The evidence remains weak for the long-term effectiveness of counselling in primary care

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General practices in the UK sometimes offer counselling to people with mental health or psychosocial problems. This is an alternative to standard GP care or the conventional treatments such as cognitive behaviour therapy or antidepressants.

However, recent guidelines have not been able to recommend the use of counselling because the evidence-base remains weak in comparison to other therapies.

This new systematic review from the Cochrane Depression, Anxiety and Neurosis Group set out to assess the effectiveness and cost effectiveness of counselling for patients with mental health and psychosocial problems in primary care.

The reviewers conducted the usual comprehensive literature search, looking for randomised controlled trials of counselling for mental health and psychosocial problems in primary care. They retrieved 9 trials involving a total of 1,384 participants.

Here’s what they found:

  • Counselling had significantly greater mental health outcomes when compared with usual care in the short-term (standardised mean difference -0.28, 95% CI -0.43 to -0.13, n = 772, 6 trials)
  • Counselling was no better then usual care in the long-term (standardised mean difference -0.09, 95% CI -0.27 to 0.10, n = 475, 4 trials)
  • Counselling was no better then usual care in terms 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.

The reviewers concluded:

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.

Bower P, Knowles S, Coventry PA, Rowland N. Counselling for mental health and psychosocial problems in primary care. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD001025. DOI: 10.1002/14651858.CD001025.pub3.

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Andre Tomlin

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 with his wife, dog and three little elflings.

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