Neuropsychological rehabilitation and psychotherapy of adult traumatic brain injury patients with depression: a systematic review and meta-analysis

INTRODUCTION. There is still insufficient appreciation whether neuropsychological rehabilitation and psychotherapy are effective in attenuating depression following traumatic brain injury (TBI). This knowledge gap was addressed in the present systematic review and meta-analysis of the literature. EVIDENCE ACQUISITION. We conducted electronic database (Medline, PsychINFO, Scopus) searches (time frame: January 1st, 2005 to December 31st, 2015) for clinical studies that had tested neuropsychological rehabilitation and psychotherapy in adult TBI survivors with depression. The studies were to have experimental or quasi-experimental study design, and to include survivors from non-military TBI. Quantitative assessment of qualifying studies was done using the random effects model. We calculated the pooled size effect using standardized mean difference (SMD) as the main effect measure. EVIDENCE SYNTHESIS. We identified three studies, totaling 231 participants, which tested cognitive behavioral therapy or mindfulnessbased cognitive therapy as interventions to attenuate post-TBI depression. The analysis revealed a small and non-significant decrease in depression symptoms due to intervention (SMD=-0.23 [95% CI: -050, 0.03; z=1.73, P=0.08]). Testing for publication bias was not feasible due to low number of identified studies. C CONCLUSIONS. Current evidence indicates only a small therapeutic effect of psychotherapy in attenuating post-TBI depression.