Depressive symptoms and their social contexts: a qualitative systematic literature review of contextual interventions.
BACKGROUND
Numerous observational studies demonstrate associations between social context and depressive symptoms, yet few intervention trials exist in this arena.


OBJECTIVE
This review examines intervention trials that explore the impact of contextual change on depressive symptoms.


METHODS
Electronic literature databases of PubMed and PsycINFO, bibliographies of retrieved articles and the publicly available internet were searched for English-language articles published between 1997 and 2008. Peer-reviewed studies were eligible for inclusion if they reported contextual interventions and depressive symptoms measures in adult populations without other significant underlying medical or psychological illness. In total, 2,128 studies met search term criteria. Of these, 13 studies meeting inclusion criteria were classified by type of intervention. Qualitative synthesis was used to interpret the mental health impact of contextual interventions.


RESULTS
The interventions focused on employment, housing, poverty, parenting and violence. Eight of these studies reported a decrease in depressive symptoms and/or psychological distress in intervention groups. Interventions varied in focus, length of follow-up and measures of depressive symptoms.


CONCLUSIONS
Contextual interventions for the prevention and treatment of depressive symptoms and psychological distress can be effective, though very limited data exist in this field. Policy implications include a greater emphasis on improving context to decrease depression and other mental disorders.
Gottlieb
Laura
L
Robert Wood Johnson Health and Society Scholars Program, University of California, San Francisco, Center for Health and Community, USA. GottliebL@chc.ucsf.edu
Waitzkin
Howard
H
Miranda
Jeanne
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D003863:Depression / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D055815:Young Adult