Ten of these 18 women went into remission. There is a considerable choice of treatment modalities of proven efficacy for treating depression, including cognitive therapy, interpersonal psychotherapy, and drug treatments. We have also witnessed an explosion of counseling, an intervention with a much more slender evidence base. The size of the benefit for treated women who agreed to enter the trial suggests that it is of the same order of magnitude as for other proven treatments, with a number needed to treat of about four. In a companion paper, the possible mechanisms of action of the intervention are explored.
Psychosocial treatments are vulnerable to accusations of high cost.
In this case, however, treatment was provided by volunteers, so the only direct healthcare costs were those of training. The availability of the treatment will be limited to those areas in which suitable volunteers, training, and supervision can be provided. Of greatest concern in the findings is the fact that only about one in three of the suitable participants agreed to be allocated to the befriending treatment. Commentators often remark on the low acceptability of drug treatments to patients, but a refusal rate of almost two-thirds severely limits the generalizability of the findings, especially in an unblinded trial. Finally, it is important to remember that this intervention was tested in a center with expertise and enthusiasm for the intervention.