Psychotherapies for depression in low- and middle-income countries: a meta-analysis

Cuijpers, Pim; Karyotaki, Eirini; Reijnders, Mirjam; Purgato, Marianna; Barbui, Corrado

doi:10.1002/wps.20493

Cited by 159Psychotherapy Techniques and ApplicationsMental Health Treatment and AccessDigital Mental Health Interventions

Psychotherapies for depression in low- and middle-income countries: a meta-analysis

Open access

Cuijpers, Pim, Karyotaki, Eirini, Reijnders, Mirjam, Purgato, Marianna, Barbui, Corrado·2018·World Psychiatry

DOI 10.1002/wps.20493PMC PMC5775122

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Abstract

Most psychotherapies for depression have been developed in high‐income Western countries of North America, Europe and Australia. A growing number of randomized trials have examined the effects of these treatments in non‐Western countries. We conducted a meta‐analysis of these studies to examine whether these psychotherapies are effective and to compare their effects between studies from Western and non‐Western countries. We conducted systematic searches in bibliographical databases and included 253 randomized controlled trials, of which 32 were conducted in non‐Western countries. The effects of psychotherapies in non‐Western countries were large (g=1.10; 95% CI: 0.91‐1.30), with high heterogeneity (I 2=90; 95% CI: 87‐92). After adjustment for publication bias, the effect size dropped to g=0.73 (95% CI: 0.51‐0.96). Subgroup analyses did not indicate that adaptation to the local situation was associated with the effect size. Comparisons with the studies in Western countries showed that the effects of the therapies were significantly larger in non‐Western countries, also after adjusting for characteristics of the participants, the treatments and the studies. These larger effect sizes in non‐Western countries may reflect true differences indicating that therapies are indeed more effective; or may be explained by the care‐as‐usual control conditions in non‐Western countries, often indicating that no care was available; or may be the result of the relative low quality of many trials in the field. This study suggests that psychotherapies that were developed in Western countries may or may not be more effective in non‐Western countries, but they are probably no less effective and can therefore also be used in these latter countries.

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Findingown data
Heterogeneity of effects in non-Western countries was very high, I2 = 90 (95% CI 87-92).
“with high heterogeneity (I 2 590; 95% CI: 87-92).”
- Also stated in: § Effects of psychotherapies in non-Western countries · plain
  “Heterogeneity was very high (I 2 590; 95% CI: 87-92).”
Quote in the paperNot a substantial claim
Findingown data
Eight high-income non-Western studies had an effect size of g = 0.86 (95% CI 0.48-1.23; NNT = 3.30; I2 = 71, 95% CI 24-84).
“We found that the eight studies in high-income, non-Western countries resulted in an effect size of g50.86 (95% CI: 0.48-1.23;NNT53.30;I 2 571; 95% CI: 24-84) compared to g50.59 in Western countries (Table 2).”
Quote in the paperNot a substantial claim
Findingown data
Type of control group was significantly associated with effect size, with care-as-usual controls producing higher effects than waiting list and other controls (p = 0.02).
“We also found that the type of control group was significantly associated with the effect size, with care-as-usual control groups resulting in higher effect sizes than waiting list and other control groups (p50.02).”
Quote in the paperNot a substantial claim
Findingown data
Bivariate meta-regression found no significant association between effect size and number of treatment sessions (coefficient 0.00; 95% CI -0.04 to 0.04; p = 1.00).
“the number of treatment sessions (coefficient: 0.00; 95% CI: 20.04 to 0.04; p51.00)”
Quote in the paperNot a substantial claim
Findingown data
The direct comparison between high-income Western and non-Western countries was not significant (p = 0.17).
“A direct comparison between high-income countries in Western and non-Western countries did not indicate a significant difference (p50.17),but this may have been related to the small number of studies from high-income non-Western countries.”
Quote in the paperNot a substantial claim

Findingown data
Bivariate meta-regression found no significant association between effect size and gross national income per capita (coefficient 0.00; 95% CI -0.00 to 0.00; p = 0.56).
“we found no indication that the effect size was significantly associated with the GNI (coefficient: 0.00; 95% CI: 20.00 to 0.00; p50.56)”
Quote in the paperSubstantial claim
Findingown data
Egger's test indicated significant funnel plot asymmetry (p = 0.004; intercept 2.42; 95% CI 0.65-4.20).
“Egger's test also pointed at significant asymmetry of the funnel plot (p50.004;intercept: 2.42; 95% CI: 0.65-4.20).”
Quote in the paperSubstantial claim
Findingown data
After excluding extreme outliers, the pooled effect was g = 0.87 (95% CI 0.73-1.06).
“The pooled effect size after excluding these extreme outliers was g50.87 (95% CI: 0.73-1.06;I 2 578; 95% CI: 69-83).”
Quote in the paperNot a substantial claim
Findingown data
In multivariate meta-regression, Western versus non-Western country remained a significant predictor of effect size after adjusting for participant, intervention, and study characteristics (p < 0.001).
“Whether the study was conducted in a Western or non-Western country remained a significant predictor of the effect size after adjusting for all other characteristics of the participants, interventions and studies (p<0.001).”
Quote in the paperSubstantial claim
Findingown data
Another 221 Western studies with 297 comparisons were included for comparison.
“Another 221 studies (with 297 comparisons between a treatment and a control group) on psychotherapies in Western countries were included (for the comparison of effect sizes in Western versus non-Western countries).”
Quote in the paperSubstantial claim
Findingown data
In a third multivariate meta-regression, upper-middle-income (p = 0.002) and low/lower-middle-income (p = 0.004) countries had significantly higher effect sizes than high-income countries, adjusting for all other variables.
“we found that both studies conducted in upper middle-(p50.002)and in low/ lower middle-income countries (p50.004) had significantly higher effect sizes than those in high-income countries, while adjusting for all other variables.”
Quote in the paperSubstantial claim
Findingown data
After excluding potential outliers, the pooled effect was g = 0.95 (95% CI 0.82-1.08; NNT = 2.95).
“After exclusion of these studies, the effects dropped to g50.95 (95% CI: 0.82-1.08;NNT52.95).”
Quote in the paperSubstantial claim
Findingown data
Nine studies were potential outliers.
“Nine studies were potential outliers 39,47,[49][50][51]53,55,58,59 .”
Quote in the paperNot a substantial claim
Findingown data
In subgroup analyses excluding extreme outliers, risk of bias was significantly associated with effect size (p < 0.001).
“In the subgroup analyses, excluding the extreme outliers, we found that the risk of bias was significantly associated with the effect size (p<0.001).”
Quote in the paperSubstantial claim
Findingown data
After adjusting for publication bias, the pooled effect size in non-Western countries was g = 0.73 (95% CI 0.51-0.96).
“After adjustment for publication bias, the effect size dropped to g50.73 (95% CI: 0.51-0.96).”
- Also stated in: § BDI -Beck Depression Inventory, HAM-D -Hamilton Rating Scale for Depression, NNT -numbers-needed-to-be-treated, CBT -cognitive behavior therapy · plain
