Care-as-usual control groups across different settings in randomized trials on psychotherapy for adult depression: a meta-analysis
Open accessAbstract
Background: Care-as-usual (CAU) is often used as a control condition in psychotherapy research, but it may vary considerably what that entails, ranging from no treatment, to routine treatment in primary care, general medical care, perinatal care, and specialized mental health care. Methods: We conducted a meta-analysis of trials comparing psychotherapy for depression to CAU, with a focus on the different categories of CAU and countries where the studies were conducted. We used an existing database of randomized trials on psychotherapy for depression that is updated every year. Results: A total of 140 studies with 15 419 patients were included. We found no significant differences in effects between categories of CAU (effect sizes ranging from g = 0.43 for CAU in primary care to g = 0.73 for no treatment), but heterogeneity was high in all CAU categories. After stratifying effects across specific countries (within CAU categories) we found that heterogeneity was considerably lower and there were several significant differences between countries. Overall, effects were larger in non-Western countries (g = 0.84 to 1.28) compared to those in Western countries (g = 0.52; p for difference = 0.002). Effects were smaller in studies with risk of bias (p = 0.01). Conclusions: There are no significant differences between major categories of CAU when compared to psychotherapy conditions in randomized trials. However, effects of psychotherapy differ considerably across CAU conditions in specific countries. CAU therefore is a heterogeneous control condition in psychotherapy research.
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TAU was found to be a very heterogeneous control condition and anything but usual or standard care.
“TAU, in addition, was also found to be a very heterogeneous control condition and anything but usual or standard care85,86.”
From A systematic review and meta-analysis of acceptance- and mindfulness-based interventions for DSM-5 anxiety disorders (2021) · cites this paper as [85]
The Discussion confirms that care-as-usual is a heterogeneous control condition, with categories ranging from no treatment to specialized mental health care. But the Introduction also describes it as care usually provided in a given setting; the paper does not establish that it is ‘anything but usual’ care in that sense. (LLM, conf=0.87)
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Pettman, D., O’Mahen, H., Blomberg, O., Svanberg, A. S., von Essen, L., & Woodford, J. (2024) · Figshare · doi:10.6084/m9.figshare.26578826
Pettman, D., O’Mahen, H., Blomberg, O., Svanberg, A. S., von Essen, L., & Woodford, J. (2024) · Figshare · doi:10.6084/m9.figshare.26578823
Pettman, D., O’Mahen, H., Blomberg, O., Svanberg, A. S., von Essen, L., & Woodford, J. (2024) · Figshare · doi:10.6084/m9.figshare.26578808
Pettman, D., O’Mahen, H., Blomberg, O., Svanberg, A. S., von Essen, L., & Woodford, J. (2024) · Figshare · doi:10.6084/m9.figshare.26578832
Pettman, D., O’Mahen, H., Blomberg, O., Svanberg, A. S., von Essen, L., & Woodford, J. (2024) · Figshare · doi:10.6084/m9.figshare.26578805
Küçükaksu, M. H., Hoekstra, T., Vermeulen, J. M., Jansen, L., Helmig, S., van Meijel, B., & Adriaanse, M. C. (2026) · Psychological Medicine · doi:10.1017/s0033291726104516
- Authors
- Cuijpers, P., Quero, S., Papola, D., Cristea, I. A., & Karyotaki, E.
- Affiliations
- Amsterdam Public Health (NL)
- Universitat Jaume I (ES)
- University of Verona (IT)
- University of Pavia (IT)
- Corresponding author
- Cuijpers, Pim
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2019-12-17
- Volume
- 51
- Issue
- 4
- Pages
- 634-644
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2994802459
- Cited by
- 62
- References
- 34
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 23 · 2023: 15 · 2022: 8 · 2021: 10 · 2020: 1
- FWCI
- 0.75
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Repositori UJI (Universitat Jaume I) (submittedVersion, public-domain)
- VU Research Portal (submittedVersion, other-oa)
- Padua Research Archive (University of Padova) (submittedVersion)
- Data Archiving and Networked Services (DANS) (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 › Applied Psychology › Digital Mental Health Interventions
- Keywords
- usual care, control conditions, psychotherapy for depression, adult depression, primary care, perinatal care, specialized mental health care, no treatment, country differences, risk of bias, heterogeneous effects
- MeSH terms
- Adult, Depression, Female, Humans, Male, Middle Aged, Psychotherapy, Randomized Controlled Trials as Topic, Control Groups
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