title: Effect of psychosocial interventions on social functioning in depression and schizophrenia: meta-analysis.
abstract: BACKGROUND
  Psychosocial interventions may contribute to reducing the burden of mental disorders in low- and middle-income (LAMI) countries by improving social functioning, but the evidence has not been systematically reviewed.
  
  
  OBJECTIVE
  Systematic review and meta-analysis of the effect of psychosocial interventions on social functioning in people with depression and schizophrenia in LAMI countries.
  
  
  METHODS
  Studies were identified through database searching up to March 2011. Randomised controlled trials were included if they compared the intervention group with a control group receiving placebo or treatment as usual. Random effects meta-analyses were performed separately for depressive disorders and schizophrenia and for each intervention type.
  
  
  RESULTS
  Of the studies that met the inclusion criteria (n = 24), 21 had sufficient data to include in the meta-analysis. Eleven depression trials showed good evidence for a moderate positive effect of psychosocial interventions on social functioning (standardised mean difference (SMD) = 0.46, 95% CI 0.24-0.69, n = 4009) and ten schizophrenia trials showed a large positive effect on social functioning (SMD = 0.84, 95% CI 0.49-1.19, n = 1671), although seven of these trials were of low quality. Excluding these did not substantially affect the size or direction of effect, although the precision of the estimate was substantially reduced (SMD = 0.89, 95% CI 0.05-1.72, n = 863).
  
  
  CONCLUSIONS
  Psychosocial interventions delivered in out-patient and primary care settings are effective at improving social functioning in people with depression and should be incorporated into efforts to scale up services. For schizophrenia there is an absence of evidence from high-quality trials and the generalisabilty of the findings is limited by the over-representation of trials conducted in populations of hospital patients in China. More high-quality trials of psychosocial interventions for schizophrenia delivered in out-patient settings are needed.
authors.affiliation: Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK. mary.desilva@lshtm.ac.uk
authors.forename: Mary J
authors.initials: MJ
authors.lastname: De Silva
authors.forename: Sara
authors.initials: S
authors.lastname: Cooper
authors.forename: Henry Lishi
authors.initials: HL
authors.lastname: Li
authors.forename: Crick
authors.initials: C
authors.lastname: Lund
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
mesh_terms: D003863:Depression / Q000523:psychology / Q000628:therapy*; D006801:Humans; D011203:Poverty / Q000523:psychology; D011613:Psychotherapy; D017594:Publication Bias; D012559:Schizophrenia / Q000628:therapy*; D012565:Schizophrenic Psychology; D012919:Social Behavior
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