  “After adjustment for publication bias, the mean effect size was reduced from g51.10 to g50.73 (95% CI: 0.51-0.96;number of missed studies: 9).”
Quote in the paperSubstantial claim
Findingown data
Effects were significantly larger in non-Western than Western countries, including after adjustment for participant, treatment, and study characteristics.
“Comparisons with the studies in Western countries showed that the effects of the therapies were significantly larger in non-Western countries, also after adjusting for characteristics of the participants, the treatments and the studies.”
- Also stated in: § Comparison between the effects of psychotherapy in Western vs. non-Western countries · plain
  “Whether the study was conducted in a Western or non-Western country remained a significant predictor of the effect size after adjusting for all other characteristics of the participants, interventions and studies (p<0.001).”
Quote in the paperSubstantial claim
Findingown data
Visual inspection of the funnel plot and trim and fill indicated considerable publication bias.
“Visual inspection of the funnel plot, as well as Duval and Tweedie's trim and fill procedure, pointed at considerable publication bias.”
Quote in the paperSubstantial claim
Findingown data
Subgroup analyses did not show an association between adaptation to the local situation and effect size.
“Subgroup analyses did not indicate that adaptation to the local situation was associated with the effect size.”
- Also stated in: § BDI -Beck Depression Inventory, HAM-D -Hamilton Rating Scale for Depression, NNT -numbers-needed-to-be-treated, CBT -cognitive behavior therapy · plain
  “None of the other subgroup analyses resulted in significant differences between subgroups, and that included the region (East Asia, Middle East and North Africa, South Asia, other), the level of income of the country (high, upper middle, low/ lower middle), and whether or not the treatment was adapted to the local situation.”
Quote in the paperNot a substantial claim
Findingown data
Three potential outliers had extremely high effect sizes (g > 2.0).
“There were three potential outliers with extremely high effect sizes (g>2.0)39,51,58 .”
Quote in the paperNot a substantial claim
Findingown data
Bivariate meta-regression found no significant association between effect size and year of publication (coefficient 0.00; 95% CI -0.03 to 0.04; p = 0.84).
“year of publication (coefficient: 0.00; 95% CI: 20.03 to 0.04; p50.84).”
Quote in the paperNot a substantial claim
Findingown data
In a second multivariate meta-regression, studies in the Middle East and North Africa and in South Asia had significantly higher effect sizes than studies from the United States.
“We found that studies conducted in the Middle East and North Africa, and in South Asia had significantly higher effect sizes than the reference group (studies from the United States).”
Quote in the paperSubstantial claim
Findingown data
Even after adjusting for study quality, non-Western studies showed better outcomes than Western ones.
“after adjustment for study quality, studies in non-Western countries were still had better outcomes than those in Western countries.”
Quote in the paperNot a substantial claim
Findingown data
Psychotherapies for depression in non-Western countries produce larger effect sizes than those in Western countries.
“We even found indications that these therapies may be more effective in non-Western than in Western countries.”
- Also stated in: § DISCUSSION · plain
  “We found that the studies in non-Western countries had better outcomes than those from Western countries”
Quote in the paperSubstantial claim
Findingown data
No evidence linked treatment format to effect size.
“Because we found no indication that the effects are associated with the treatment format”
Quote in the paperSubstantial claim
Findingown data
No evidence suggested that adapting treatment to the local context improved outcomes.
“We did not find indications that a specific adaptation of the treatment to the context where the therapy was conducted was associated with better outcomes.”
Quote in the paperSubstantial claim
Findingown data
Western-developed psychotherapies for depression are effective in non-Western countries.
“Our study documents that psychotherapies for depression that have been developed in Western countries are also effective in non-Western countries.”
Quote in the paperSubstantial claim
Findingown data
Effect sizes were significantly higher in upper middle- and low/lower middle-income countries than in high-income countries.
“that studies in upper middle-and low/lower middle-income countries resulted in significantly higher effect sizes than studies in highincome countries.”
Quote in the paperSubstantial claim
Findingown data
Only 6 of the 32 comparisons had low risk of bias.
“Risk of bias was low in only 6 of the 32 included comparisons”
Quote in the paperSubstantial claim
Findingown data
The Middle East and North Africa and South Asia showed particularly large effect sizes.
“that the effect sizes were especially high in the Middle East and North-Africa, and in South Asia”
Quote in the paperNot a substantial claim
Findingown data
High-quality studies reported much smaller effects than lower-quality studies.
“these high-quality studies found considerably smaller effect sizes than the others”
Quote in the paperSubstantial claim
Premisereasoning
It was not well known whether these therapies are effective in low- and middle-income countries.
“It is therefore not well known whether these therapies are also effective in low-and middle-income countries.”
Quote in the paperSubstantial claim
- Rests on an assumption: Most psychotherapies for depression were developed in high-income Western countries.
Premisecitation
The vast majority of more than 450 randomized trials on psychotherapies for depression were conducted in high-income Western countries.
“Most psychotherapies have been developed in high-income Western countries in North America, Europe and Australia, and the vast majority of the more than 450 randomized trials which have examined their effects 20 have been conducted in those countries.”
Quote in the paperSubstantial claim0 of 1 sources checked
- cites [20] source
  Not checked in the free run.
Study design and conductown data
The greater effectiveness in non-Western countries remained significant in multivariate meta-regression analyses that controlled for participant, intervention, and study characteristics.
“This finding remained significant in multivariate meta-regression analyses in which we controlled for characteristics of the participants, the interventions and the studies.”
Quote in the paperSubstantial claim
Interpretationreasoning
Selection bias may have distorted the results.
“That implies that our results may be distorted because of bias in the selection of studies.”
Quote in the paperNot a substantial claim
Interpretationown data
Western-developed psychotherapies can be delivered in non-Western settings without cultural adaptation, provided resources are sufficient.
“These findings do suggest that psychotherapies developed in Western countries can be implemented in non-Western countries when sufficient resources are available and without culturally adapting them.”
Quote in the paperSubstantial claim
Interpretationown data
The actual effects are likely smaller than those observed.
“suggesting that the true effects are probably smaller than we found.”
Quote in the paperSubstantial claim

