The effectiveness of self-help interventions in the treatment of depressive symptoms in low-and-middleincome countries (LMICs): a meta-analysis

Abstract

Background: Self-help psychological interventions show great potential to close the treatment gap for depressive symptoms in low-and middle-income countries (LMICs). The current meta-analysis investigated the pooled effect of self-help interventions for people with depressive symptoms in LMICs and moderators of these psychological interventions. Method: PubMed, Cochrane Register of Randomized Controlled Trials, PsychInfo, Embase, and Sabinet databases were searched between June 2021 and December 2022 to select studies that met pre-defined inclusion criteria. A coding protocol was used to retrieve and code relevant data from selected studies. We measured publication bias and assessed the study quality using the Cochrane Risk of Bias tool. The program ‘Comprehensive Meta-Analysis’ (CMA) was used for the data analysis. Overall effect sizes were calculated to assess the effectiveness of selfhelp programs for depression. Results: Eighteen studies were included in the meta-analysis. Self-help interventions were found to have a medium positive effect on depressive symptoms at post-test (Hedges’ g = 0.74) and at follow-up (Hedges’ g = 0.82). There was evidence for publication bias. Larger effects were found for studies that were conducted in lower-middle income countries, had at least mild depression as inclusion criterion, reported less than 30% attrition, did not use relaxation techniques, had a low or medium risk of bias, and that used a booklet form of intervention. Conclusion: This meta-analysis suggests that self-help interventions have a positive effect on people with depressive symptoms in LMICs. The findings could inform the design and implementation of mental health interventions that could prevent or treat depression.