Summary of findings 2. Interpersonal Psychotherapy for Depression (IPT‐D) compared with Other Psychological Interventions for co‐occurring depression and substance use disorders.
| Interpersonal Psychotherapy for Depression (IPT‐D) compared with Other Psychological Interventions for co‐occurring depression and substance use disorders | ||||||
| Patient or population: Individuals experiencing co‐occurring depression and substance use disorders Setting: any setting Intervention: Interpersonal Psychotherapy for Depression (IPT‐D) Comparison: Other Psychological Interventions | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with Other Theraputic Interventions | Risk with Interpersonal Psychotherapy for Depression (IPT‐D) | |||||
| Depression score Assessed with: Hamilton Depression Rating Scale (HDRS) ‐ Structured clinical interview (17 and 24 items) Scale from: 0 to 54 (higher score worse) Follow‐up: end of treatment | SMD 0.54 SD lower (1.04 lower to 0.04 lower) | ‐ | 64 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 2 3 | ||
| Depression score Assessed with: Hamilton Depression Rating Scale (HDRS) ‐ Structured clinical interview (17 items) Scale from: 0 to 54 (higher score worse) Follow‐up: 3 months | The mean depression score was 15.8 | MD 3.80 higher (3.83 lower to 11.43 higher) | ‐ | 38 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 3 4 5 | |
| Percentage of days abstinent Assessed with: the calendar‐assisted structured interview ‐ Time‐Line Follow‐Back (TLFB) for past month of alcohol use Scale from: 0 to 100 (better) Follow‐up: end of treatment | The mean percentage of days abstinent was 49.7 | MD 2.70 lower (28.74 lower to 23.34 higher) | ‐ | 26 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 3 6 7 | |
| Substance use ‐ relapse Assessed with: self‐reported heavy drinking (4+ drinks) or drug use on at least 10% of non‐incarcerated days or positive urine test Follow‐up: 3‐months | Study population | RR 0.67 (0.30 to 1.50) | 38 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 3 4 5 | ||
| 316 per 1,000 | 212 per 1,000 (95 to 474) | |||||
| Treatment retention | Study population | RR 1.00 (0.81 to 1.23) | 64 (2 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 2 3 | ||
| 774 per 1,000 | 744 per 1,000 (627 to 952) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; MD: mean difference; RR: Risk ratio; SMD: standardised mean difference | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Downgraded two levels due to serious risk of bias: high levels of performance bias due to difficulties with blinding participants and personnel, one of the studies also had high attrition bias and reported group differences in use of antidepressants and adjunctive mental health counselling
2 Downgraded one level due to indirectness: one of the study was based on a female prison population, the other were recruited through a medical college, neither sample is likely to be representative of broader population of individuals experience comorbid substance use and depressive disorders
3 Downgraded two levels due to very small sample size
4 Downgraded two levels due to serious risk of bias: high levels of performance bias due to difficulties with blinding participants and personnel and reported group differences in use of antidepressants and adjunctive mental health counselling
5 Downgraded one level due to indirectness: Female prison population unlikely to be representative of broader population of individuals experience comorbid substance use and depressive disorders
6 Downgraded two levels due to serious risk of bias: high levels of performance bias due to difficulties with blinding participants and personnel
7 Downgraded one level due to indirectness: sample recruited through a medical college, predominately White male, unlikely to be representative of broader population of individuals experience comorbid substance use and depressive disorders