May combine two claims. 21
Classified as probably not a substantial claim. 8

May combine two claims.
Findingown data
There was a significant difference across country income levels, with the highest effect sizes in low- and middle-income countries.
“We also found a significant difference across countries with different incomes, with the highest effect sizes in low-and middle-income countries.”
Quote in the paperSubstantial claim
May combine two claims.
Findingown data
Psychotherapies in non-Western countries had a large pooled effect size, Hedges' g = 1.10 (95% CI 0.91-1.30), corresponding to NNT = 2.51.
“The effects of psychotherapies in non-Western countries were large (g51.10;95% CI: 0.91-1.30),with high heterogeneity (I 2 590; 95% CI: 87-92).”
- Also stated in: § Effects of psychotherapies in non-Western countries · plain
  “The overall effect in the 35 comparisons between psychotherapies and control groups was g51.10 (95% CI: 0.91-1.30),which corresponds with a NNT of 2.51.”
Quote in the paperSubstantial claim
May combine two claims.
Findingown data
Thirty-two non-Western studies with 35 comparisons met inclusion criteria.
“A total of 32 studies conducted in non-Western countries (with 35 comparisons between a psychotherapy and a control condition) met inclusion criteria for this meta-analysis (Table 1).”
Quote in the paperSubstantial claim
May combine two claims.
Findingown data
Analyses including only one effect size per study produced effect sizes almost the same as the overall analyses, with heterogeneity still very high.
“As can be seen from Table 2, the resulting effect sizes were almost the same as in the overall analyses.Heterogeneity was still very high in these analyses.”
Quote in the paperNot a substantial claim
May combine two claims.
Findingown data
The effect size in Western countries was g = 0.60 (95% CI 0.55-0.64; I2 = 59, 95% CI 53-64; NNT = 4.99), significantly lower than in non-Western countries (p < 0.001).
“We found that the effect size in Western countries (g5 0.60; 95% CI: 0.55-0.64;I 2 559; 95% CI: 53-64; NNT54.99) was significantly lower than in non-Western countries (p<0.001).”
Quote in the paperSubstantial claim
May combine two claims.
Findingown data
In parsimonious stepwise models, risk of bias and type of control group remained significant, as did Western versus non-Western country, region, and income level.
“As can be seen, in all three models, risk of bias and type of control group remained significant, as well as the dummies indicating Western vs. non-Western countries, the regions and the income level.”
Quote in the paperSubstantial claim
May combine two claims.
Findingown data
The meta-analysis included 253 randomized controlled trials, of which 32 were from non-Western countries.
“We conducted systematic searches in bibliographical databases and included 253 randomized controlled trials, of which 32 were conducted in non-Western countries.”
- Also stated in: § Selection and inclusion of studies · plain
  “This makes a total of 253 studies that were included in the analyses.”
Quote in the paperSubstantial claim
May combine two claims.
Findingown data
No significant subgroup differences were found for region or country income level.
“None of the other subgroup analyses resulted in significant differences between subgroups, and that included the region (East Asia, Middle East and North Africa, South Asia, other), the level of income of the country (high, upper middle, low/ lower middle), and whether or not the treatment was adapted to the local situation.”
Quote in the paperSubstantial claim
May combine two claims.
Findingown data
The six comparisons with the lowest risk of bias had an effect size of g = 0.51 (95% CI 0.34-0.69; NNT = 6.01), compared with g = 1.20 (95% CI 0.84-1.56; NNT = 2.29) in studies with the highest risk of bias.
“The six comparisons with the lowest risk of bias (no risk of bias for any of the four items of the assessment tool) had an effect size of g50.51 (95% CI: 0.34-0.69;NNT56.01)compared to g51.20 (95% CI: 0.84-1.56;NNT52.29) in the studies with the highest risk of bias.”
Quote in the paperSubstantial claim
May combine two claims.
Findingown data
Effect sizes differed significantly across regions (p < 0.001), with the lowest in North America, Europe, and Australia and the highest in East Asia, South Asia, and the Middle East and North Africa.
“We also examined the effect sizes in the different regions and found that they differed significant across regions (p<0.001), with the lowest effect sizes in North America, Europe and Australia, and the highest in East Asia, South Asia and the Middle East and North Africa.”
Quote in the paperSubstantial claim
May combine two claims.
Findingown data
Low-risk-of-bias studies yielded much smaller effect sizes than higher-risk studies, similar to those in Western countries.
“these studies with low risk of bias had considerably lower effect sizes than those with higher risk, very comparable to the ones found in Western countries.”
Quote in the paperSubstantial claim
Classified as probably not a substantial claim.
Study design and conductown data
Systematic searches were conducted in bibliographical databases.
“We conducted systematic searches in bibliographical databases and included 253 randomized controlled trials, of which 32 were conducted in non-Western countries.”
- Also stated in: § Identification and selection of studies · plain
  “For this database we searched four major bibliographical sources (PubMed, Psyc-INFO, Embase and the Cochrane Library) by combining terms (both index terms and text words) indicative of depression and psychotherapies, with filters for randomized controlled trials.”
Quote in the paperSubstantial claim
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown data
Quality assessment was conducted by two independent researchers, with disagreements resolved through discussion.
“Assessment of the quality of the included studies was conducted by two independent researchers, and disagreements were solved through discussion.”
Quote in the paperNot a substantial claim
Classified as probably not a substantial claim.
Study design and conductreasoning
A random effects pooling model was used in all analyses because considerable heterogeneity was expected.
“Because we expected considerable heterogeneity among the studies, we employed a random effects pooling model in all analyses.”
Quote in the paperSubstantial claim
Classified as probably not a substantial claim. May combine two claims.
Study design and conductown data
Records were screened by two independent researchers, and inclusion/exclusion decisions were made by two independent researchers with disagreements resolved through discussion.
“All records were screened by two independent researchers and all papers that could possibly meet inclusion criteria according to one of the researchers were retrieved as full text.The decision to include or exclude a study was also done by the two independent researchers, and disagreements were solved through discussion.”
Quote in the paperSubstantial claim
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown data
Publication bias was tested by funnel plot inspection, Duval and Tweedie's trim and fill, and Egger's test.
“We tested for publication bias by inspecting the funnel plot on primary outcome measures and by Duval and Tweedie's trim and fill procedure 34 , which yields an estimate of the effect size after the publication bias has been taken into account (as implemented in Comprehensive Meta-Analysis).We also conducted Egger's test of the intercept to quantify the bias captured by the funnel plot and to test”
Quote in the paperNot a substantial claim0 of 1 sources checked
- cites [34] source
  Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown data
Sensitivity analyses excluded potential outliers, defined as studies whose 95% CI did not overlap with the pooled effect size 95% CI.
“We conducted sensitivity analyses excluding potential outliers.These were defined as studies in which the 95% CI of the effect size did not overlap with the 95% CI of the pooled effect size.”
Quote in the paperNot a substantial claim
May combine two claims.
Interpretationown data
The study suggests that Western-developed psychotherapies may or may not be more effective in non-Western countries, but are probably no less effective and can be used there.
“This study suggests that psychotherapies that were developed in Western countries may or may not be more effective in non-Western countries, but they are probably no less effective and can therefore also be used in these latter countries.”
Quote in the paperSubstantial claim
- Rests on an assumption: The 32 included non-Western trials are representative of psychotherapies for depression in non-Western countries generally.
May combine two claims.
Study design and conductown data
Three studies included two psychological treatments compared with the same control group, which may have affected heterogeneity and the pooled effect size.
“In this meta-analysis, we included three studies in which two psychological treatments were compared with the same control group.This means that multiple comparisons were included in the same analysis, which may have resulted in an artificial reduction of heterogeneity and may have affected the pooled effect size.”
Quote in the paperSubstantial claim
May combine two claims.
Study design and conductown data
Most included studies were of suboptimal quality, with only a few rated high quality.
“the quality of most of the included studies was not optimal, and only a handful of them had a high quality.”
Quote in the paperSubstantial claim
May combine two claims.
Study design and conductown data
The literature search relied mainly on Western databases, and non-English studies were not directly accessible.
“our searches mainly focused on Western databases, while studies published in other languages were not directly accessible.”
Quote in the paperNot a substantial claim
Classified as probably not a substantial claim. May combine two claims.
Study design and conductreasoning
Most papers described interventions only briefly, so undetected cultural adaptations cannot be ruled out.
“because the description of the intervention was very brief in most papers, so that it cannot be excluded that the interventions were still adapted although this was not mentioned in the paper.”
Quote in the paperSubstantial claim
May combine two claims.
Interpretationown data
Western-developed psychotherapies are likely at least as effective in non-Western countries as in Western ones, so they can be used there irrespective of income level.
“this study suggests that psychotherapies developed in Western countries may or not be more effective in non-Western countries, but are probably no less effective and can therefore also be used in these latter countries, regardless of their income level.”
Quote in the paperSubstantial claim
May combine two claims.
Study design and conductown data
Non-Western studies came mostly from a selected set of Asian countries, with few from Africa or Latin America.
“most studies in non-Western countries were conducted in a selected sample of countries in Asia, and only few in Africa and Latin America.”
Quote in the paperNot a substantial claim
Probably not a substantial claim: may not pass S2 (checkable).
Interpretationreasoning
Low-intensity interventions could be offered as a first-line treatment.
“it would be possible to introduce low intensity interventions as a first line treatment”
Quote in the paperNot a substantial claim
- Rests on an assumption: Low-intensity interventions are simpler and less costly to deliver than high-intensity ones.

25 of 25

The paper relies on this without support.
Most psychotherapies for depression were developed in high-income Western countries.
“Most psychotherapies have been developed in high-income Western countries in North America, Europe and Australia, and the vast majority of the more than 450 randomized trials which have examined their effects 20 have been conducted in those countries.”
The paper relies on this without support.
The 32 included non-Western trials are representative of psychotherapies for depression in non-Western countries generally.
“This study suggests that psychotherapies that were developed in Western countries may or may not be more effective in non-Western countries, but they are probably no less effective and can therefore also be used in these latter countries.”
The paper relies on this without support.
Low-intensity interventions are simpler and less costly to deliver than high-intensity ones.
“because these are easier and cheaper to implement than high intensity ones.”

3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Accumulating evidence from 30 trials supports efficacy of mindfulness-based CBT, preventive CBT, and IPT in relapse prevention.
“Accumulating evidence from 30 trials also supports efficacy of mindfulness-based CBT, preventive CBT, and IPT in relapse prevention. 553”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [553]
A recent meta-analysis of depression treatments in low- and middle-income countries with 32 RCTs found an effect size of 0.73 (Hedges g) for symptoms of depression.
“A recent meta-analysis of depression treatments in low- and middle-income countries has been conducted with 32 RCTs, looking at different intervention types, formats (eg, guided self-help, group therapy), and comparators (eg, waitlist, treatment as usual) [25]. An effect size of 0.73 (Hedges g) was found for symptoms of depression.”
From Evaluating the Effectiveness of an E-Mental Health Intervention for People Living in Lebanon: Protocol for Two Randomized Controlled Trials (2021) · cites this paper as [25]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

Conflicting upper confidence limits for the same pooled effect
Minor
The text and Table 3 report the same effect size and heterogeneity after excluding the three extreme outliers, but give different upper limits for its 95% confidence interval: 1.06 versus 1.02.

