Psychological intervention in individuals with subthreshold depression: individual participant data meta-analysis of treatment effects and moderators

Research output: Journal contributionsScientific review articlesResearch

Authors

  • Author Collaboration of "Psychological intervention in individuals with subthreshold depression: individual participant data meta-analysis of treatment effects and moderators"
  • Mathias Harrer
  • Antonia A. Sprenger
  • Susan Illing
  • Marcel C. Adriaanse
  • Steven M. Albert
  • Esther Allart
  • Dirk Lehr

Background It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission. Aims To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers. Method Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment-covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values. Results IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = -0.48 to -0.27). Effects could not be ascertained up to 24 months (s.m.d. = -0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27-2.79), reliable improvement (relative risk = 1.38-3.17), deterioration (relative risk = 0.67-0.54) and close-to-symptom-free status (relative risk = 1.41-2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = -0.33 for PHQ-9 = 5). Conclusions Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.

Original languageEnglish
JournalBritish Journal of Psychiatry
Number of pages14
ISSN0007-1250
DOIs
Publication statusAccepted/In press - 2025

Bibliographical note

Publisher Copyright:
© 2025 The Author(s).

    Research areas

  • depressive disorders, Meta-analysis, precision medicine, prevention, psychological treatments
  • Psychology

DOI

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