In task-shared therapy for depression and anxiety, social support and problem-solving did the work — relaxation did not

The edition in brief

A Bayesian component network meta-analysis using individual data from 10,612 adults in 30 trials of psychosocial interventions delivered by non-specialists found three components associated with the largest added benefit: strengthening social support, behavioural activation and problem management. Relaxation, and less clearly cognitive reframing, were associated with worse outcomes when added. This is relevant to Indian task-shared programmes, which already rely on these elements. A Queensland cohort of 30,189 people with schizophrenia-spectrum or bipolar disorder found physical disease accumulating across body systems faster than in matched controls: about 18 extra people per 100 had two or more affected systems at 20 years (subdistribution HR 2.25), with the steepest relative excess in the youngest patients. In the ODDESSI cluster-randomised trial in England, Open Dialogue did not delay relapse after a mental health crisis (HR 0.95, 0.67–1.32), though secondary outcomes including inpatient admission favoured it. A meta-analysis of home-based transcranial direct current stimulation for depression found a small effect over sham (g 0.36, 0.06–0.66) that did not survive removing one positive trial; the two largest trials were negative. In a 316-child sequential randomised trial, starting with fluoxetine or with cognitive behavioural therapy gave similar improvement in anxiety, and adding the other treatment at 12 weeks did not beat continuing the first. The pearl: in psychosis and bipolar disorder, the physical health check starts at the first episode, not in middle age.