1 of 1

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Uncertainty in heterogeneity estimates in meta-analyses
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A Meta-Analysis of Cognitive-Behavioural Therapy for Adult Depression, Alone and in Comparison with other Treatments
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Psychotherapy for depression in adults: A meta-analysis of comparative outcome studies.
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Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial
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Group Interpersonal Psychotherapy for Depression in Rural Uganda: A Randomized Controlled Trial
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The effects of psychotherapies for major depression in adults on remission, recovery and improvement: a meta-analysis
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How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence
Cuijpers, P., Cristea, I. A., Karyotaki, E., Reijnders, M., & Huibers, M. J. H. (2016) · World Psychiatry · doi:10.1002/wps.20346 · Cited by 572 · see citing works
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Comparative Efficacy of Seven Psychotherapeutic Interventions for Patients with Depression: A Network Meta-Analysis
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Behavioural Activation for Depression; An Update of Meta-Analysis of Effectiveness and Sub Group Analysis
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The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta‐analysis of direct comparisons
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The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size
Cuijpers, P., van Straten, A., Bohlmeijer, E., Hollon, S. D., & Andersson, G. (2010) · Psychological Medicine · doi:10.1017/s0033291709006114 · Cited by 533 · see citing works
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Interpersonal Psychotherapy for Depression: A Meta-Analysis
Cuijpers, P., Geraedts, A. S., van Oppen, P., Andersson, G., Markowitz, J. C., & van Straten, A. (2011) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2010.10101411 · Cited by 511 · see citing works
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Efficacy of cognitive–behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias
Cuijpers, P., Smit, F., Bohlmeijer, E., Hollon, S. D., & Andersson, G. (2010) · British Journal of Psychiatry · doi:10.1192/bjp.bp.109.066001 · Cited by 391 · see citing works
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Psychological treatment of depression: Results of a series of meta-analyses
Cuijpers, P., Andersson, G., Donker, T., & van Straten, A. (2011) · Nordic Journal of Psychiatry · doi:10.3109/08039488.2011.596570 · Cited by 335 · see citing works
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Cognitive–behavioral group therapy is an effective treatment for major depression in hemodialysis patients
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Problem solving therapies for depression: A meta-analysis
Cuijpers, P., van Straten, A., & Warmerdam, L. (2007) · European Psychiatry · doi:10.1016/j.eurpsy.2006.11.001 · Cited by 261 · see citing works
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A group-based counselling intervention for depression comorbid with HIV/AIDS using a task shifting approach in South Africa: A randomized controlled pilot study
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Effects of support group intervention in postnatally distressed women
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Nakimuli‐Mpungu, E., Wamala, K., Okello, J., Alderman, S., Odokonyero, R. F., Mojtabai, R., Mills, E. J., Kanters, S., Nachega, J. B., & Musisi, S. (2015) · The Lancet HIV · doi:10.1016/s2352-3018(15)00041-7 · Cited by 111 · see citing works
Effectiveness of cognitive-behavioral therapy on depressive symptomatology, stress and coping strategies among Jordanian university students
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Antenatal Cognitive-behavioral Therapy for Prevention of Postpartum Depression: A Pilot Study
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The Effect of Telephone-Based Cognitive-Behavioral Therapy on Postnatal Depression: A Randomized Controlled Trial
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Telephone Cognitive-Behavioral Therapy for Subthreshold Depression and Presenteeism in Workplace: A Randomized Controlled Trial
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A randomized controlled trial of group cognitive behavioral therapy for Chinese breast cancer patients with major depression
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Evaluation of an Outpatient Intervention for Women With Severe Depression and a History of Childhood Trauma
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Cognitive behavioral treatment groups for people with chronic depression in Hong Kong: a randomized wait-list control design
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Target groups for the prevention of late-life anxiety
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A multicentre randomised controlled trial of a carer supervised Culturally adapted CBT (CaCBT) based self-help for depression in Pakistan
Naeem, F., Sarhandi, I., Gul, M., Khalid, M., Aslam, M., Anbrin, A., Saeed, S., Noor, M., Fatima, G., Minhas, F., et al. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.10.051 · Cited by 57 · see citing works
THE LONG-TERM EFFICACY OF ACUTE-PHASE PSYCHOTHERAPY FOR DEPRESSION: A META-ANALYSIS OF RANDOMIZED TRIALS
Karyotaki, E., Smit, Y., Beurs, D. P. D., Henningsen, K. H., Robays, J., Huibers, M. J. H., Weitz, E. S., & Cuijpers, P. J. (2016) · Depression and Anxiety · doi:10.1002/da.22491 · Cited by 56 · see citing works
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A Comparison of Two Modalities of Cognitive Therapy (Individual and Marital) in Treating Depression
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A Chinese Chan-based mind–body intervention for patients with depression
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Comparing mindfulness based cognitive therapy and traditional cognitive behavior therapy with treatments as usual on reduction of major depressive disorder symptoms
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Cognitive behavioral therapy in combination with systemic family therapy improves mild to moderate postpartum depression
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A comparison of cognitive-behavioral therapy, antidepressants, their combination and standard treatment for Chinese patients with moderate–severe major depressive disorders
Zu, S., Xiang, Y., Liu, J., Zhang, L., Wang, G., Ma, X., Kilbourne, A. M., Ungvari, G. S., Chiu, H. F. K., Lai, K. Y. C., et al. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.09.022 · Cited by 47 · see citing works
Cognitive and Health-Related Outcomes of Group Cognitive Behavioural Treatment for People With Depressive Symptoms in Hong Kong: Randomized Wait-List Control Study
Wong, D. F. K. (2008) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/00048670802203418 · Cited by 45 · see citing works
Effects of motivational enhancement therapy plus cognitive behaviour therapy on depressive symptoms and health-related quality of life in adults with type II diabetes mellitus: a randomised controlled trial
Huang, C., Lai, H., Chen, C., Lu, Y., Li, S.-C., Wang, L.-W., & Su, Y. (2015) · Quality of Life Research · doi:10.1007/s11136-015-1165-6 · Cited by 37 · see citing works
A randomised controlled study to explore the effect of life story review on depression in older Chinese in Singapore
Chan, M. F., Ng, S. E., Tien, A., Ho, R., & Thayala, J. (2013) · Health & Social Care in the Community · doi:10.1111/hsc.12043 · Cited by 35 · see citing works
Effectiveness of Integrated Body–Mind–Spirit Group Intervention on the Well-Being of Indian Patients With Depression
Rentala, S., Reddemma, K., Chan, C., Leung, P. P. Y., Wong, V., & Chan, C. (2013) · Journal of Nursing Research · doi:10.1097/jnr.0b013e3182a0b041 · Cited by 27 · see citing works
Exploring the Efficacy of Cognitive Bibliotherapy and a Potential Mechanism of Change in the Treatment of Depressive Symptoms Among the Chinese: A Randomized Controlled Trial
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Evaluation of a cognitive behavioural self‐help manual for reducing depression: a randomized controlled trial
Songprakun, W., & McCann, T. V. (2012) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/j.1365-2850.2011.01861.x · Cited by 25 · see citing works
Culturally sensitive, preventive antenatal group cognitive–behavioural therapy for C hinese women with depression
Leung, S. S., Lee, A. M., Chiang, C. L. V., Lam, S., Yung, W. K., & Wong, D. F. (2013) · International Journal of Nursing Practice · doi:10.1111/ijn.12021 · Cited by 25 · see citing works
Psychological intervention for postpartum depression
Jiang, L., Wang, Z.-Z., Qiu, L.-R., Wan, G., Lin, Y., & Wei, Z. (2014) · Journal of Huazhong University of Science and Technology [Medical Sciences] · doi:10.1007/s11596-014-1297-x · Cited by 14 · see citing works
Personalized treatment for functional outcome in depression
Cuijpers, P. (2014) · VU Research Portal · Cited by 11 · see citing works
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One‐Year Follow‐Up of the Effectiveness of Cognitive Behavioral Group Therapy for Patients’ Depression: A Randomized, Single‐Blinded, Controlled Study
Chiang, K., Chen, T.-H., Hsieh, H.-T., Tsai, J.-C., Ou, K., & Chou, K. (2015) · The Scientific World JOURNAL · doi:10.1155/2015/373149 · Cited by 11 · see citing works
Predictors of Group Cognitive Behaviour Therapy outcomes for the treatment of depression in Malaysia
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Clinical effectiveness of group cognitive-behavioural therapy for depressed older people in primary care: A randomised controlled trial
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The effect of life story review on depression of older community‐dwelling Chinese adults in Singapore: a preliminary result
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Sorted by citations

