Psychotherapies are effective treatments for depression and anxiety in low and middle income countries

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A new meta-analysis published in the African Journal of Psychiatry investigates the efficacy of psychological treatments for depression and anxiety disorders in low and middle income countries. To date there has perhaps existed a view that psychological mindedness is missing amongst the population of developing countries. There is good evidence that psychological treatments work as well as drug treatments for treating depression and anxiety in developed countries. This new review therefore helps to start filling a gap in the evidence.

The authors conducted a comprehensive literature search dating back to the mid-1960s, to identify randomised controlled trials that compared psychological treatment with treatment as usual. 17 trials were included with the total of 3010 participants. All of the trials were conducted in low and middle income countries across South America, Africa and Asia. The authors noted that most of the studies included in this review were published between 2003 and 2008, which highlights an encouraging recent research trend in this field.

The mean effect size of psychological treatments at post-test was 1.02 (95% CI: 0.76~1.28), which corresponds with an NNT of 1.89. Heterogeneity was very high so the authors conducted a subgroup analysis, which found that cognitive behavioural therapy had significantly higher effect sizes than other psychotherapies.

The authors concluded:

The common misconception of a lack of psychological mindedness in developing countries is negated by the positive results for psychological treatments in this meta-analysis. The current meta-analysis may therefore help to encourage additional research on psychological treatments in low and middle income countries.

Van’t Hof E, Cuijpers P, Waheed W, Stein DJ. Psychological treatments for depression and anxiety disorders in Low- and middle- income countries: a meta-analysis (PDF). Afr J Psychiatry (Johannesbg). 2011 Jul;14(3):200-7. doi:

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