Summary of findings 2. Psychological therapy compared to usual care and/or attention control for preventing depression after stroke.
| Psychological therapy compared to usual care and/or attention control for preventing depression after stroke | ||||||
| Patient or population: people with stroke Setting: hospital and community Intervention psychological therapy Comparison: usual care and/or attention control | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with usual care and/or attention control | Risk with psychological therapy | |||||
| Depression: meeting study criteria for depression at end of treatment (Analysis 2.1) | Study population | RR 0.68 (0.49 to 0.94) | 607 (2 RCTs) | ⊕⊝⊝⊝ Very lowa,b | ||
| 296 per 1000 | 201 per 1000 (145 to 278) | |||||
| Scoring above cut‐off points for a depressive disorder at end of treatment (Analysis 2.2) | ‐ | ‐ | ‐ | (0 RCTs) | ‐ | No data available |
| Depression: mean scores at end of treatment (Analysis 2.3) | ‐ | ‐ | 132 (2 studies) | ‐ | No totals HDRS (high score = more depressed) MADRS (high score = more depressed) |
|
| Psychological distress: mean scores at end of treatment (Analysis 2.6) | ‐ | ‐ | 450 (1 RCT) | No totals GHQ‐28 (high score = greater psychological distress) |
||
| General Health: mean scores at end of treatment (Analysis 2.8) | MD 4.60 higher (21.25 lower to 30.45 higher) | ‐ | 240 (1 study) | ‐ | No totals Nottingham Health Profile (high score = better health) |
|
| Social activities: mean scores at end of treatment (Analysis 2.10) | MD 0.39 lower (3.81 lower to 3.03 higher) | ‐ | 690 (2 RCTs) | ⊕⊝⊝⊝ Very lowa,c,d | Frenchay Activities Index (high score = better level of activity) | |
| Activities of daily living: mean scores at end of treatment (Analysis 2.12) | ‐ | ‐ | 879 (4 studies) | ‐ | No totals Barthel Index (high score = more dependent) Nottingham Extended Activities of daily living (high score = more independent) |
|
| Adverse events: death ‐ at end of treatment (Analysis 2.16) | Study population | RR 1.18 (0.73 to 1.91) | 975 (5 RCTs) | ⊕⊝⊝⊝ Very lowa,c | ||
| 42 per 1000 | 49 per 1000 (30 to 79) | |||||
| *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; GHQ‐28: 28‐item General Health Questionnaire; HDRS: Hamilton Depression Rating Scale; MADRS: Montgomery Aserg Depression Rating Scale; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio | ||||||
| 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. | ||||||
aWe downgraded the certainty of evidence as the studies were rated high risk in multiple risk of bias domains.
bWe downgraded the certainty of evidence because the confidence intervals were wide.
cWe downgraded the certainty of evidence because the confidence intervals were very wide.
dWe downgraded the certainty of evidence because of substantial heterogeneity observed (I = 80%).