Time for united action on depression: a Lancet–World Psychiatric Association Commission
Herrman, H., Patel, V., Kieling, C., Berk, M., Buchweitz, C., Cuijpers, P., Furukawa, T. A., Kessler, R. C., Kohrt, B. A., Maj, M., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)02141-3 · Cited by 1,104 · see citing works
Self-citation
A network meta‐analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression
Cuijpers, P., Noma, H., Karyotaki, E., Vinkers, C. H., Cipriani, A., & Furukawa, T. A. (2020) · World Psychiatry · doi:10.1002/wps.20701 · Cited by 540 · see citing works
Self-citation
The Role of Communities in Mental Health Care in Low- and Middle-Income Countries: A Meta-Review of Components and Competencies
Kohrt, B. A., Asher, L., Bhardwaj, A., Fazel, M. S., Jordans, M. J. D., Mutamba, B. B., Nadkarni, A., Pedersen, G. A., Singla, D. R., & Patel, V. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15061279 · Cited by 363 · see citing works
“, 2017 [35] Common mental disorders, Perinatal mental disorders De Silva et al.”
BackgroundInfluential
Efficacy of Psychosocial Interventions for Mental Health Outcomes in Low-Income and Middle-Income Countries: An Umbrella Review
Barbui, C., Purgato, M., Abdulmalik, J., Acarturk, C., Eaton, J., Gastaldon, C., Gureje, O., Hanlon, C., Jordans, M., Lund, C., et al. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30511-5 · Cited by 349 · see citing works
“In children, psychosocial interventions were supported by at least suggestive evidence in conduct disorders and for PTSD ; 35,37 however, on the basis of umbrella review and GRADE criteria, none of these effect sizes reached the maximum of the ratings in terms of strength of association and…”
Self-citation
The effects of fifteen evidence-supported therapies for adult depression: A meta-analytic review
Cuijpers, P., Karyotaki, E., de Wit, L., & Ebert, D. D. (2020) · Psychotherapy Research · doi:10.1080/10503307.2019.1649732 · Cited by 276 · see citing works
“…have been consistently found to be significant predictors of the effects of therapies: type of control condition (Mohr et al., 2014), risk of bias (Cuijpers, van Straten, Bohlmeijer, Hollon, &Andersson, 2010), and whether or not the study was conducted in a Western country (Cuijpers et al., 2018).”
BackgroundSelf-citation
Innovative Models in Mental Health Delivery Systems: Task Sharing Care with Non-specialist Providers to Close the Mental Health Treatment Gap
Raviola, G., Naslund, J. A., Smith, S. L., & Patel, V. (2019) · Current Psychiatry Reports · doi:10.1007/s11920-019-1028-x · Cited by 258 · see citing works
Cultural Adaptation of Scalable Psychological Interventions: A New Conceptual Framework
Heim, E., & Kohrt, B. A. (2019) · Clinical Psychology in Europe · doi:10.32872/cpe.v1i4.37679 · Cited by 191 · see citing works
Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries
van Ginneken, N., Chin, W. Y., Lim, Y. C., Ussif, A., Singh, R. K., Shahmalak, U., Purgato, M., Rojas‐García, A., Uphoff, E., McMullen, S., et al. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009149.pub3 · Cited by 195 · see citing works
Self-citation
Two decades of digital interventions for anxiety disorders: a systematic review and meta-analysis of treatment effectiveness
Pauley, D., Cuijpers, P., Papola, D., Miguel, C., & Karyotaki, E. (2021) · Psychological Medicine · doi:10.1017/s0033291721001999 · Cited by 170 · see citing works
“…et al., 2016), providing open-access, self-managed care as a valuable treatment strategy where healthcare systems lack the infrastructure to provide mental health services at scale, a common barrier in low-and middle-income countries (Cuijpers, Karyotaki, Reijnders, Purgato, & Barbui, 2018).”
Self-citation
Psychological interventions to prevent the onset of depressive disorders: a meta-analysis of randomized controlled trials
Cuijpers, P., Pineda, B. S., Quero, S., Karyotaki, E., Struijs, S. Y., Figueroa, C. A., Llamas, J. A., Furukawa, T. A., & Muñoz, R. F. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101955 · Cited by 148 · see citing works
Self-citation
Psychological treatment of depression: A systematic overview of a 'Meta-Analytic Research Domain'
Cuijpers, P., Miguel, C., Harrer, M., Plessen, C. Y., Ciharova, M., Papola, D., Ebert, D., & Karyotaki, E. (2023) · Journal of Affective Disorders · doi:10.1016/j.jad.2023.05.011 · Cited by 136 · see citing works
Self-citation
Problem-solving therapy for adult depression: An updated meta-analysis
Cuijpers, P., de Wit, L., Kleiboer, A., Karyotaki, E., & Ebert, D. D. (2018) · European Psychiatry · doi:10.1016/j.eurpsy.2017.11.006 · Cited by 134 · see citing works
“We also searched a number of bibliographical databases to identify trials in non-Western countries [30], because the number of trials on psychological treatments in these countries is growing rapidly.”
MethodSelf-citation
Implementation and Effectiveness of Nonspecialist-Delivered Interventions for Perinatal Mental Health in High-Income Countries
Singla, D. R., Lawson, A., Kohrt, B. A., Jung, J. W., Meng, Z., Ratjen, C., Zahedi, N., Dennis, C., & Patel, V. (2021) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2020.4556 · Cited by 136 · see citing works
Cognitive restructuring, behavioral activation and cognitive-behavioral therapy in the treatment of adult depression: A network meta-analysis
Ciharova, M., Furukawa, T. A., Efthimiou, O., Karyotaki, E., Miguel, C., Noma, H., Cipriani, A., Riper, H., & Cuijpers, P. (2021) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000654 · Cited by 124 · see citing works
Who benefits from psychotherapies for adult depression? A meta-analytic update of the evidence
Cuijpers, P., Karyotaki, E., Reijnders, M., & Huibers, M. J. H. (2018) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2017.1420098 · Cited by 115 · see citing works
Self-citation
Effects of a WHO-guided digital health intervention for depression in Syrian refugees in Lebanon: A randomized controlled trial
Cuijpers, P., Heim, E., Abi Ramia, J., Burchert, S., Carswell, K., Cornelisz, I., Knaevelsrud, C., Noun, P., van Klaveren, C., van’t Hof, E., et al. (2022) · PLoS Medicine · doi:10.1371/journal.pmed.1004025 · Cited by 118 · see citing works
“Assuming 70% dropout [31,32], we planned to recruit 568 participants to show that the intervention was effective.”
BackgroundSelf-citation
Negative effects of psychotherapies for adult depression: A meta-analysis of deterioration rates
Cuijpers, P., Reijnders, M., Karyotaki, E., de Wit, L., & Ebert, D. D. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.05.050 · Cited by 105 · see citing works
“We also searched a number of bibliographical databases to identify trials in non-Western countries (Cuijpers et al., 2018), because the number of trials on psychological treatments in these countries is growing rapidly.”
BackgroundMethodSelf-citation
Psychological treatment of perinatal depression: a meta-analysis
Cuijpers, P., Franco, P., Ciharova, M., Miguel, C., Segre, L., Quero, S., & Karyotaki, E. (2023) · Psychological Medicine · doi:10.1017/s0033291721004529 · Cited by 103 · see citing works
“Numbers needed-to-be-treated (NNT) for depression outcomes were calculated using the formulae provided by Furukawa (1999). The NNT is the inverse of the risk difference between the treatment and control group (Laupacis, Sackett, & Roberts, 1988), based on a binary outcome.”
MethodSelf-citation
A Meta-analytic Review: Psychological Treatment of Subthreshold Depression in Children and Adolescents
Cuijpers, P., Pineda, B. S., Ng, M. Y., Weisz, J. R., Muñoz, R. F., Gentili, C., Quero, S., & Karyotaki, E. (2021) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2020.11.024 · Cited by 102 · see citing works
Self-citation
A culturally adapted cognitive behavioral Internet-delivered intervention for depressive symptoms: randomized controlled trial
Salamanca-Sanabria, A., Richards, D., Timulak, L., Connell, S., Mojica Perilla, M., Parra-Villa, Y., & Castro-Camacho, L. (2020) · JMIR Mental Health · doi:10.2196/13392 · Cited by 83 · see citing works
“LMICs around the world have scarce access to mental health services [26].”
Influential
Scaling up mental health care and psychosocial support in low-resource settings: a roadmap to impact
Jordans, M. J. D., & Kohrt, B. A. (2020) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796020001018 · Cited by 83 · see citing works
“, 2014), though this association is not undisputed (Cuijpers et al., 2018).”
Background
The silent burden: a landscape analysis of common perinatal mental disorders in low- and middle-income countries
McNab, S., Dryer, S., Fitzgerald, L., Gomez, P., Bhatti, A. M., Kenyi, E. E., Somji, A., Khadka, N., & Stalls, S. (2022) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-022-04589-z · Cited by 94 · see citing works
Scaling up psychological treatments for common mental disorders: a call to action
Singla, D. R., Raviola, G., & Patel, V. (2018) · World Psychiatry · doi:10.1002/wps.20532 · Cited by 69 · see citing works
Community cognitive interviewing to inform local adaptations of an e-mental health intervention in Lebanon
Abi Ramia, J., Harper Shehadeh, M., Kheir, W., Zoghbi, E., Watts, S., Heim, E., & El Chammay, R. (2018) · Global Mental Health · doi:10.1017/gmh.2018.29 · Cited by 65 · see citing works
