Initial severity of depression and efficacy of cognitive-behavioural therapy: individual-participant data meta-analysis of pill-placebo-controlled trials

被引:53
作者
Furukawa, Toshi A. [1 ,2 ,3 ]
Weitz, Erica S. [4 ,5 ]
Tanaka, Shiro [6 ]
Hollon, Steven D. [7 ]
Hofmann, Stefan G. [8 ]
Andersson, Gerhard [9 ,10 ,11 ]
Twisk, Jos [12 ]
DeRubeis, Robert J. [13 ,15 ]
Dimidjian, Sona [14 ]
Hegerl, Ulrich
Mergl, Roland [16 ]
Jarrett, Robin B.
Vittengl, Jeffrey R.
Watanabe, Norio [17 ,18 ]
Cuijpers, Pim [19 ]
机构
[1] Kyoto Univ, Grad Sch Med, Dept Hlth Promot, Kyoto, Japan
[2] Kyoto Univ, Grad Sch Med, Sch Publ Hlth, Dept Human Behav, Kyoto, Japan
[3] Kyoto Univ, Grad Sch Med, Sch Publ Hlth, Dept Clin Epidemiol, Kyoto, Japan
[4] Vrije Univ Amsterdam, Dept Clin Psychol, Amsterdam, Netherlands
[5] Vrije Univ Amsterdam, EMGO Inst Hlth & Care Res, Amsterdam, Netherlands
[6] Kyoto Univ, Grad Sch Med, Sch Publ Hlth, Dept Pharmacoepidemiol, Kyoto, Japan
[7] Vanderbilt Univ, Dept Psychol, Nashville, TN USA
[8] Boston Univ, Dept Psychol & Brain Sci, Boston, MA USA
[9] Linkoping Univ, Dept Behav Sci & Learning, Linkoping, Sweden
[10] Linkoping Univ, Dept Behav Sci & Learning, Linkoping, Sweden
[11] Karolinska Inst, Psychiat Sect, Dept Clin Neurosci, Stockholm, Sweden
[12] Vrije Univ Amsterdam, Dept Epidemiol & Biostat, EMGO Inst Hlth & Care Res, Amsterdam, Netherlands
[13] Univ Penn, Dept Psychol, Philadelphia, PA USA
[14] Univ Colorado Boulder, Dept Psychol & Neurosci, Boulder, CO USA
[15] Univ Leipzig, Dept Psychiat & Psychotherapy, Leipzig, Germany
[16] Univ Texas Southwest Med Ctr, Dept Psychiat, Dallas, TX USA
[17] Truman State Univ, Dept Psychol, Kirksville, MO USA
[18] Kyoto Univ, Grad Sch Med, Sch Publ Hlth, Kyoto, Japan
[19] Vrije Univ Amsterdam, Inst Hlth & Care Res, Dept Clin Psychol & EMGO, Amsterdam, Netherlands
基金
日本学术振兴会;
关键词
2ND-GENERATION ANTIDEPRESSANTS; PSYCHOTHERAPY TRIALS; COMPARATIVE BENEFITS; SYSTEMATIC REVIEWS; ADULT DEPRESSION; WAITING-LIST; DISORDER; PHARMACOTHERAPY; PUBLICATION; MODERATE;
D O I
10.1192/bjp.bp.116.187773
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
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 (interaction P=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, l(2)=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.
引用
收藏
页码:190 / 196
页数:7
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