Systematic review of mental health interventions for patients with common somatic symptoms: can research evidence from secondary care be extrapolated to primary care?

Observed Findings

• Cognitive behaviour therapy and behaviour therapy showed effectiveness for ME/CFS in both primary and secondary care settings.
• Antidepressants demonstrated efficacy for irritable bowel syndrome but were ineffective for ME/CFS.
• Effect sizes and evidence consistency were larger for secondary care patients compared to primary care patients with back pain.
• Little research evidence was identified for brief psychodynamic interpersonal therapy across all three conditions.
• Secondary care interventions appeared more effective overall than primary care interventions, with potential explanations including greater disease severity, different treatment regimens, or closer supervision.

Inferred Conclusions

• Cognitive behaviour therapy and behaviour therapy are evidence-supported treatments for ME/CFS, though results are more robust in secondary care.
• Treatment effectiveness may depend on setting, patient severity, intervention fidelity, and supervision level.
• Large pragmatic trials are needed in primary care with appropriately trained staff to determine whether secondary care results can be generalized.
• Methodological improvements are essential before drawing firm conclusions about effectiveness across different care settings.

Remaining Questions