Initial severity of depression and efficacy of cognitive–behavioural therapy: Individual-participant data meta-analysis of pill-placebo-controlled trials
Year: 2017
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Background The influence of baseline severity has been examined for antidepressant medications but has not been studied properly for cognitive–behavioural therapy (CBT) in comparison with pill placebo. Aims To synthesise evidence regarding the influence of initial severity on efficacy of CBT from all randomised controlled trials (RCTs) in which CBT, in face-to-face individual or group format, was compared with pill-placebo control in adults with major depression. Method A systematic review and an individual-participant data meta-analysis using mixed models that included trial effects as random effects. We used multiple imputation to handle missing data. Results We identified five RCTs, and we were given access to individual-level data (n= 509) for all five. The analyses revealed that the difference in changes in Hamilton Rating Scale for Depression between CBT and pill placebo was not influenced by baseline severity (interactionP= 0.43). Removing the non-significant interaction term from the model, the difference between CBT and pill placebo was a standardised mean difference of −0.22 (95% CI −0.42 to −0.02,P= 0.03,I2= 0%). Conclusions Patients suffering from major depression can expect as much benefit from CBT across the wide range of baseline severity. This finding can help inform individualised treatment decisions by patients and their clinicians.
Institutions: Linköping University, Boston University, Vanderbilt University, Kyoto University, Karolinska Institutet, Amsterdam Public Health, Vrije Universiteit Amsterdam, University of Pennsylvania, University of Colorado Boulder, Leipzig University, The University of Texas Southwestern Medical Center, Truman State University
Language: English
Subfield: Experimental and Cognitive Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: hybrid
Estimated APC paid: $4,920
Funders: Bristol-Myers Squibb, Eli Lilly and Company, Pfizer, Ministry of Health, Labour and Welfare, Ministry of Education, Science and Technology, Servier, H. Lundbeck A/S, National Institutes of Health, Japan Society for the Promotion of Science, National Institute of Mental Health, National Center for Complementary and Integrative Health
Awards: G1773316229, G2449883732, Toward Outcome Measurement of Anxiety in Youth with Autism Spectrum Disorders, 2/3-Dose Timing of D-cycloserine to Augment CBT for Social Anxiety Disorder, G3315728346, G3343094243, G3746933981, G4058782959, Fear extinction memory in primary insomnia, Prevention of Recurrence in Depression with Drugs and CT, G5897165952, G7752674917, G824439374, Network meta-analysis as a new method for evidence synthesis, G8773824831, G9000085893, G9000096064, G9000116120, G9000215294
OpenAlex ID: W2573040034