematic review is to examine the definition, frequency, nature, and severity of adverse effects occurring parallel to or following psychotherapeutic treatment and to compare it against control groups.

Methods

All registered randomised controlled trials published since 2004 (publication year of harm-reporting extension of the CONSORT statement) with adult patients fulfilling clinical criteria of defined mental disorders, which compare individual or group psychotherapy against a control group, will be included. First, a search through international trial registers as well as a search in literature databases (e.g. MEDLINE) and in relevant journals (e.g. Trials) for study protocols will be conducted to identify eligible trials. In a second step, we will search for respective publications of the results of the eligible studies. Publications will be retrieved and screened for eligibility. Two previously trained, independent raters will extract the data in duplicate. Reporting of adverse effects will be descriptively analysed regarding frequency, heterogeneity, and longitudinal course. We will further compare the adverse effects of psychotherapeutic interventions against various control groups. For each categorical outcome, we will calculate relative risks (RR) together with 95% confidence intervals. For continuous outcomes, standardised mean differences (Hedges’ g) with a 95% confidence interval will be computed. Between-study heterogeneity will be tested with the Q statistic and quantified using I ².

Discussion

Preselecting studies with regard to randomised controlled trials might induce bias due to dropout before the beginning of treatment or end of treatment. However, we will thoroughly assess the negative effects of randomisation, e.g. reasons for non-randomisation, if reported. Even if delayed adverse effects might be overlooked in randomised controlled trials, these are the only sources of causal evidence.

Systematic review registration

PROSPERO International Prospective Register of Systematic Reviews 2017: CRD42017055507 (17 January 2017)

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Most cited references 40

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Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement.

Ronald C Kessler, Shelli Avenevoli, E. Jane Costello … (2012)

Community epidemiological data on the prevalence and correlates of adolescent mental disorders are needed for policy planning purposes. Only limited data of this sort are available. To present estimates of 12-month and 30-day prevalence, persistence (12-month prevalence among lifetime cases and 30-day prevalence among 12-month cases), and sociodemographic correlates of commonly occurring DSM-IV disorders among adolescents in the National Comorbidity Survey Replication Adolescent Supplement. The National Comorbidity Survey Replication Adolescent Supplement is a US national survey of DSM-IV anxiety, mood, behavior, and substance disorders among US adolescents based on face-to-face interviews in the homes of respondents with supplemental parent questionnaires. Dual-frame household and school samples of US adolescents. A total of 10,148 adolescents aged 13 to 17 years (interviews) and 1 parent of each adolescent (questionnaires). The DSM-IV disorders assessed with the World Health Organization Composite International Diagnostic Interview and validated with blinded clinical interviews based on the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Good concordance (area under the receiver operating characteristic curve ≥0.80) was found between Composite International Diagnostic Interview and Schedule for Affective Disorders and Schizophrenia for School-Age Children diagnoses. The prevalence estimates of any DSM-IV disorder are 40.3% at 12 months (79.5% of lifetime cases) and 23.4% at 30 days (57.9% of 12-month cases). Anxiety disorders are the most common class of disorders, followed by behavior, mood, and substance disorders. Although relative disorder prevalence is quite stable over time, 30-day to 12-month prevalence ratios are higher for anxiety and behavior disorders than mood or substance disorders, suggesting that the former are more chronic than the latter. The 30-day to 12-month prevalence ratios are generally lower than the 12-month to lifetime ratios, suggesting that disorder persistence is due more to episode recurrence than to chronicity. Sociodemographic correlates are largely consistent with previous studies. Among US adolescents, DSM-IV disorders are highly prevalent and persistent. Persistence is higher for adolescents than among adults and appears to be due more to recurrence than chronicity of child-adolescent onset disorders.

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Premature discontinuation in adult psychotherapy: a meta-analysis.

Joshua K Swift, Roger Greenberg (2012)

