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 DeRubeis; Sona Dimidjian; Ulrich Hegerl; Roland Mergl; Robin B Jarrett; Jeffrey R Vittengl; Norio Watanabe; Pim Cuijpers

doi: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

Br J Psychiatry. 2017 Mar;210(3):190-196. doi: 10.1192/bjp.bp.116.187773. Epub 2017 Jan 19.

Authors

Affiliations

¹ Toshi A. Furukawa, MD, PhD, Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan; Erica S. Weitz, MA, Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University Amsterdam, The Netherlands; Shiro Tanaka, PhD, Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan; Steven D. Hollon, PhD, Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA; Stefan G. Hofmann, PhD, Department of Psychological and Brain Science, Boston University, Massachusetts, USA; Gerhard Andersson, PhD, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden and Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stokholm, Sweden; Jos Twisk, PhD, Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Amsterdam, The Netherlands; Robert J. DeRubeis, PhD, Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Sona Dimidjian, PhD, Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, USA; Ulrich Hegerl, MD, PhD, Roland Mergl, PhD, Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany; Robin B. Jarrett, PhD, Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA; Jeffrey R. Vittengl, PhD, Department of Psychology, Truman State University, Kirksville, Missouri, USA; Norio Watanabe, MD, PhD, Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan; Pim Cuijpers, PhD, Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University Amsterdam, The Netherlands furukawa@kuhp.kyoto-u.ac.jp.
² Toshi A. Furukawa, MD, PhD, Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan; Erica S. Weitz, MA, Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University Amsterdam, The Netherlands; Shiro Tanaka, PhD, Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan; Steven D. Hollon, PhD, Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA; Stefan G. Hofmann, PhD, Department of Psychological and Brain Science, Boston University, Massachusetts, USA; Gerhard Andersson, PhD, Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden and Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stokholm, Sweden; Jos Twisk, PhD, Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Amsterdam, The Netherlands; Robert J. DeRubeis, PhD, Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Sona Dimidjian, PhD, Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, USA; Ulrich Hegerl, MD, PhD, Roland Mergl, PhD, Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany; Robin B. Jarrett, PhD, Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas, USA; Jeffrey R. Vittengl, PhD, Department of Psychology, Truman State University, Kirksville, Missouri, USA; Norio Watanabe, MD, PhD, Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan; Pim Cuijpers, PhD, Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University Amsterdam, The Netherlands.

Abstract

BackgroundThe 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.AimsTo 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.MethodA 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.ResultsWe 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, I² = 0%).ConclusionsPatients 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.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Cognitive Behavioral Therapy / statistics & numerical data*
Depressive Disorder, Major / therapy*
Humans
Outcome Assessment, Health Care / statistics & numerical data*
Randomized Controlled Trials as Topic / statistics & numerical data*
Severity of Illness Index*

Abstract

Publication types

MeSH terms

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