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

Toshi A. Furukawa, Erica S. Weitz, Shiro Tanaka, Steven D. Hollon, Stefan G. Hofmann, Gerhard Andersson, Jos Twisk, Robert J. De Rubeis, Sonas Dimidjian, Ulrich Hegerl, Roland Mergl, Robin B. Jarrett, Jeffrey R. Vittengl, Norio Watanabe, Pim Cuijpers

Research output: Contribution to journalReview articleAcademicpeer-review

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 (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 70.22 (95% CI 70.42 to 70.02, 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.

Original languageEnglish
Pages (from-to)190-196
Number of pages7
JournalBritish Journal of Psychiatry
Volume210
Issue number3
DOIs
Publication statusPublished - 1 Mar 2017

Cite this

Furukawa, Toshi A. ; Weitz, Erica S. ; Tanaka, Shiro ; Hollon, Steven D. ; Hofmann, Stefan G. ; Andersson, Gerhard ; Twisk, Jos ; De Rubeis, Robert J. ; Dimidjian, Sonas ; Hegerl, Ulrich ; Mergl, Roland ; Jarrett, Robin B. ; Vittengl, Jeffrey R. ; Watanabe, Norio ; Cuijpers, Pim. / Initial severity of depression and efficacy of cognitive-behavioural therapy : Individual-participant data meta-analysis of pill-placebo-controlled trials. In: British Journal of Psychiatry. 2017 ; Vol. 210, No. 3. pp. 190-196.
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title = "Initial severity of depression and efficacy of cognitive-behavioural therapy: Individual-participant data meta-analysis of pill-placebo-controlled trials",
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 (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 70.22 (95{\%} CI 70.42 to 70.02, 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.",
author = "Furukawa, {Toshi A.} and Weitz, {Erica S.} and Shiro Tanaka and Hollon, {Steven D.} and Hofmann, {Stefan G.} and Gerhard Andersson and Jos Twisk and {De Rubeis}, {Robert J.} and Sonas Dimidjian and Ulrich Hegerl and Roland Mergl and Jarrett, {Robin B.} and Vittengl, {Jeffrey R.} and Norio Watanabe and Pim Cuijpers",
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Furukawa, TA, Weitz, ES, Tanaka, S, Hollon, SD, Hofmann, SG, Andersson, G, Twisk, J, De Rubeis, RJ, Dimidjian, S, Hegerl, U, Mergl, R, Jarrett, RB, Vittengl, JR, Watanabe, N & Cuijpers, P 2017, 'Initial severity of depression and efficacy of cognitive-behavioural therapy: Individual-participant data meta-analysis of pill-placebo-controlled trials' British Journal of Psychiatry, vol. 210, no. 3, pp. 190-196. https://doi.org/10.1192/bjp.bp.116.187773

Initial severity of depression and efficacy of cognitive-behavioural therapy : Individual-participant data meta-analysis of pill-placebo-controlled trials. / Furukawa, Toshi A.; Weitz, Erica S.; Tanaka, Shiro; Hollon, Steven D.; Hofmann, Stefan G.; Andersson, Gerhard; Twisk, Jos; De Rubeis, Robert J.; Dimidjian, Sonas; Hegerl, Ulrich; Mergl, Roland; Jarrett, Robin B.; Vittengl, Jeffrey R.; Watanabe, Norio; Cuijpers, Pim.

In: British Journal of Psychiatry, Vol. 210, No. 3, 01.03.2017, p. 190-196.

Research output: Contribution to journalReview articleAcademicpeer-review

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T1 - Initial severity of depression and efficacy of cognitive-behavioural therapy

T2 - Individual-participant data meta-analysis of pill-placebo-controlled trials

AU - Furukawa, Toshi A.

AU - Weitz, Erica S.

AU - Tanaka, Shiro

AU - Hollon, Steven D.

AU - Hofmann, Stefan G.

AU - Andersson, Gerhard

AU - Twisk, Jos

AU - De Rubeis, Robert J.

AU - Dimidjian, Sonas

AU - Hegerl, Ulrich

AU - Mergl, Roland

AU - Jarrett, Robin B.

AU - Vittengl, Jeffrey R.

AU - Watanabe, Norio

AU - Cuijpers, Pim

PY - 2017/3/1

Y1 - 2017/3/1

N2 - 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 70.22 (95% CI 70.42 to 70.02, 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.

AB - 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 70.22 (95% CI 70.42 to 70.02, 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.

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JF - British Journal of Psychiatry

SN - 0007-1250

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