title: Efficacy and acceptability of group cognitive behavioral therapy for depression: a systematic review and meta-analysis.
abstract: BACKGROUND
  Despite treatment guidelines for depression placing group cognitive behavioral therapy (group CBT) between low- and high-intensity evidence-based psychological interventions, the validity of the placement remains unknown. We aimed to systematically review evidence for the efficacy and acceptability of group CBT in patients with depression compared to four intensity levels of psychosocial interventions.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, and Web of Science and hand-searched the references in identified publications. We selected randomized controlled trials comparing group CBT with four levels of interventions for adult patients with depression. Two authors independently assessed risk of bias.
  
  
  RESULTS
  From 7953 records, we identified 35 studies that compared group CBT to non-active (k=30), low-intensity (k=2), middle-intensity (k=8), and high-intensity (k=1) interventions. Group CBT had a superior efficacy (standardized mean difference [SMD]=-0.68) and a similar acceptability compared to non-active controls. Pooled results showed a small but non-significant excess of group CBT relative to middle-intensity interventions (SMD=-0.21).
  
  
  CONCLUSIONS
  Over 60% of studies did not report enough information to judge selection and selective reporting bias.
  
  
  CONCLUSIONS
  These results suggest the need for high-quality trials of group CBT compared to low- and high-intensity interventions.
authors.affiliation: Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo 105-0003, Japan. Electronic address: yokumura@blue.zero.jp.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Okumura
authors.affiliation: Section of Liaison Psychiatry and Palliative Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8519, Japan; Japan Society for the Promotion of Science, Tokyo 102-0083, Japan.
authors.forename: Kanako
authors.initials: K
authors.lastname: Ichikura
mesh_terms: D016022:Case-Control Studies; D015928:Cognitive Behavioral Therapy; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D006801:Humans; D011615:Psychotherapy, Group; D016896:Treatment Outcome
keywords: Cognitive therapy; Group therapy; Meta-analysis; Randomized controlled trial; Stepped care