title: Cognitive behavioural therapy for the treatment of depression in people with multiple sclerosis: a systematic review and meta-analysis.
abstract: BACKGROUND
  Depression is a common symptom in people with multiple sclerosis. We systematically reviewed published controlled trials on the effectiveness of cognitive behavioural therapy (CBT) for the treatment of depression in people with multiple sclerosis.
  
  
  METHODS
  Publications were identified using MEDLINE, PsycINFO and the Cochrane Central Register of Controlled Trials to June/July 2013. We combined thesaurus and free-text terms which were synonyms of the concepts multiple sclerosis, depression and cognitive behavioural therapy. We included published controlled trials which compared individual, group CBT, conducted face-to-face or remotely, to no CBT. Two reviewers extracted data to calculate standardized mean differences (SMD) for self-reported symptoms of depression and weighted mean differences (WMD) for the Multiple Sclerosis Impact Scale (MSIS-29), with 95% Confidence Intervals (CIs). We investigated statistical heterogeneity using I².
  
  
  RESULTS
  Seven eligible studies (n = 433) were identified, which evaluated the effect on depression of CBT delivered individually (3 studies), in a group (3 studies) and by computer (1 study). The summary effect (SMD -0.61, 95% CI -0.96 to -0.26, p=0.0006) was reduced (SMD -0.46, 95% CI -0.75 to -0.17, p=0.002) when an outlying study was removed in a sensitivity analysis to examine statistical heterogeneity. Three studies (n=213) observed a direction of effect using the MSIS-29 which was not statistically significant (WMD -4.36, 95% CI -9.33 to 0.62, p=0.09). There was no between-subgroup heterogeneity (I²=0).
  
  
  CONCLUSIONS
  CBT can be an effective treatment for depression in MS. Further research should explore optimal durations and modalities of treatment for patients with different characteristics.
authors.affiliation: Clinical Trials Research Unit, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK. d.hind@sheffield.ac.uk.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hind
authors.forename: Jack
authors.initials: J
authors.lastname: Cotter
authors.forename: Anna
authors.initials: A
authors.lastname: Thake
authors.forename: Mike
authors.initials: M
authors.lastname: Bradburn
authors.forename: Cindy
authors.initials: C
authors.lastname: Cooper
authors.forename: Claire
authors.initials: C
authors.lastname: Isaac
authors.forename: Allan
authors.initials: A
authors.lastname: House
mesh_terms: D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000209:etiology / Q000628:therapy*; D006801:Humans; D009103:Multiple Sclerosis / Q000150:complications* / Q000523:psychology; D016896:Treatment Outcome