How much do we know about the functional effectiveness of interventions for depression? A systematic review.
BACKGROUND
Functional difficulties are determined as one of the reasons for the public health priority given to depression. However, previous literature shows that the evidence on treatment effectiveness in depression does not reflect all relevant functional areas affected. This paper aimed to review recent literature and identify which areas are addressed and what are the gaps in the measurement of treatment effectiveness in depression.


METHODS
Electronic search was performed in PsycINFO, PubMed, Web of science, and the Cochrane Central Register of Controlled Trials. A content item analysis of outcome measures was performed.


RESULTS
Two hundred and fourty-seven studies were included. The functional areas addressed in the measurement process did not vary across studies assessing psychotherapeutic, pharmacological or alternative interventions. The content analysis revealed that 80% of the areas covered by instruments represented symptomatology. Many functional areas were insufficiently covered, whereas others like handling stress, solving problems, maintaining daily routine, problems in education, or participation in community, political or religious life were not addressed at all.


CONCLUSIONS
Only articles in English were included and the time frame was limited.


CONCLUSIONS
More than 10 years after the first global burden of disease studies have been published evidence on the treatment effectiveness in depression is still based primarily on symptoms. Many important functional areas remain unexplored. Consequently the effectiveness of well recognized interventions might be overestimated. Future steps should include use of comprehensive tools, provision of detailed information on functional areas instead of global scores of instruments, and design of functional impairment oriented therapies.
Instituto de Salud Carlos III, Centro Investigación Biomédica en Red, CIBER, C/ Diego de León 62, 28006 Madrid, Spain.
Kaloyan
K
Kamenov
Instituto de Salud Carlos III, Centro Investigación Biomédica en Red, CIBER, C/ Diego de León 62, 28006 Madrid, Spain.
Maria
M
Cabello
Department of Medical Informatics, Biometry and Epidemiology (IBE), Research Unit for Biopsychosocial Health, Ludwig-Maximilians University (LMU), Marchioninistr. 15, 81377 Munich, Germany.
Michaela
M
Coenen
Instituto de Salud Carlos III, Centro Investigación Biomédica en Red, CIBER, C/ Diego de León 62, 28006 Madrid, Spain; Department of Psychiatry, Universidad Autónoma de Madrid, C/ Arzobispo Morcillo 4, 28029 Madrid, Spain; Instituto de investigación de la Princesa, (IIS-IP), Hospital Universitario de la Princesa, C/ Diego de León 62, 28006 Madrid, Spain. Electronic address: joseluis.ayuso@uam.es.
José Luis
JL
Ayuso-Mateos
D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000628:therapy*; D003866:Depressive Disorder / Q000628:therapy*; D006801:Humans; D011615:Psychotherapy, Group / Q000379:methods*; D016896:Treatment Outcome
Depression; Functioning; Intervention; Outcome measure; Treatment effectiveness