A systematic review including 22 studies with a total of 5 550 adult participants with depression was abstracted in DARE. The majority of studies assessed individual problem-solving therapy (PST), the remainder assessed group or telephone-based PST. Most interventions lasted an average of 8 sessions delivered over 10 weeks. Outcomes were usually assessed over a period of 52 weeks. PST was significantly superior to control (waiting list, usual care or treatment) in reducing depressive symptoms, with effects persisting up to 52 weeks (7 studies). Two of 6 studies comparing PST with antidepressant therapy (amitriptyline or paroxetine) and placebo found a combination of PST and paroxetine to reduce depressive symptoms. Three of 5 studies comparing PST with alternative interventions found PST superior. All 5 studies assessing multifaceted PST reported reductions in depressive symptoms. Significant effects were found in most cases to be maintained for up to 12 months.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in study populations, interventions and outcomes) and by study quality (inadequate intention-to-treat adherence).