“On the other hand, in a recent meta-analysis of studies testing psychological interventions for the treatment of depression in low- and middle-income countries, cultural adaption did not affect effect sizes (Cuijpers et al. 2018).”
Background
Effectiveness of psychological treatments for depressive symptoms among people living with HIV/AIDS in low- and middle-income countries: A systematic review and meta-analysis
Asrat, B., Schneider, M., Ambaw, F., & Lund, C. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.03.068 · Cited by 63 · see citing works
Guided digital health intervention for depression in Lebanon: randomised trial
Cuijpers, P., Heim, E., Ramia, J. A., Burchert, S., Carswell, K., Cornelisz, I., Knaevelsrud, C., Noun, P., van Klaveren, C., van’t Hof, E., et al. (2022) · Evidence-Based Mental Health · doi:10.1136/ebmental-2021-300416 · Cited by 60 · see citing works
Self-citation
The effectiveness and cost-effectiveness of integrating mental health services in primary care in low- and middle-income countries: systematic review
Cubillos, L., Bartels, S. M., Torrey, W. C., Naslund, J. A., Uribe-Restrepo, J. M., Gaviola, C., Castro, S., John, D. T., Williams, M. J., Cepeda, M., et al. (2020) · BJPsych Bulletin · doi:10.1192/bjb.2020.35 · Cited by 61 · see citing works
Care-as-usual control groups across different settings in randomized trials on psychotherapy for adult depression: a meta-analysis
Cuijpers, P., Quero, S., Papola, D., Cristea, I. A., & Karyotaki, E. (2021) · Psychological Medicine · doi:10.1017/s0033291719003581 · Cited by 62 · see citing works
“That is in line with a previous meta-analysis comparing the effect sizes of psychotherapy for depression in Western and non-Western countries (Cuijpers et al., 2018).”
MethodResultSelf-citation
Efficacy of physical activity interventions on psychological outcomes in refugee, asylum seeker and migrant populations: A systematic review and meta-analysis
Purgato, M., Richards, J. A., Prina, E., Kip, A., Piccolo, L. D., Michencigh, G., Rimondini, M., Rudi, D., Vitali, F., Carta, M. G., et al. (2021) · Psychology of sport and exercise · doi:10.1016/j.psychsport.2021.101901 · Cited by 59 · see citing works
Self-citation
EMPOWER: Toward the Global Dissemination of Psychosocial Interventions
Patel, V., Naslund, J. A., Wood, S., Patel, A., Chauvin, J. J., Agrawal, R. N., Bhan, A., Joshi, U., Amara, M., Kohrt, B. A., et al. (2022) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20220042 · Cited by 56 · see citing works
Digital Interventions for Common Mental Disorders in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis
Karyotaki, E., Miguel, C., Panagiotopoulou, O. M., Harrer, M., Seward, N., Sijbrandij, M., Araya, R., Patel, V., & Cuijpers, P. (2023) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2023.50 · Cited by 56 · see citing works
“Such differences have been previously identified in the literature on psychotherapy trials (Cuijpers et al., 2018) and raise important considerations.”
BackgroundResultInfluentialSelf-citation
Depression and Incident HIV in Adolescent Girls and Young Women in HIV Prevention Trials Network 068: Targets for Prevention and Mediating Factors
Goin, D. E., Pearson, R. M., Craske, M. G., Stein, A. L., Pettifor, A. E., Lippman, S. A., Kahn, K., Neilands, T. B., Hamilton, E. L., Selin, A., et al. (2019) · American Journal of Epidemiology · doi:10.1093/aje/kwz238 · Cited by 49 · see citing works
“As depression is common and potentially modifiable in low and middle-income countries (42), it represents a promising prevention target.”
Background
Adapting an internet-delivered intervention for depression for a Colombian college student population: an illustration of an integrative empirical approach
Salamanca-Sanabria, A., Richards, D., & Timulak, L. (2019) · Internet Interventions · doi:10.1016/j.invent.2018.11.005 · Cited by 49 · see citing works
The Cultural and Contextual Adaptation Process of an Intervention to Reduce Psychological Distress in Young Adolescents Living in Lebanon
Brown, F. L., Aoun, M., Taha, K., Steen, F., Hansen, P., Bird, M., Dawson, K. S., Watts, S., Chammay, R. E., Sijbrandij, M., et al. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00212 · Cited by 50 · see citing works
Digital training for non-specialist health workers to deliver a brief psychological treatment for depression in India: Protocol for a three-arm randomized controlled trial
Naslund, J. A., Tugnawat, D. K., Anand, A., Cooper, Z., Dimidjian, S., Fairburn, C. G., Hollon, S. D., Joshi, U., Khan, A., Lu, C., et al. (2021) · Contemporary Clinical Trials · doi:10.1016/j.cct.2021.106267 · Cited by 45 · see citing works
What Four Decades of Meta-Analysis Have Taught Us About Youth Psychotherapy and the Science of Research Synthesis
Weisz, J. R., Venturo‐Conerly, K. E., Fitzpatrick, O. M., Frederick, J., & Ng, M. Y. (2023) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-080921-082920 · Cited by 46 · see citing works
Online psychotherapy: trailblazing digital healthcare
McDonald, A., Eccles, J. A., Fallahkhair, S., & Critchley, H. D. (2020) · BJPsych Bulletin · doi:10.1192/bjb.2019.66 · Cited by 45 · see citing works
Psychological interventions for depression in Chinese university students: A systematic review and meta-analysis
Fu, Z., Zhou, S., Burger, H., Bockting, C. L. H., & Williams, A. D. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.11.058 · Cited by 44 · see citing works
Culturally and developmentally adapting group interpersonal therapy for adolescents with depression in rural Nepal
Rose‐Clarke, K., Pradhan, I., Shrestha, P., Prakash, B. K., Magar, J., Luitel, N. P., Devakumar, D., Rafaeli, A. K., Clougherty, K. F., Kohrt, B. A., et al. (2020) · BMC Psychology · doi:10.1186/s40359-020-00452-y · Cited by 51 · see citing works
Scale up task-sharing of psychological therapies
Patel, V. (2021) · The Lancet · doi:10.1016/s0140-6736(21)02736-7 · Cited by 44 · see citing works
Five decades of research on psychological treatments of depression: A historical and meta-analytic overview.
Cuijpers, P. J., Harrer, M., Miguel, C., Čihařová, M., & Karyotaki, E. (2023) · American Psychologist · doi:10.1037/amp0001250 · Cited by 43 · see citing works
Self-citation
Lay-delivered talk therapies for adults affected by humanitarian crises in low- and middle-income countries
Ryan, G. K., Bauer, A., Endale, T., Qureshi, O., Doukani, A., Pashoja, A. C., Brar, S. K., Eaton, J., & Bass, J. (2021) · Conflict and Health · doi:10.1186/s13031-021-00363-8 · Cited by 36 · see citing works
Amount and frequency of psychotherapy as predictors of treatment outcome for adult depression: A meta-regression analysis
Čihařová, M., Karyotaki, E., Miguel, C., Walsh, E., de Ponti, N., Amarnath, A., van Ballegooijen, W., Riper, H. M., Arroll, B., & Cuijpers, P. J. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.05.070 · Cited by 36 · see citing works
Self-citation
From neural circuits to communities: an integrative multidisciplinary roadmap for global mental health
Craske, M. G., Herzallah, M. M., Nusslock, R., & Patel, V. (2023) · Nature Mental Health · doi:10.1038/s44220-022-00012-w · Cited by 30 · see citing works
Meta-analysis: The Effectiveness of Youth Psychotherapy Interventions in Low- and Middle-Income Countries
Venturo‐Conerly, K. E., Eisenman, D., Wasil, A. R., Singla, D. R., & Weisz, J. R. (2022) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2022.12.005 · Cited by 31 · see citing works
Psychosocial Interventions for Children With Externalized Behavior Problems: An Updated Meta-analysis of Moderator Effects
Baumel, A., Mathur, N., Pawar, A. K. S., & Muench, F. J. (2021) · Journal of Child and Family Studies · doi:10.1007/s10826-020-01863-6 · Cited by 27 · see citing works
A Point in the Heart: Concepts of Emotional Distress Among Albanian-Speaking Immigrants in Switzerland
Shala, M., Morina, N., Gross, C. S., Maercker, A. R. A., & Heim, E. (2019) · Culture Medicine and Psychiatry · doi:10.1007/s11013-019-09638-5 · Cited by 30 · see citing works
Cultural adaptation of Hap-pas-Hapi, an internet and mobile-based intervention for the treatment of psychological distress among Albanian migrants in Switzerland and Germany
Shala, M., Morina, N., Burchert, S., Cerga-Pashoja, A., Knaevelsrud, C., Maercker, A., & Heim, E. (2020) · Internet Interventions · doi:10.1016/j.invent.2020.100339 · Cited by 29 · see citing works
Effects of interventions to reduce adolescent depression in low- and middle-income countries: A systematic review and meta-analysis
Davaasambuu, S., Hauwadhanasuk, T., Matsuo, H., & Szatmári, P. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.01.020 · Cited by 25 · see citing works
Primary-level and community worker interventions for the prevention of mental disorders and the promotion of well-being in low- and middle-income countries
Purgato, M., Prina, E., Ceccarelli, C., Cadorin, C., Abdulmalik, J. O., Amaddeo, F., Arcari, L., Churchill, R., Jordans, M. J., Lund, C., et al. (2023) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd014722.pub2 · Cited by 27 · see citing works
Self-citation
Will increasing access to mental health treatment close India's mental health gap?
