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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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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