It’s a meta-analysis month again. Meta-analysis, when approached rigorously, can provide much more confidence in research findings by combining and analysing data from multiple studies. This month I will report more than the standard number of 10 studies because some meta-analytic findings from different papers complimented one another, painting a bigger, more detailed picture.

THE BEST

Therapists perceived as empathic and genuine have a strong relationship with clients

The first meta-analysis of its kind assessed how therapist empathy and genuineness contribute to the therapeutic alliance (i.e. the relationship between client and therapist). Analysis of 53 studies found that therapeutic alliance was significantly related to perceptions of therapist empathy as well as therapists’ genuineness.

Effect sizes for the relationships were large, highlighting the importance of therapists cultivating an empathetic and genuine relationship with their clients, particularly seeing how the strength of the therapeutic alliance is integral to therapeutic effectiveness.

MDMA-assisted therapy best for adults and trauma-focused CBT best for children with PTSD

Two meta-analyses assessed the efficacy of various interventions for the treatment of post-traumatic stress disorder, one in adults, one in children.

For children and adolescents, the analysis compared psychological and psychopharmacological interventions for the PTSD treatment. In particular, trauma-focused cognitive behavioural therapy (CBT) had a large effect on PTSD symptoms, however there was very little evidence to support the use of drugs in psychopharmacological interventions. Again this points to the need to severely limit the prescription of drugs for mental health problems in youth populations.

For adults, the analysis compared the efficacy of the most widely accepted treatment for PTSD, prolonged exposure therapy, and ±3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. MDMA-assisted psychotherapy had a larger therapeutic effect as observed by the therapist and the patient, and a lower percentage of patients dropping out of therapy than prolonged exposure therapy. This meta-analysis is rather groundbreaking as it gives very solid grounds for popularizing MDMA-assisted psychotherapy as the “go to” therapy for treating adult PTSD.

Psychotherapy can reduce stomach problems in IBS even 12 months after treatment

Forty-one trials were included in a meta-analysis, comprising data from 2,290 individuals (1,183 assigned to psychotherapy and 1,107 assigned to a control condition), to assess the immediate, short-term, and long-term effictiveness of psychotherapy for reducing gastrointestinal problems in adults with irritable bowel syndrome (IBS).

It was found that psychotherapy had a medium effect immediately after therapy, with this medium strength effect being maintained after short-term follow-up periods (1-6 months after treatment) and long-term follow-up periods (6-12 months after treatment). This indicates that psychotherapy should be an essential part of IBS treatment.

Being a conscientious, open introvert is best recipe for preventing cognitive decline in old age

Certain personality traits have been linked with risk of dementia. Although the slowing of our brain in its use to understand the world is a natural part of aging, there are tremendous differences in the rate of decline from person to person, which is partly due to personality and psychology.

Using a collective sample of over 13,000 participants, the analysis found that higher neuroticism was associated with worse performance on global cognitive function and greater decline in memory. Conversely, conscientiousness and openness were associated with better memory performance and less cognitive decline over time. Additionally conscientiousness and lower extraversion (i.e. higher introversion) were associated with better cognitive status and less decline.

Exercise improves physical and psychological quality of life in people with depression

It has been stated that pharmacological antidepressants on average have a 50:50 chance of having any clinical benefit. Even for those that there is a benefit, the impairment of their quality of life in the physical, psychological, social and environmental domains typically remains.

The meta-analysis of the 6 studies meeting strict inclusion criteria found exercise to be a useful strategy to improve the physical and psychological domains of quality of life but not the social and environmental domains. Much more rigorous research is needed to find out what aspects of exercise (e.g., duration, intensity, modality and group or individualized sessions) work best depending on the individual (e.g., age, gender, depression severity).

THE WORST

Higher levels of depression in female sex workers linked to increased risk of STIs

The paper explored the associations between the psychological health of female sex workers and HIV risk by analyzing eight publications. They found that the prevalence of probable depression was as high as 62.4%. The majority of studies showed that higher scores in psychological health problems were associated with increased HIV risk behavior, in particular inconsistent condom use, or sexually transmitted infections.

Meta-analysis was used to examine the association between depression and inconsistent condom use and found that higher scores in depression put women at 2-3 times higher risk of inconsistent condom use, which puts them at greater risk of HIV and other sexually transmitted diseases.

Transition to menopause and menopause linked with double risk of depression symptoms

In an analysis of 11 studies, a women had double the risk of depressive symptoms during the perimenopause as compared to the premenopause, but not compared to the postmenopause. Moreover, symptoms were much more severe during perimenopause when compared to the premenopause. However, it is important to note that the odds of developing clinical depression were not significantly different between the stages of menopause.

Premenopause simply means when a woman is still having her typical menstrual cycle. Perimenopause refers to when women are going through the transition to menopause (i.e. when menstruation ceases and a women becomes infertile).

This means that women transitioning to menopause (i.e. perimenopause) and postmenopausal women have double the risk of depression symptoms than in their younger more fertile years, where perimenopause may offer a window of opportunity for early recognition and prevention of depression.

Additionally, a link between severity of vasomotor symptoms (e.g. hot flashes) and depressive symptoms was found during perimenopause, making vasomotor symptoms another early indicator or depression risk.

Conception-assisted mothers of twins and multiple births have higher depression risk than mothers of singletons

Eight papers constituting 2,993 mothers were included in the meta-analysis. Mothers of assisted reproductive technology (ART) multiple births were significantly more likely to have depression and stress than mothers of ART singletons, but were no different from mothers of naturally conceived multiples.

