Effectiveness of psychological interventions in preventing recurrence of depressive disorder: Meta-analysis and meta-regression
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Effectiveness of psychological interventions in preventing recurrence of depressive disorder : Meta-analysis and meta-regression. / Biesheuvel-Leliefeld, Karolien E M; Kok, Gemma D.; Bockting, Claudi L H et al.
In: Journal of Affective Disorders, Vol. 174, 15.03.2015, p. 400-410.Research output: Journal contributions › Journal articles › Research › peer-review
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TY - JOUR
T1 - Effectiveness of psychological interventions in preventing recurrence of depressive disorder
T2 - Meta-analysis and meta-regression
AU - Biesheuvel-Leliefeld, Karolien E M
AU - Kok, Gemma D.
AU - Bockting, Claudi L H
AU - Cuijpers, Pim
AU - Hollon, Steven D.
AU - Van Marwijk, Harm W J
AU - Smit, Filip
PY - 2015/3/15
Y1 - 2015/3/15
N2 - Methods We systematically reviewed the pertinent trial literature until May 2014. The random-effects model was used to compute the pooled relative risk of relapse or recurrence (RR). A distinction was made between two comparator conditions: (1) treatment-as-usual and (2) the use of antidepressants. Other sources of heterogeneity in the data were explored using meta-regression.Background Major depression is probably best seen as a chronically recurrent disorder, with patients experiencing another depressive episode after remission. Therefore, attention to reduce the risk of relapse or recurrence after remission is warranted. The aim of this review is to meta-analytically examine the effectiveness of psychological interventions to reduce relapse or recurrence rates of depressive disorder.Results Twenty-five randomised trials met inclusion criteria. Preventive psychological interventions were significantly better than treatment-as-usual in reducing the risk of relapse or recurrence (RR=0.64, 95% CI=0.53-0.76, z=4.89, p<0.001, NNT=5) and also more successful than antidepressants (RR=0.83, 95% CI=0.70-0.97, z=2.40, p=0.017, NNT=13). Meta-regression showed homogeneity in effect size across a range of study, population and intervention characteristics, but the preventive effect of psychological intervention was usually better when the prevention was preceded by treatment in the acute phase (b=-1.94, SEb=0.68, z=-2.84, p=0.005).Limitations Differences between the primary studies in methodological design, composition of the patient groups and type of intervention may have caused heterogeneity in the data, but could not be evaluated in a meta-regression owing to poor reporting.Conclusions We conclude that there is supporting evidence that preventive psychological interventions reduce the risk of relapse or recurrence in major depression.
AB - Methods We systematically reviewed the pertinent trial literature until May 2014. The random-effects model was used to compute the pooled relative risk of relapse or recurrence (RR). A distinction was made between two comparator conditions: (1) treatment-as-usual and (2) the use of antidepressants. Other sources of heterogeneity in the data were explored using meta-regression.Background Major depression is probably best seen as a chronically recurrent disorder, with patients experiencing another depressive episode after remission. Therefore, attention to reduce the risk of relapse or recurrence after remission is warranted. The aim of this review is to meta-analytically examine the effectiveness of psychological interventions to reduce relapse or recurrence rates of depressive disorder.Results Twenty-five randomised trials met inclusion criteria. Preventive psychological interventions were significantly better than treatment-as-usual in reducing the risk of relapse or recurrence (RR=0.64, 95% CI=0.53-0.76, z=4.89, p<0.001, NNT=5) and also more successful than antidepressants (RR=0.83, 95% CI=0.70-0.97, z=2.40, p=0.017, NNT=13). Meta-regression showed homogeneity in effect size across a range of study, population and intervention characteristics, but the preventive effect of psychological intervention was usually better when the prevention was preceded by treatment in the acute phase (b=-1.94, SEb=0.68, z=-2.84, p=0.005).Limitations Differences between the primary studies in methodological design, composition of the patient groups and type of intervention may have caused heterogeneity in the data, but could not be evaluated in a meta-regression owing to poor reporting.Conclusions We conclude that there is supporting evidence that preventive psychological interventions reduce the risk of relapse or recurrence in major depression.
KW - Health sciences
KW - Major depressive disorder
KW - Meta-analysis
KW - Prevention
KW - Psychotherapy
KW - Recurrence
KW - Relapse
UR - http://www.scopus.com/inward/record.url?scp=84920177798&partnerID=8YFLogxK
U2 - 10.1016/j.jad.2014.12.016
DO - 10.1016/j.jad.2014.12.016
M3 - Journal articles
C2 - 25553400
AN - SCOPUS:84920177798
VL - 174
SP - 400
EP - 410
JO - Journal of Affective Disorders
JF - Journal of Affective Disorders
SN - 0165-0327
ER -