Author
GUSTAFSSON Carina; et al.;
Effects of psychosocial interventions for people with intellectual disabilities and mental health problems: a survey of systematic reviews.
Journal citation/publication details
Research on Social Work Practice, 19(3), May 2009, pp.281-290.
Summary
None of the three systematic reviews identified (two of psychotherapy interventions and one on integrated care and support) were able to provide strong evidence on the effects of psychosocial interventions aimed at people with intellectual disabilities (ID) and a comorbid mental health problem. The methodological limitations of both the included and excluded systematic reviews, as well as the primary research on which they were based, are discussed.
Context
People with intellectual disabilities (IDs) have been found to exhibit the full range of mental health disorders but the effectiveness of care and support to this population remains unclear. The aim of this study was to 'survey the results from systematic reviews, including meta-analyses, that have evaluated the effects of psychosocial interventions' for adults with IDs and/or an autistic syndrome disorder with comorbid mental health problems.
Methods
What sources were searched?
Ten electronic databases were searched: Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment (HTA) Database, Campbell Collaboration Reviews of Interventions and Policy Evaluations (C2-RIPE), PubMed, Applied Social Sciences Index and Abstracts (ASSIA), PsycINFO, CINAHL, SocINDEX, and EMBASE.
What search terms/strategies were used?
Search strategies, using both controlled vocabulary and free-text searches were tailored to each database. The terms used related to the target population and 'systematic review' or 'review'. The searches were performed by information specialists (last search January 2006) and were not restricted by date or language. Specific details of the search strategies are available from the first author.
What criteria were used to decide on which studies to include?
Eligible studies were systematic reviews, as defined by the Campbell Collaboration, of psychosocial interventions in adults (aged 18 years and older) with: ID (IQ 70 or less) confirmed in childhood or adolescence; and impairment of adaptive functioning; and/or autistic disorder; and mental health disorders. Studies of adults receiving special services because of low intelligence and adaptive behaviour deficits were also included. Autism and mental health disorders were defined according to ICD-10 and DSM-IV. Psychosocial interventions included: psychotherapy, training of cognitive functions, social skills training, training in activities of daily living, family interventions and psychoeducation programmes, and integrated care and support interventions.
Who decided on their relevance and quality?
The titles and abstracts of the 1,789 articles retrieved from the database searches were screened for relevance. The full text of 126 potentially relevant reviews was obtained and assessed in detail against the inclusion criteria. The screening process was carried out independently by two unspecified authors. Disagreements were resolved by discussion. A quality assessment score of 1 to 4, where Level 1 indicated a high level of evidence, was assigned to each review based on Swedish guidelines.
How many studies were included and where were they from?
Three systematic reviews met the criteria for inclusion.
How were the study findings combined?
Data from the 126 reviews was extracted and the results of the three systematic reviews which met the inclusion criteria, as well as details of why the remaining reviews were excluded, are presented as a narrative synthesis under three headings: 'Housing Support and Social Skills Training', 'Psychotherapy', and 'Interventions of Integrated care and Support'. None of the information is tabulated.
Findings of the review
Housing support and social skills training
Eight reviews on housing support and 21 reviews of social skills training (19 reporting results on adults with ID) were identified. All were excluded due to poor methodological quality or non-adherence to the inclusion/exclusion criteria.
Psychotherapy
Only two of the 55 reviews of psychotherapy for people with ID matched the definition of 'systematic review' laid down for this study. One was a review of three trials (two randomised controlled trials and one quasi-experimental study) of the effect of behavioural and cognitive-behavioural interventions for ID people with aggressive behaviour. All three studies were small, heterogeneous, and had methodological limitations. The second review aimed to examine the effectiveness of pharmacological and psychological treatment for people with ID who had been convicted of a sexual offence or had exhibited sexually offensive behaviour and found no randomised controlled trials to include.
Interventions of integrated care and support
The single systematic review identified within this category was subject to a number of limitations due to the poor quality of the trials included.
Authors' conclusions
'There is only weak scientific support for some of the specific psychosocial interventions implemented to meet the special needs of people with IDs and a concurrent mental health problem.'
Implications for policy or practice
The need for future studies in social psychiatry where this special population is not excluded is emphasised.