Weaver, L. J., Karasz, A., Muralidhar, K., Jaykrishna, P., Krupp, K., & Madhivanan, P. (2022) · SSM - Mental Health · doi:10.1016/j.ssmmh.2022.100184 · Cited by 25 · see citing works
Identifying challenges and recommendations for advancing global mental health implementation research: A key informant study of the National Institute of Mental Health Scale-Up Hubs
Naslund, J. A., Kalha, J., Restivo, J. L., Amarreh, I., Callands, T. A., Chen, H., Gómez–Restrepo, C., Hamoda, H. M., Kapoor, A., Levkoff, S. E., et al. (2021) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2021.102557 · Cited by 27 · see citing works
Guided internet-based transdiagnostic intervention for Indonesian university students with symptoms of anxiety and depression: A pilot study protocol
Rahmadiana, M., Karyotaki, E., Passchier, J., Cuijpers, P., van Ballegooijen, W., Wimbarti, S., & Riper, H. (2019) · Internet Interventions · doi:10.1016/j.invent.2018.11.002 · Cited by 25 · see citing works
Self-citation
Recent approaches to provision of mental healthcare in refugee populations
Koesters, M., Barbui, C., & Purgato, M. (2018) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000428 · Cited by 25 · see citing works
Self-citation
Evaluation of competency-driven training for facilitators delivering a psychological intervention for children in Lebanon: a proof-of-concept study
Jordans, M. J. D., Steen, F., Koppenol‐Gonzalez, G. V., Masri, R. E., Coetzee, A. R., Chamate, S.-J., Ghatasheh, M., Pedersen, G. A., Itani, M., Chammay, R. E., et al. (2022) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796022000348 · Cited by 24 · see citing works
“With increasing evidence for effectiveness of psychological interventions implemented by nonspecialists (Singla et al., 2017; Cuijpers et al., 2018; Barbui et al., 2020), there is a need to demonstrate how task-shifted evidence-based treatments can be scaled-up to reduce the gap between need and availability of mental…”
Background
Psychological treatment of depression in institutional settings: A meta-analytic review
Cuijpers, P. J., Čihařová, M., Miguel, C., Harrer, M., Ebert, D. D., Brakemeier, E.-L., & Karyotaki, E. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.03.017 · Cited by 24 · see citing works
Self-citation
Mental Health Disturbances and Related Problems in Italian University Medical Students from 2000 to 2020: An Integrative Review of Qualitative and Quantitative Studies
Sampogna, G., Lovisi, G. M., Zinno, F., Vecchio, V. D., Luciano, M., Sol, É. G. L., Unger, R. J. G., Ventriglio, A., & Fiorillo, A. (2020) · Medicina · doi:10.3390/medicina57010011 · Cited by 26 · see citing works
Primary-level and community worker interventions for the prevention of mental disorders and the promotion of well-being in low- and middle-income countries
Purgato, M., Abdulmalik, J. O., Prina, E., Ceccarelli, C., Tol, W. A., van Ginneken, N., Uphoff, E., Papola, D., Amaddeo, F., Churchill, R. C., et al. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd014722 · Cited by 21 · see citing works
Self-citation
Effect of a lay counselor delivered integrated maternal mental health and early childhood development group-based intervention in Siaya County, Kenya: A quasi-experimental longitudinal study
Kim, E. T., Opiyo, T., Acayo, P. S., Lillie, M., Gallis, J. A., Zhou, Y., Ochieng, M., Okuro, S., Hembling, J., McEwan, E., et al. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.06.002 · Cited by 20 · see citing works
“…picture-based iMBC program was steeped in cognitive behavioral therapy (CBT) and the literature regarding the efficacy of CBT for a range of specific mental and behavioral problems is strong, although largely based on studies in high-income countries (Hofmann et al., 2012; Cuijpers et al., 2018).”
Method
Integrating depression care within NCD provision in Bangladesh and Pakistan: a qualitative study
Wright, J., Mazumdar, P., Barua, D., Lina, S., Bibi, H., Kanwal, A., Aslam, F., Naz, Q., Safi, R., Haq, B. U., et al. (2020) · International Journal of Mental Health Systems · doi:10.1186/s13033-020-00399-y · Cited by 19 · see citing works
Preliminary evaluation of a culturally adapted CBT-based online programme for depression and anxiety from a lower middle-income country
Latif, M., Awan, F., Gul, M., Husain, M. O., Husain, M. I., Sayyed, K., Magsi, T., Naz, S., Aylem, O., Phiri, P., et al. (2021) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x21000313 · Cited by 20 · see citing works
“A recent systematic review of psychotherapies for depression in LMICs identified only three GSH studies (Cuijpers et al., 2018) including our multicentre randomized controlled trial (RCT) of culturally adapted guided self-help from Pakistan (Naeem et al., 2014).”
Background
The Effects of Mental Health Interventions on Labor Market Outcomes in Low- and Middle-Income Countries
Lund, C., Orkin, K., Witte, M., Walker, J., Davies, T., Haushofer, J., Murray, S. M., Bass, J., Murray, L. K., Tol, W. A., et al. (2024) · National Bureau of Economic Research · doi:10.3386/w32423 · Cited by 19 · see citing works
An online mindfulness intervention for international students: A randomized controlled feasibility trial
Balci, S., Küchler, A., Ebert, D. D., & Baumeister, H. (2023) · Clinical Psychology in Europe · doi:10.32872/cpe.9341 · Cited by 19 · see citing works
“This might bring out the idea that some intervention contents might not significantly benefit from an elaborate adaptation process, especially for low threshold interventions (Böttche et al., 2021; Cuijpers et al., 2018; Spanhel, Burdach, et al., 2021).”
Background
Adaptation of the WHO group interpersonal therapy for people living with HIV/AIDS in Northwest Ethiopia: A qualitative study
Asrat, B., Lund, C., Ambaw, F., & Schneider, M. (2020) · PLoS ONE · doi:10.1371/journal.pone.0238321 · Cited by 20 · see citing works
The efficacy of cognitive behavioural therapy for depression and anxiety in multiple sclerosis: A systematic review and meta-analysis
Lucien, A., Francis, H., Wu, W., Woldhuis, T., & Gandy, M. (2024) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2024.105858 · Cited by 22 · see citing works
Evaluating the Effectiveness of an E-Mental Health Intervention for People Living in Lebanon: Protocol for Two Randomized Controlled Trials
van 't Hof, E., Heim, E., Abi Ramia, J., Burchert, S., Cornelisz, I., Cuijpers, P., El Chammay, R., Harper Shehadeh, M., Noun, P., Smit, F., et al. (2021) · JMIR Research Protocols · doi:10.2196/21585 · Cited by 16 · see citing works
“A recent meta-analysis of depression treatments in low-and middle-income countries has been conducted with 32 RCTs, looking at different intervention types, formats (eg, guided self-help, group therapy), and comparators (eg, waitlist, treatment as usual) [25].”
BackgroundSelf-citation
The ASHA (Hope) Project: Testing an Integrated Depression Treatment and Economic Strengthening Intervention in Rural Bangladesh: A Pilot Randomized Controlled Trial
Karasz, A., Anne, S., Hamadani, J. D., & Tofail, F. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18010279 · Cited by 17 · see citing works
“A recent meta-analysis found that task sharing interventions generally outperform no-treatment/treatment-as-usual controls [26], although recent large-scale studies in South Asia have shown disappointing results [27,28].”
Result
Effectiveness of psychosocial interventions on the psychological outcomes of parents with preterm infants: A systematic review and meta-analysis
Chan, S. H., & Shorey, S. (2023) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2023.10.028 · Cited by 19 · see citing works
Psychotherapy for comorbid depression and somatic disorders: a systematic review and meta-analysis
Miguel, C., Karyotaki, E., Čihařová, M., Cristea, I. A., Penninx, B. W. J. H., & Cuijpers, P. J. (2021) · Psychological Medicine · doi:10.1017/s0033291721004414 · Cited by 23 · see citing works
“These differences have been previously observed in psychotherapy research (Cuijpers, Karyotaki, Reijnders, Purgato, & Barbui, 2018), and it could be explained by considerable differences in usual care control conditions across countries (Cuijpers, Quero, Papola, Cristea, & Karyotaki, 2019).”
Self-citation
Effectiveness of Behavioral Activation in Treating Thai Older Adults with Subthreshold Depression Residing in the Community
Ayudhaya, W. S. N., Pityaratstian, N., & Jiamjarasrangsi, W. (2020) · Clinical Interventions in Aging · doi:10.2147/cia.s274262 · Cited by 11 · see citing works
School-based group interpersonal therapy for adolescents with depression in rural Nepal: a mixed methods study exploring feasibility, acceptability, and cost
Rose‐Clarke, K., Prakash, B. K., Magar, J., Pradhan, I., Shrestha, P., Hassan, E., Jaoude, G. J. A., Haghparast‐Bidgoli, H., Devakumar, D., Carrino, L., et al. (2022) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2022.46 · Cited by 15 · see citing works
“and exporting them to LMIC settings poses multiple challenges (Benish et al., 2011; Hall et al., 2016; Cuijpers et al., 2018).”
Background
Psychosocial interventions for depression among young people in Sub-Saharan Africa: a systematic review and meta-analysis
Olisaeloka, L., Udokanma, E. E., & Ashraf, A. (2024) · International Journal of Mental Health Systems · doi:10.1186/s13033-024-00642-w · Cited by 16 · see citing works
