Different control conditions can produce different effect estimates in psychotherapy trials for depression

Ioannis Michopoulos; Toshi A Furukawa; Hisashi Noma; Sanae Kishimoto; Akira Onishi; Edoardo G Ostinelli; Marketa Ciharova; Clara Miguel; Eirini Karyotaki; Pim Cuijpers

doi:10.1016/j.jclinepi.2020.12.012

Different control conditions can produce different effect estimates in psychotherapy trials for depression

J Clin Epidemiol. 2021 Apr:132:59-70. doi: 10.1016/j.jclinepi.2020.12.012. Epub 2020 Dec 15.

Authors

Affiliations

¹ Eating Disorders Unit, 2nd Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece. Electronic address: imihopou@med.uoa.gr.
² Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
³ Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan.
⁴ Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan.
⁵ Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Hyogo, Japan.
⁶ Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK; Department of Psychiatry, University of Oxford, Oxford, UK.
⁷ Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
⁸ Department of Global Health and Social Medicine, Harvard Medical School, Boston MA, USA; Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

PMID: 33338564
DOI: 10.1016/j.jclinepi.2020.12.012

Abstract

Objectives: Control conditions' influence on effect estimates of active psychotherapeutic interventions for depression has not been fully elucidated. We used network meta-analysis to estimate the differences between control conditions.

Study design and setting: We have conducted a comprehensive literature search of randomized trials of psychotherapies for adults with depression up to January 1, 2019 in four major databases (PubMed, PsycINFO, Embase, and Cochrane). The network meta-analysis included broadly conceived cognitive behavior therapies in comparison with the following control conditions: Waiting List (WL), No Treatment (NT), Pill Placebo (PillPlacebo), Psychological Placebo (PsycholPlacebo).

Results: 123 studies with 12,596 participants were included. The I-squared was 55.9% (95% CI: 45.9%; to 64.0%) (moderate heterogeneity). The design-by-treatment global test of inconsistency was not significant (P = 0.44). Different control conditions led to different estimates of efficacy for the same intervention. WL appears to be the weakest control (odds ratio of response against NT = 1.93 (1.30 to 2.86), PsycholPlacebo = 2.03 (1.21 to 3.39), and PillPlacebo = 2.66 (1.45 to 4.89), respectively).

Conclusions: Different control conditions produce different effect estimates in psychotherapy randomized controlled trials for depression. WL was the weakest, followed by NT, PsycholPlacebo, and PillPlacebo in this order. When conducting meta-analyses of psychotherapy trials, different control conditions should not be lumped into a single group.

Keywords: Control conditions; Depression; Network meta-analysis; Psychotherapy; RCT.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Clinical Trials as Topic / methods*
Data Management
Depressive Disorder / therapy*
Humans
Psychotherapy / methods*
Research Design*

Grants and funding

BRC-1215-20005/DH_/Department of Health/United Kingdom