Paraprofessionals for anxiety and depressive disorders
Editorial Group: Cochrane Depression, Anxiety and Neurosis Group
Published Online: 20 APR 2005
Assessed as up-to-date: 16 FEB 2005
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Boer PCAM, Wiersma D, Russo S, Bosch RJ. Paraprofessionals for anxiety and depressive disorders. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD004688. DOI: 10.1002/14651858.CD004688.pub2.
- Publication Status: Edited (no change to conclusions)
- Published Online: 20 APR 2005
The established mental health care system does not have the resources to meet the extensive need for care of those with anxiety and depressive disorders. Paraprofessionals partially replacing professionals may be cost-effective.
To investigate the effectiveness of any kind of psychological treatment for anxiety and depressive disorders performed by paraprofessionals. To examine whether the results apply to clinically significant disorders.
CCDANCTR-Studies, EMBASE (ExerptaMedica), MEDLINE, PsycINFO, all years published using the key words: para-/paraprofessional, non-/nonprofessional, rand*, psy*; peer; volunt*; citation lists of articles reviewing the subject and included studies; correspondence with authors of controlled studies, and review reports on the subject.
Randomised controlled trials that used symptom measures, and compared the effects of treatments given by paraprofessionals (paid or voluntary, unqualified with respect to the psychological treatment) with treatments given by professionals, and with waiting list or placebo condition.
Data collection and analysis
The standard mean difference was used to pool continuous data, and odds ratios were used to pool dichotomous data, using a random effects model. The generic inverse variance method was used for combining continuous and dichotomous data. The effect of low quality studies and the use of self-rated versus observer-rated measures were tested. Subgroup analyses were performed for differences between depression and anxiety diagnosis, paraprofessionals with/without professional background, group/individual intervention, length of follow-up and gender (post-hoc subgroup analysis).
Five studies reported five comparisons of paraprofessionals versus professionals (n=106) and five comparisons of paraprofessionals versus control condition (n=220). No differences were found between paraprofessionals and professionals (SMD=0.09, 95% CI -0.23 to 0.40, p=0.58), and no significant heterogeneity. Studies comparing paraprofessionals versus control (mixed continuous and dichotomous data) showed a significant effect in favour of paraprofessionals (OR=0.34, 95% CI 0.13 to 0.88, p=0.03), but heterogeneity was indicated (I²=60.9%, Chi²= 10.24, df=4, p=0.04). After correction for heterogeneity and removing one study of low quality, the pooling of data from three studies (n=128; mixed gender; women) indicated no significant difference in effect between paraprofessionals and professionals (SMD=0.13, 95% CI -0.39 to 0.64; p=0.63) and a strongly significant pooled effect for three studies (n=188; women) favouring paraprofessionals over the control condition (OR=0.30, 95% CI 0.18 to 0.48, p<0.00001), and homogeneity indicated between studies (I²=0%, Chi²=0.47, df=2, p=0.79).
The few studies included in the review did not allow conclusions about the effect of paraprofessionals compared to professionals, but three studies (women only) indicated a significant effect for paraprofessionals (all volunteers) compared to no treatment. The evidence to date may justify the development and evaluation of programs incorporating paraprofessionals in treatment programs for anxiety and depressive disorders.
Plain language summary
The involvement of paraprofessionals for anxiety and depressive disorders
The established mental health care system does not have the resources to meet the increasing need for care of those with anxiety and depressive disorders. This review investigated the effectiveness of any kind of psychological treatment conducted by paraprofessionals.The few studies found did not allow conclusions about the effect of paraprofessionals compared to professionals in the treatment of anxiety and depressive disorders. Pooling data from three studies, involving women only, indicated a significant effect for paraprofessionals compared to no treatment. The evidence so far may justify the development and evaluation of programs incorporating paraprofessionals in treatment programs for anxiety and depressive disorders.
在CCDANCTRStudies, EMBASE (ExerptaMedica), MEDLINE, PsycINFO中搜尋所有年份的刊載文章,並使用下列的關鍵字搜尋:para/paraprofessional, non/nonprofessional, rand*, psy*; peer; volunt*;引證回顧上述的主題以及研究,相關的文章,操作型類似文章的作者以及這個主題的回顧報告.
The standard mean difference 被用來群聚連續的資料,而odds ratios 被用來群聚使用隨機作用模式的雙向資料. The generic inverse variance method 被用來結合連續性及雙向性資料.低品質實驗的效果以及selfrated versus observerrated measures 的使用已被測試.次群體的分析被用來區分憂鬱疾焦慮的診斷,專業輔助人員(沒)有專業背景,群體(個人)的介入,追蹤時間的長短,及性別posthoc subgroup analysis).
有五篇研究報告了五個專業輔助人員與專業人員(n = 106) 的比較以及以五個專業輔助人員與控制組(n = 220)的比較.在專業輔助人員與專業人員的比較不具差異性SMD = 0.09, 95% CI −0.23 to 0.40, p = 0.58),而在樣本的異質性方面亦無顯著差異.比較專業輔助人員以及控制組(混合了連續性及雙向性的資料),顯示了顯著偏好專業輔助人員的效果(OR = 0.34, 95% CI 0.13 to 0.88, p = 0.03), 但異質性卻較為顯著(I² = 60.9%, Chi² = 10.24, df = 4, p = 0.04).在矯正了異質性並且移除了一篇低品質的研究,這三篇資料的聚集(n = 128; mixed gender; women)指出, 在專業輔助人員與專業人員(SMD = 0.13, 95% CI −0.39 to 0.64; p = 0.63)的效果並沒有顯著差異,以及專業輔助人員優於控制組,並具有強烈的顯著差異(OR = 0.30, 95% CI 0.18 to 0.48, p<0.00001), 以及在這三篇文章顯示出了同質性(I² = 0%, Chi² = 0.47, df = 2, p = 0.79).
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。