Abstract
Rural and remote populations have a high burden of depression and poorer access to mental healthcare services than their urban counterparts. This systematic review aimed to assess the effectiveness of psychological and pharmacological treatments on reducing depression specifically in rural and remote residents. Cochrane Library, Medline, PsycInfo, Embase and Scopus, and two clinical trial registries were searched. Included studies were randomised or cluster randomised trials conducted with rural and remote adult populations; examined the effectiveness of any treatment for depression; included a control group or comparator; measured depression; and were published in English. Two authors independently screened records for eligibility, extracted information from eligible studies and assessed risk of bias and certainty of evidence. Seventeen studies were included. Meta-analyses found a small benefit of behavioural activation therapy (standardised mean difference -0.43, 95% CI -0.78, -0.08, I(2) = 40%), a large benefit of group therapy (standardised mean difference -1.80, 95% CI -2.80, -0.79, I(2) = 93%) and no evidence of benefit of interpersonal therapy (standardised mean difference -0.89, 95% CI -2.30, 0.52, I(2) = 96%) and cognitive behavioural therapy (standardised mean difference -2.39, 95% CI -5.83, 1.05, I(2) = 98%) for reducing depression in rural populations. Behavioural activation and group therapy appear effective for treating depression among rural populations, although the certainty of evidence is low, and so further research is warranted. Further research on the effectiveness of psychological and pharmacological treatments on depression in rural and remote populations is needed.