Further research is necessary to discover what makes depression and stress risks higher for multiple births specific to assisted reproductive technology to find ways to prevent post-natal distress, and negative consequences for fetal growth and development, and possibly develop an international framework to improve support for families of multiples.

Feeling unaccomplished linked with doubting of self-efficacy and job burnout

A meta-analytical review of 57 studies totalling over 20,000 participants found the effect that one’s level of self-efficacy (i.e. belief in one’s ability to succeed in specific situations or accomplish a task) has on increasing levels of job burnout (i.e. a special form of job stress involving physical, emotional or mental exhaustion combined with doubts about your competence and the value of your work) was of medium size.

One component of burnout in particular was heavily affected by personal beliefs of one’s level of self-efficacy, beliefs in one’s level of personal accomplishment. Belief in your ability to get the job done is linked with feeling proud and satisfied with your personal achievements at work. This protects from burnout. Whereas feeling unaccomplished is linked with feeling unable to perform well; this exacerbates burnout.

The effect of beliefs of accomplishment on burnout was strongest in teachers (compared to health-care providers), older workers, and those with longer work experience. Interestingly, personal accomplishment was previously proposed to be removed from burnout level tests, which is not supported by this meta-analysis.

Paternal depression in new fathers relatively common, more so if mum is depressed too

While postnatal depression in mothers is extensively researched and documented, little attention has been paid to depression in fathers. A total of 74 studies from 1980 to 2015 totalling over 40,000 participants found an average of 8% of men experience paternal depression during the transition to parenthood, with higher rates of maternal depression coinciding with higher rates of paternal depression, and the highest rates (13%) found in North America. Meanwhile, prevalence rates were not found to be affected by paternal age, education, parity, history of paternal depression, and timing of assessment. Considering how common paternal depression is, screening policies and interventions are recommended, especially when maternal depression is also present.

It should be noted that there was a large difference in rates from study to study indicating the importance of standardizing the measurement method. In fact, over 50 additional studies have been published since the analysis was conducted, increasing the likelihood of obtaining more accurate prevalence rates in the near future.

References

Amoroso, T., & Workman, M. (2016). Treating posttraumatic stress disorder with MDMA-assisted psychotherapy: A preliminary meta-analysis and comparison to prolonged exposure therapy Journal of Psychopharmacology, 30 (7), 595-600 DOI: 10.1177/0269881116642542

Cameron, E., Sedov, I., & Tomfohr-Madsen, L. (2016). Prevalence of paternal depression in pregnancy and the postpartum: An updated meta-analysis Journal of Affective Disorders, 206, 189-203 DOI: 10.1016/j.jad.2016.07.044

de Kruif, M., Spijker, A., & Molendijk, M. (2016). Depression during the perimenopause: A meta-analysis Journal of Affective Disorders, 206, 174-180 DOI: 10.1016/j.jad.2016.07.040

Laird, K., Tanner-Smith, E., Russell, A., Hollon, S., & Walker, L. (2016). Short-term and Long-term Efficacy of Psychological Therapies for Irritable Bowel Syndrome: A Systematic Review and Meta-analysis Clinical Gastroenterology and Hepatology, 14 (7), 937-9470000 DOI: 10.1016/j.cgh.2015.11.020

Luchetti, M., Terracciano, A., Stephan, Y., & Sutin, A. (2016). Personality and Cognitive Decline in Older Adults: Data From a Longitudinal Sample and Meta-Analysis The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 71 (4), 591-601 DOI: 10.1093/geronb/gbu184

Morina, N., Koerssen, R., & Pollet, T. (2016). Interventions for children and adolescents with posttraumatic stress disorder: A meta-analysis of comparative outcome studies Clinical Psychology Review, 47, 41-54 DOI: 10.1016/j.cpr.2016.05.006

Nienhuis, J., Owen, J., Valentine, J., Winkeljohn Black, S., Halford, T., Parazak, S., Budge, S., & Hilsenroth, M. (2016). Therapeutic alliance, empathy, and genuineness in individual adult psychotherapy: A meta-analytic review Psychotherapy Research, 1-13 DOI: 10.1080/10503307.2016.1204023

Schuch, F., Vancampfort, D., Rosenbaum, S., Richards, J., Ward, P., & Stubbs, B. (2016). Exercise improves physical and psychological quality of life in people with depression: A meta-analysis including the evaluation of control group response Psychiatry Research, 241, 47-54 DOI: 10.1016/j.psychres.2016.04.054

Shoji, K., Cieslak, R., Smoktunowicz, E., Rogala, A., Benight, C., & Luszczynska, A. (2015). Associations between job burnout and self-efficacy: a meta-analysis Anxiety, Stress, & Coping, 29 (4), 367-386 DOI: 10.1080/10615806.2015.1058369

van den Akker, O., Postavaru, G., & Purewal, S. (2016). Maternal psychosocial consequences of twins and multiple births following assisted and natural conception: a meta-analysis Reproductive BioMedicine Online, 33 (1), 1-14 DOI: 10.1016/j.rbmo.2016.04.009

Yuen, W., Tran, L., Wong, C., Holroyd, E., Tang, C., & Wong, W. (2016). Psychological health and HIV transmission among female sex workers: a systematic review and meta-analysis AIDS Care, 28 (7), 816-824 DOI: 10.1080/09540121.2016.1139038

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