Psychological Distress

Interventions Effects on Psychological Distress: A Systematic Review & Meta-Analysis

Published: Jun 2023

Authors

Molly A Nowels

Department of Health Behavior, Society, and Policy (M.A.N., S.K., P.R.D., E.C., E.K.), Rutgers School of Public Health, Piscataway, New Jersey, USA; Center for Health Services Research (M.A.N.), Institute for Health, Health Care Policy, and Aging Research

Saurabh Kalra

Department of Health Behavior, Society, and Policy (M.A.N., S.K., P.R.D., E.C., E.K.), Rutgers School of Public Health, Piscataway, New Jersey, USA.

Paul R Duberstein

Department of Health Behavior, Society, and Policy (M.A.N., S.K., P.R.D., E.C., E.K.), Rutgers School of Public Health, Piscataway, New Jersey, USA.

Emily Coakley

Department of Health Behavior, Society, and Policy (M.A.N., S.K., P.R.D., E.C., E.K.), Rutgers School of Public Health, Piscataway, New Jersey, USA.

Biren Saraiya

Rutgers Cancer Institute of New Jersey (B.S.), New Brunswick, New Jersey, USA.

Login George

Rutgers School of Nursing (L.G.), New Brunswick, New Jersey, USA.

Elissa Kozlov

Department of Health Behavior, Society, and Policy (M.A.N., S.K., P.R.D., E.C., E.K.), Rutgers School of Public Health, Piscataway, New Jersey, USA.

Abstract

Background: Managing psychological distress is an objective of palliative care. No meta-analysis has evaluated whether palliative care reduces psychological distress.

Objectives: Examine the effects of palliative care on depression, anxiety, and general psychological distress for adults with life-limiting illnesses and their caregivers.

Design: We searched PubMed, PsycInfo, Embase, and CINAHL for randomized clinical trials (RCTs) of palliative care interventions. RCTs were included if they enrolled adults with life-limiting illnesses or their caregivers, reported data on psychological distress at 3 months after study intake, and if authors had described the intervention as "palliative care."

Results: We identified 38 RCTs meeting our inclusion criteria. Many (14/38) included studies excluded participants with common mental health conditions. There were no statistically significant improvements in patient or caregiver anxiety (patient SMD: -0.008, P = 0.96; caregiver SMD: -0.21, P = 0.79), depression (patient SMD: -0.13, P = 0.25; caregiver SMD -0.27, P = 0.08), or psychological distress (patient SMD: 0.26, P = 0.59; caregiver SMD: 0.04, P = 0.78).

Conclusions: Psychological distress is not likely to be reduced in the context of a typical palliative care intervention. The systemic exclusion of patients with common mental health conditions in more than 1/3 of the studies raises ethical questions about the goals of palliative care RCTS and could perpetuate inequalities.

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Web link: https://pubmed.ncbi.nlm.nih.gov/36764410/