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

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

doi:10.1192/bjp.2025.56

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

Research output: Journal contributions › Scientific review articles › Research

Standard

Psychological intervention in individuals with subthreshold depression: individual participant data meta-analysis of treatment effects and moderators. / Author Collaboration of "Psychological intervention in individuals with subthreshold depression: individual participant data meta-analysis of treatment effects and moderators"; Harrer, Mathias; Sprenger, Antonia A. et al.
In: British Journal of Psychiatry, 2025.

Research output: Journal contributions › Scientific review articles › Research

Harvard

Author Collaboration of "Psychological intervention in individuals with subthreshold depression: individual participant data meta-analysis of treatment effects and moderators", Harrer, M, Sprenger, AA, Illing, S, Adriaanse, MC, Albert, SM, Allart, E & Lehr, D 2025, 'Psychological intervention in individuals with subthreshold depression: individual participant data meta-analysis of treatment effects and moderators', British Journal of Psychiatry. https://doi.org/10.1192/bjp.2025.56

APA

Author Collaboration of "Psychological intervention in individuals with subthreshold depression: individual participant data meta-analysis of treatment effects and moderators", Harrer, M., Sprenger, A. A., Illing, S., Adriaanse, M. C., Albert, S. M., Allart, E., & Lehr, D. (in press). Psychological intervention in individuals with subthreshold depression: individual participant data meta-analysis of treatment effects and moderators. British Journal of Psychiatry. https://doi.org/10.1192/bjp.2025.56

Vancouver

Author Collaboration of "Psychological intervention in individuals with subthreshold depression: individual participant data meta-analysis of treatment effects and moderators", Harrer M, Sprenger AA, Illing S, Adriaanse MC, Albert SM et al. Psychological intervention in individuals with subthreshold depression: individual participant data meta-analysis of treatment effects and moderators. British Journal of Psychiatry. 2025. doi: 10.1192/bjp.2025.56

Bibtex

@article{3502e0967130446ea340c889922db169,

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

abstract = "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.",

keywords = "depressive disorders, Meta-analysis, precision medicine, prevention, psychological treatments, Psychology",

author = "{Author Collaboration of {"}Psychological intervention in individuals with subthreshold depression: individual participant data meta-analysis of treatment effects and moderators{"}} and Mathias Harrer and Sprenger, {Antonia A.} and Susan Illing and Adriaanse, {Marcel C.} and Albert, {Steven M.} and Esther Allart and Almeida, {Osvaldo P.} and Julian Basanovic and {Van Bastelaar}, {Kim M.P.} and Batterham, {Philip J.} and Harald Baumeister and Thomas Berger and Vanessa Blanco and Ragnhild B{\o} and Casten, {Robin J.} and Dicken Chan and Helen Christensen and Marketa Ciharova and Lorna Cook and John Cornell and Davis, {Elysia P.} and Dobson, {Keith S.} and Elsien Dozeman and Simon Gilbody and Hankin, {Benjamin L.} and Rimke Haringsma and Kristof Hoorelbeke and Irwin, {Michael R.} and Femke Jansen and Rune Jonassen and Eirini Karyotaki and Norito Kawakami and {Philipp Klein}, J. and Candace Konnert and Kotaro Imamura and Landr{\o}, {Nils Inge} and Lara, {Mar{\'i}a Asunci{\'o}n} and Le, {Huynh Nhu} and Dirk Lehr and Luciano, {Juan V.} and Steffen Moritz and Mossey, {Jana M.} and Mu{\~n}oz, {Ricardo F.} and Anna Muntingh and Stephanie Nobis and Richard Olmstead and Patricia Otero and Pim Cuijpers and Claudia Buntrock and Ebert, {David Daniel}",

note = "Publisher Copyright: {\textcopyright} 2025 The Author(s).",

year = "2025",

doi = "10.1192/bjp.2025.56",

language = "English",

journal = "British Journal of Psychiatry",

issn = "0007-1250",

publisher = "Cambridge University Press",

}

RIS

TY - JOUR

T1 - Psychological intervention in individuals with subthreshold depression

T2 - individual participant data meta-analysis of treatment effects and moderators

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

AU - Harrer, Mathias

AU - Sprenger, Antonia A.

AU - Illing, Susan

AU - Adriaanse, Marcel C.

AU - Albert, Steven M.

AU - Allart, Esther

AU - Almeida, Osvaldo P.

AU - Basanovic, Julian

AU - Van Bastelaar, Kim M.P.

AU - Batterham, Philip J.

AU - Baumeister, Harald

AU - Berger, Thomas

AU - Blanco, Vanessa

AU - Bø, Ragnhild

AU - Casten, Robin J.

AU - Chan, Dicken

AU - Christensen, Helen

AU - Ciharova, Marketa

AU - Cook, Lorna

AU - Cornell, John

AU - Davis, Elysia P.

AU - Dobson, Keith S.

AU - Dozeman, Elsien

AU - Gilbody, Simon

AU - Hankin, Benjamin L.

AU - Haringsma, Rimke

AU - Hoorelbeke, Kristof

AU - Irwin, Michael R.

AU - Jansen, Femke

AU - Jonassen, Rune

AU - Karyotaki, Eirini

AU - Kawakami, Norito

AU - Philipp Klein, J.

AU - Konnert, Candace

AU - Imamura, Kotaro

AU - Landrø, Nils Inge

AU - Lara, María Asunción

AU - Le, Huynh Nhu

AU - Lehr, Dirk

AU - Luciano, Juan V.

AU - Moritz, Steffen

AU - Mossey, Jana M.

AU - Muñoz, Ricardo F.

AU - Muntingh, Anna

AU - Nobis, Stephanie

AU - Olmstead, Richard

AU - Otero, Patricia

AU - Cuijpers, Pim

AU - Buntrock, Claudia

AU - Ebert, David Daniel

PY - 2025

Y1 - 2025

N2 - 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.

AB - 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.

KW - depressive disorders

KW - Meta-analysis

KW - precision medicine

KW - prevention

KW - psychological treatments

KW - Psychology

UR - http://www.scopus.com/inward/record.url?scp=105005716473&partnerID=8YFLogxK

U2 - 10.1192/bjp.2025.56

DO - 10.1192/bjp.2025.56

M3 - Scientific review articles

C2 - 40365980

AN - SCOPUS:105005716473

JO - British Journal of Psychiatry

JF - British Journal of Psychiatry

SN - 0007-1250

ER -

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