Article type
Year
Abstract
Background: Delivering effective healthcare for women is a priority for policymakers and requires evidence about effective interventions.
Objectives: To evaluate reporting on the inclusion of women and evaluation of sex-specific intervention effects in systematic reviews (SR).
Methods: We engaged stakeholders to prioritize conditions and interventions. We searched PubMED and the Cochrane Library for English-language SR published since 2009, that addressed a medication, behavioral, quality improvement (QI), or exercise intervention for depression, diabetes mellitus, fibromyalgia, chronic low back or knee pain. We summarized data on the inclusion of women, intervention effects and sex effects as a moderator using descriptive statistics. Results are reported for depression; evaluation of the other conditions is in progress.
Results: We screened 629 citations for depression, and 79 SR were eligible. The most commonly evaluated conditions were: major depression (n = 54 studies), minor depression (n = 22), dysthymia (n = 21), and treatment-resistant depression (n = 5). Evaluated interventions included: psychotherapy (n = 47), antidepressants (n = 34), relapse prevention strategies (n = 6), guided self-help (n = 4), exercise (n = 1) and QI (n = 1). The proportion of women enrolled in the primary studies was reported in 27 SR (34%) and in this subset, women constituted ≥ 50% of the sample in all pooled estimates. Sex-specific effects were evaluated in 14 SR (18%), using meta-regression (n = 7), patient level meta-analyses (n = 3), subgroup analyses (n = 2), or qualitative synthesis (n = 2). Four SR reported no sex effects for: therapy vs antidepressant (AD), therapy and AD vs AD alone, self-help, and QI. Cognitive behavioral therapy and antidepressants (i.e. SSRI and venlafaxine) were found to be more effective for women than men. Sexual adverse effects were more common in men than women treated with paroxetine.
Conclusions: The minority of SR described the inclusion of women or evaluated sex as a moderator of treatment effect. Some depression interventions appear more effective for women. However, moderator effects were often evaluated using suboptimal methods.
Objectives: To evaluate reporting on the inclusion of women and evaluation of sex-specific intervention effects in systematic reviews (SR).
Methods: We engaged stakeholders to prioritize conditions and interventions. We searched PubMED and the Cochrane Library for English-language SR published since 2009, that addressed a medication, behavioral, quality improvement (QI), or exercise intervention for depression, diabetes mellitus, fibromyalgia, chronic low back or knee pain. We summarized data on the inclusion of women, intervention effects and sex effects as a moderator using descriptive statistics. Results are reported for depression; evaluation of the other conditions is in progress.
Results: We screened 629 citations for depression, and 79 SR were eligible. The most commonly evaluated conditions were: major depression (n = 54 studies), minor depression (n = 22), dysthymia (n = 21), and treatment-resistant depression (n = 5). Evaluated interventions included: psychotherapy (n = 47), antidepressants (n = 34), relapse prevention strategies (n = 6), guided self-help (n = 4), exercise (n = 1) and QI (n = 1). The proportion of women enrolled in the primary studies was reported in 27 SR (34%) and in this subset, women constituted ≥ 50% of the sample in all pooled estimates. Sex-specific effects were evaluated in 14 SR (18%), using meta-regression (n = 7), patient level meta-analyses (n = 3), subgroup analyses (n = 2), or qualitative synthesis (n = 2). Four SR reported no sex effects for: therapy vs antidepressant (AD), therapy and AD vs AD alone, self-help, and QI. Cognitive behavioral therapy and antidepressants (i.e. SSRI and venlafaxine) were found to be more effective for women than men. Sexual adverse effects were more common in men than women treated with paroxetine.
Conclusions: The minority of SR described the inclusion of women or evaluated sex as a moderator of treatment effect. Some depression interventions appear more effective for women. However, moderator effects were often evaluated using suboptimal methods.