“A possible clinical implication could be to administer low self-esteem with a valid instrument at the beginning of the intervention for early detection, as this may improve the treatment outcome for both depression and self-esteem,” said lead author Shalini Bhattacharya, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom, and co-authors.
“The benefit of examining low self-esteem at an initial phase could provide more evidence for future research to design targeted interventions for improving self-esteem and that could possibly be effective for treating depression.”
Researchers analyzed randomized control psychotherapy trials for adult depression, following the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Self-esteem was used as an outcome at post-treatment. The meta-analysis included 19 studies with 3423 participants in total. Researchers calculated measure of effect size (Hedges' g) for depression and self-esteem, and separated them into 2 meta-analyses. Meta-regression was used to examine the association between the effect of psychotherapy on depression and self-esteem.
Psychotherapy’s effect on depression was significant (Hedges' g = −0.95; [95 % CI: −1.27, −0.63]), though effects on self-esteem were smaller (Hedges'g = 0.63; [95 % CI:0.32, 0.93]), with continued effects shown at 6-12 months (Hedges'g = 0.70; [95 % CI: −0.03, 1.43]). A strong inverse association between the effects of psychotherapy for depression and self-esteem was also found (β = −0.60, p < 0.001).
Authors acknowledged study limitations as a small number of included studies, low quality trial (those considered high-risk by the Cochrane RoB assessment), and an inability to compute inter-rater agreement.
Authors also noted that there was a limited number of studies available examining low self-esteem in patients with depression and comorbid somatic disorders like HIV and cancer.
“Although there is evidence suggesting that the effects of psychotherapy for depression might be particularly small in depressed adults with HIV, the small number of studies did not allow us to explore whether there are significant differences regarding the effects on self-esteem between medical patients and general adults with depression. Examining the effects of psychological interventions on self-esteem in this target group could be particularly important for interventions to improve their quality of life.”
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