Premature discontinuation from therapy is a widespread problem that impedes the delivery of otherwise effective psychological interventions. The most recent comprehensive review found an average dropout rate of 47% across 125 studies (Wierzbicki & Pekarik, 1993); however, given a number of changes in the field over the past 2 decades, an updated meta-analysis is needed to examine the current phenomenon of therapy dropout. A series of meta-analyses and meta-regressions were conducted in order to identify the rate at which treatment dropout occurs and predictors of its occurrence. This review included 669 studies representing 83,834 clients. Averaging across studies using a random effects model, the weighted dropout rate was 19.7%, 95% CI [18.7%, 20.7%]. Further analyses, also using random effects models, indicated that the overall dropout rate was moderated by client diagnosis and age, provider experience level, setting for the intervention, definition of dropout, type of study (efficacy vs. effectiveness), and other design variables. Dropout was not moderated by orientation of therapy, whether treatment was provided in an individual or group format, and a number of client demographic variables. Although premature discontinuation is occurring at a lower rate than what was estimated 20 years ago (Wierzbicki & Pekarik, 1993), it is still a significant problem, with about 1 in every 5 clients dropping out of therapy. Special efforts should be made to decrease premature discontinuation, particularly with clients who are younger, have a personality or eating disorder diagnosis, and are seen by trainee clinicians. © 2012 American Psychological Association

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Twelve-month prevalence, comorbidity and correlates of mental disorders in Germany: the Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1-MH).

Frank Jacobi, Michael Höfler, Jens Siegert … (2014)

This paper provides up to date prevalence estimates of mental disorders in Germany derived from a national survey (German Health Interview and Examination Survey for Adults, Mental Health Module [DEGS1-MH]). A nationally representative sample (N = 5318) of the adult (18-79) population was examined by clinically trained interviewers with a modified version of the Composite International Diagnostic Interview (DEGS-CIDI) to assess symptoms, syndromes and diagnoses according to DSM-IV-TR (25 diagnoses covered). Of the participants 27.7% met criteria for at least one mental disorder during the past 12 months, among them 44% with more than one disorder and 22% with three or more diagnoses. Most frequent were anxiety (15.3%), mood (9.3%) and substance use disorders (5.7%). Overall rates for mental disorders were substantially higher in women (33% versus 22% in men), younger age group (18-34: 37% versus 20% in age group 65-79), when living without a partner (37% versus 26% with partnership) or with low (38%) versus high socio-economic status (22%). High degree of urbanization (> 500,000 inhabitants versus < 20,000) was associated with elevated rates of psychotic (5.2% versus 2.5%) and mood disorders (13.9% versus 7.8%). The findings confirm that almost one third of the general population is affected by mental disorders and inform about subsets in the population who are particularly affected.

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Author and article information

Contributors

Rahel Klatte: rahel.klatte@med.uni-jena.de

Bernhard Strauss: bernhard.strauss@med.uni-jena.de

Christoph Flückiger: christoph.flueckiger@psychologie.uzh.ch

Jenny Rosendahl:

ORCID: http://orcid.org/0000-0001-7535-7571

jenny.rosendahl@med.uni-jena.de

Journal

Journal ID (nlm-ta): Syst Rev

Journal ID (iso-abbrev): Syst Rev

Title: Systematic Reviews

Publisher: BioMed Central (London )

ISSN (Electronic): 2046-4053

Publication date (Electronic): 8 September 2018

Publication date PMC-release: 8 September 2018

Publication date Collection: 2018

Volume: 7

Electronic Location Identifier: 135

Affiliations

[1 ]ISNI 0000 0000 8517 6224, GRID grid.275559.9, Institute of Psychosocial Medicine and Psychotherapy, , Jena University Hospital, ; Stoystr. 3, 07740 Jena, Germany

[2 ]ISNI 0000 0004 1937 0650, GRID grid.7400.3, Department of Psychology, Division of Psychological Interventions and Psychotherapy, , University of Zurich, ; Binzmühlestrasse 14, Box 04, CH-8050 Zürich, Switzerland

Author information

Jenny Rosendahl http://orcid.org/0000-0001-7535-7571

Article

Publisher ID: 802

DOI: 10.1186/s13643-018-0802-x

PMC ID: 6128985

PubMed ID: 30193585

SO-VID: 9217b329-4a4e-42a2-9e57-a34c6fcb374c

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 20 April 2018

Date accepted : 27 August 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100002347, Bundesministerium für Bildung und Forschung;

Award ID: 01KG1704

Award Recipient : Bernhard Strauss

Custom metadata

ScienceOpen disciplines: Public health

Keywords: psychotherapy,harms,adverse effects,adverse events,safety,systematic review

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ScienceOpen disciplines: Public health

Keywords: psychotherapy, harms, adverse effects, adverse events, safety, systematic review

Adverse effects of psychotherapy: protocol for a systematic review and meta-analysis

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Abstract

Background

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Systematic review registration

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Creative methods for psychotherapy

Most cited references 40

Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement.

Premature discontinuation in adult psychotherapy: a meta-analysis.

Twelve-month prevalence, comorbidity and correlates of mental disorders in Germany: the Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1-MH).

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