“In their review, Cuijpers et al . did not find any indication that a specific contextual adaptation was associated with better outcomes [47].”
Background
Editorial: Transcultural aspects and cultural adaptations of psychotherapeutic treatments in the Asia Pacific‐Rim Region
Alfonso, C. A., & Botbol, M. (2020) · Asia-Pacific Psychiatry · doi:10.1111/appy.12429 · Cited by 11 · see citing works
Cost-effectiveness of psychological intervention within services for depression delivered by primary care workers in Nepal: economic evaluation of a randomized control trial
Aldridge, L. R., Luitel, N. P., Jordans, M. J. D., Bass, J., & Patenaude, B. (2022) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2022.54 · Cited by 11 · see citing works
“In the absence of valid, sensitive quality of life measures appropriate for LMIC, deriving QALYs from WHODAS provides an opportunity to strengthen and standardize methodological approaches to economic evaluation within global mental health.”
ResultInfluential
What matters in mental health care? A co-design approach to developing clinical supervision tools for practitioner competency development
Böhm, B., Keane, G., Karimet, M., & Palma, M. (2022) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2022.53 · Cited by 7 · see citing works
Psychotherapy for adult depression in low- and middle-income countries: an updated systematic review and meta-analysis
Tong, L., Miguel, C., Panagiotopoulou, O.-M., Karyotaki, E., & Cuijpers, P. J. (2023) · Psychological Medicine · doi:10.1017/s0033291723002246 · Cited by 10 · see citing works
“We considered the intervention was adapted if (1) the authors explicitly stated that the study used adaptions or (2) the intended interventions were developed based on local conditions, models, or theories in non-Western countries (Cuijpers et al., 2018).”
BackgroundMethodResultInfluentialSelf-citation
Effectiveness of a supportive care program via a smartphone application on the quality of life and care burden among family caregivers of patients with major depressive disorder: a randomized controlled trial
Minaei-Moghadam, S., Manzari, Z. S., Vaghee, S., & Mirhosseini, S. (2024) · BMC Public Health · doi:10.1186/s12889-023-17594-4 · Cited by 10 · see citing works
“Depression treatment rates are very low in low-and middle-income countries [5].”
Background
Preliminary results of adapting the stepped care model for depression management in Vietnam
Do, M. T., Nguyen, T. T., & Tran, H. T. T. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.922911 · Cited by 10 · see citing works
Psychotherapy over the Last Four Decades
Weissman, M. M., & Cuijpers, P. J. (2017) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000165 · Cited by 10 · see citing works
Self-citation
Physical injury and depression in six low- and middle-income countries: A nationally representative study
Jacob, L., Pizzol, D., Veronese, N., Stubbs, B., & Koyanagi, A. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.01.023 · Cited by 9 · see citing works
Adapting brief problem-solving therapy for pregnant women experiencing depressive symptoms and intimate partner violence in rural Ethiopia
Keynejad, R. C., Fenta, T. B., Sorsdahl, K. R., MYERS, B. J., Honikman, S., Mulushoa, A., Demissie, M., Deyessa, N., Howard, L. M., & Hanlon, C. (2023) · Psychotherapy Research · doi:10.1080/10503307.2023.2222899 · Cited by 10 · see citing works
“While cultural adaptation of psychological interventions was not associated with efficacy in a meta-analysis of LMIC studies, descriptions were often extremely brief (Cuijpers et al., 2018).”
Background
Encompassing a global mental health perspective into psychotherapy research: a critique of approaches to measuring the efficacy of psychotherapy for depression
Purgato, M., Jayaram, G., Surkan, P. J., Bass, J., & Bolton, P. A. (2019) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796018000781 · Cited by 8 · see citing works
Self-citation
Cultural adaptation of INDIGO mental health stigma reduction interventions using an ecological validity model in north India
Daniel, M., Kallakuri, S., Gronholm, P. C., Wahid, S. S., Kohrt, B. A., Thornicroft, G., & Maulik, P. K. (2024) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1337662 · Cited by 10 · see citing works
Cultural adaptations of digital therapeutics
Naslund, J. A., & Spagnolo, J. (2022) · Elsevier eBooks · doi:10.1016/b978-0-323-90045-4.00001-0 · Cited by 9 · see citing works
Interpersonal Psychotherapy—Adolescent Skills Training With Youth From Asian American and Immigrant Families: Cultural Considerations and Intervention Process
Kodish, T., Weiss, B., Duong, J. B., Rodríguez, A., Anderson, G. E., Nguyen, H., Olaya, C., & Lau, A. S. (2020) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2020.05.009 · Cited by 7 · see citing works
Cost-Effectiveness of Digital Mental Health Versus Usual Care During Humanitarian Crises in Lebanon: Pragmatic Randomized Trial
Hana, R. A., Ramia, J. A., Burchert, S., Carswell, K., Cuijpers, P. J., Heim, E., Knaevelsrud, C., Noun, P., Sijbrandij, M., van Ommeren, M., et al. (2024) · JMIR Mental Health · doi:10.2196/55544 · Cited by 8 · see citing works
“…would be powered to detect a standardized mean difference of medium size ( d ≥ 0.50) between the conditions, as statistically significant at α≤ .05 (2-tailed) and a power of (1 – β ) ≥ 0.90 while accounting for an expected dropout rate of 70%, which is typical for self-help interventions [23].”
BackgroundInfluentialSelf-citation
Exploring the Association between Serum B Vitamins, Homocysteine and Mental Disorders: Insights from Mendelian Randomization
Hu, Y., Yu, M., Wang, Y., Wu, H., Yang, X., Chen, X., & Wu, J. (2024) · Nutrients · doi:10.3390/nu16131986 · Cited by 6 · see citing works
“Mental disorders have a considerable impact on the lives of patients and their families, representing a significant public health concern globally and resulting in substantial medical burden and economic loss [4].”
Background
Development of a digital program for training non-specialist providers to deliver a psychosocial intervention for depression: a formative study to support scaling up task-shared depression care in the United States
Naslund, J. A., Carmio, N., Taha, S., Amara, M., Wood, S., Patel, A., Romero, S. A., Floyd, K., Meredith, B., Rodriguez, B., et al. (2025) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2025.5 · Cited by 5 · see citing works
“…in depression care supported by scientific evidence attesting to its effectiveness involves the delivery of proven psychosocial interventions by frontline providers without specialized training in mental health care delivery (Singla et al., 2017; Cuijpers et al., 2018; Raviola et al., 2019).”
Scaling up the task-sharing of an evidence-based psychological treatment for depression in rural India: an implementation study
Agrawal, R. N., Sood, M., Patel, A., Sharma, T., Yadav, H., Kaur, J., Kumari, S., Sharma, P. V., Shukla, V., Tripathi, B., et al. (2025) · BMC Family Practice · doi:10.1186/s12875-025-02943-6 · Cited by 7 · see citing works
“These interventions typically incorporate a single or a few “active ingredients” and can be delivered in a few sessions in community or primary care settings(4), or remotely, by using digital technology(5).”
Interpersonal Psychotherapy: A Review of Theory, History, and Evidence of Efficacy
Stuart, S. P., Schultz, J. M., Molina, A. P., & Siber, S. (2024) · Psychodynamic Psychiatry · doi:10.1521/pdps.2024.52.3.370 · Cited by 5 · see citing works
Psychotherapy for perinatal mental disorders in low- and middle-income countries
Davies, T., Rahman, A., & Lund, C. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-814932-4.00014-8 · Cited by 7 · see citing works
Designing an App to Support Measurement-Based Peer Supervision of Frontline Health Workers Delivering Brief Psychosocial Interventions in Texas: Multimethod Study
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Authors: Cuijpers, P., Karyotaki, E., Reijnders, M., Purgato, M., & Barbui, C.
Affiliations: Vrije Universiteit Amsterdam (NL)
University of Verona (IT)
ORCID: Cuijpers, Pim
Karyotaki, Eirini
Reijnders, Mirjam
Purgato, Marianna
Barbui, Corrado
Venue: World Psychiatry
Publisher: Wiley
Published: 2018-01-19
Volume: 17
Issue: 1
Pages: 90-101
ISSN: 1723-8617 (ISSN-L)
2051-5545
DOI: 10.1002/wps.20493
PMC: PMC5775122
OpenAlex: W2724934802
Cited by: 159
References: 69
Citations by year: 2026: 6 · 2025: 12 · 2024: 27 · 2023: 28 · 2022: 19 · 2021: 26 · 2020: 18 · 2019: 14 · 2018: 8 · 2017: 1
FWCI: 19.35
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: World Psychiatry (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
VU Research Portal (publishedVersion, other-oa)
Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Topics: Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords: depression, psychotherapy, low- and middle-income countries, cross-cultural generalizability, treatment effectiveness, publication bias, trial quality

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Psychotherapies for depression in low- and middle-income countries: a meta-analysis

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