The outcomes of mental health care for depression over time: A meta-regression analysis of response rates in usual care
Open accessAbstract
BACKGROUND: Over the past decades dozens of randomized trials have shown that psychological treatments are more effective than care-as-usual (CAU). It could be expected that these treatments are implemented in routine care and that the response rates in usual care improve over time. The aim of the current meta-analysis is to examine if response and remission rates in usual care have improved over time. METHODS: We used an existing meta-analytic database of randomized controlled trials examining the effects of psychological treatments of depression and selected CAU control groups from these trials. We only included CAU conditions in primary care, specialized mental health care, perinatal care and general medical care. The response rate (50 % symptom reduction) was the primary outcome. RESULTS: = 83; 95 % CI: 80; 85), with somewhat higher rates in primary care (0.27; 95 % CI: 0.23; 0.31). We found hardly any indications that the outcomes have improved over the years. The meta-regression analysis with publication year as predictor in the full dataset resulted in a coefficient of 0.1 (SE = 0.01; p = 0.0.35). A series of sensitivity analyses supported the main findings. Remission rates and pre-post effect sizes also did not significantly improve over time. CONCLUSIONS: Response and remission rates in usual care are low, with the large majority of patients not responding or remitting, and the outcomes have probably not improved over time.
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Remission rates following CBT for depression and anxiety disorders are still disappointing, leading to a debate about stagnating outcomes of CBT.
“However, it has become evident that remission rates following CBT for depression and anxiety disorders are still disappointing [5], leading to a debate about the stagnating outcomes of CBT in depression [6] and anxiety disorders [7].”
From Process-based therapy vs. routine-CBT for difficult-to-treat mood and anxiety disorders: study protocol for a randomized controlled trial (2024) · cites this paper as [6]
The LCT program's treatment response rate is substantially higher than the treatment response rates for depression found in standard, face-to-face mental health care settings.
“This is substantially higher than the treatment response rates for depression found in standard, face-to-face mental health care settings.”
A recent meta-analysis estimated that depression treatment response rates in "usual care" mental health treatment are approximately 20%.
“For example, a recent meta-analysis estimated that depression treatment response rates in “usual care” mental health treatment are approximately 20% [19].”
Approximately 87% (29,012/33,492) of clients achieved clinical improvement over a median of 6 live synchronous sessions, compared with 22%-67% improvement rates over 8-15 sessions (or even longer) in traditional mental health care settings.
“Approximately 87% (29,012/33,492) of clients achieved clinical improvement (ie, reliable improvement or recovery) over a median of 6 live synchronous sessions, compared with 22%-67% improvement rates over 8-15 sessions (or even longer) in traditional mental health care settings [19,39-41].”
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References 29 · Cited by 30
- Authors
- Cuijpers, P., Miguel, C., Harrer, M., Ciharova, M., & Karyotaki, E.
- Affiliations
- Babeș-Bolyai University (RO)
- Amsterdam Public Health (NL)
- Technical University of Munich (DE)
- Corresponding author
- Cuijpers, Pim
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2024-08
- Volume
- 358
- Pages
- 89-96
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W4396643202
- Cited by
- 30
- References
- 29
- Citations by year
- 2026: 16 · 2025: 9 · 2024: 5
- FWCI
- 2.64
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Affective Disorders (publishedVersion, cc-by)
- PubMed (publishedVersion)
- VU Research Portal (submittedVersion, other-oa)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- depression, usual care, response rate, remission rate, psychological intervention, primary care, mental health services
- MeSH terms
- Depression, Depressive Disorder, Humans, Mental Health Services, Primary Health Care, Psychotherapy, Regression Analysis, Remission Induction, Randomized Controlled Trials as Topic, Treatment Outcome
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