Bentley Amelia, Hogan Lucinda, Howard Jack, Singh Ramnik, Watt Lucinda, Hall Alix, Tzelepis Flora
School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia.
Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.
Clin Psychol Psychother. 2025 Mar-Apr;32(2):e70058. doi: 10.1002/cpp.70058.
Rural and remote populations have a high burden of depression and poorer access to mental healthcare services than their urban counterparts. This systematic review aimed to assess the effectiveness of psychological and pharmacological treatments on reducing depression specifically in rural and remote residents. Cochrane Library, Medline, PsycInfo, Embase and Scopus, and two clinical trial registries were searched. Included studies were randomised or cluster randomised trials conducted with rural and remote adult populations; examined the effectiveness of any treatment for depression; included a control group or comparator; measured depression; and were published in English. Two authors independently screened records for eligibility, extracted information from eligible studies and assessed risk of bias and certainty of evidence. Seventeen studies were included. Meta-analyses found a small benefit of behavioural activation therapy (standardised mean difference -0.43, 95% CI -0.78, -0.08, I = 40%), a large benefit of group therapy (standardised mean difference -1.80, 95% CI -2.80, -0.79, I = 93%) and no evidence of benefit of interpersonal therapy (standardised mean difference -0.89, 95% CI -2.30, 0.52, I = 96%) and cognitive behavioural therapy (standardised mean difference -2.39, 95% CI -5.83, 1.05, I = 98%) for reducing depression in rural populations. Behavioural activation and group therapy appear effective for treating depression among rural populations, although the certainty of evidence is low, and so further research is warranted. Further research on the effectiveness of psychological and pharmacological treatments on depression in rural and remote populations is needed.
农村和偏远地区人口的抑郁症负担较重，与城市人口相比，他们获得心理保健服务的机会更少。本系统评价旨在评估心理治疗和药物治疗对降低农村和偏远地区居民抑郁症的有效性。检索了Cochrane图书馆、Medline、PsycInfo、Embase和Scopus以及两个临床试验注册库。纳入的研究为针对农村和偏远地区成年人群开展的随机或整群随机试验；检验了任何抑郁症治疗方法的有效性；设有对照组或比较组；测量了抑郁症；且以英文发表。两位作者独立筛选记录以确定其是否符合纳入标准，从符合条件的研究中提取信息，并评估偏倚风险和证据的确定性。共纳入17项研究。荟萃分析发现，行为激活疗法有较小益处（标准化均差-0.43，95%CI -0.78，-0.08，I² = 40%），团体治疗有较大益处（标准化均差-1.80，95%CI -2.80，-0.79，I² = 93%），而人际治疗（标准化均差-0.89，95%CI -2.30，0.52，I² = 96%）和认知行为疗法（标准化均差-2.39，95%CI -5.83，1.05，I² = 98%）在降低农村人口抑郁症方面无益处证据。行为激活和团体治疗似乎对治疗农村人口的抑郁症有效，尽管证据的确定性较低，因此有必要进一步研究。需要进一步研究心理治疗和药物治疗对农村和偏远地区人口抑郁症的有效性。
