Does pretreatment severity moderate the efficacy of psychological treatment of adult outpatient depression? A meta-analysis.
Abstract
OBJECTIVE: It is widely believed that psychological treatment has little effect on more severely depressed patients. This study assessed whether pretreatment severity moderates psychological treatment outcome relative to controls by means of meta-analyses. METHOD: We included 132 studies (10,134 participants) from a database of studies (www.evidencebasedpsychotherapies.org) in which the effects of psychological treatment on adult outpatients with a depressive disorder or an elevated level of depressive symptoms were compared with a control condition in a randomized controlled trial. Two raters independently extracted outcome data and rated study characteristics. We conducted metaregression analyses assessing whether mean pretreatment depression scores predicted psychological treatment versus control condition posttreatment effect size and subgroup analyses summarizing the results of studies reporting within-study analyses of depression severity and psychological treatment outcome. RESULTS: Psychological treatment was found to be consistently superior to control conditions (d = 0.40-0.88). We found no indication that pretreatment mean depression scores predicted psychological treatment versus control condition posttreatment effect size, even after adjusting for relevant study characteristics. However, among the smaller subset of studies that reported within-study severity analyses, posttreatment effect sizes were higher for high-severity patients (d = 0.63) than for low-severity patients (d = 0.22) when psychological treatment was efficacious relative to a more stringent control. CONCLUSION: Contrary to conventional wisdom, our findings suggest that when compared with control conditions, psychological treatment might be more efficacious for high-severity than for low-severity patients. Because the number of studies reporting within-study severity analyses is small, we recommend that future studies routinely report tests for Severity × Treatment interactions.
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Similar results were also found in people with diabetes, that psychological treatment might be more efficacious for high-severity than for low-severity participants with depression.
“Similar results were also found in people with diabetes, that psychological treatment might be more efficacious for high‐severity than for low‐severity participants with depression 37 .”
From Effects of mindfulness-based intervention on glycemic control and psychological outcomes in people with diabetes: a systematic review and meta-analysis (2021) · cites this paper as [37]
The finding of increased effect sizes with increased baseline symptoms is broadly consistent with data within previous psychotherapy studies showing increased effect sizes with samples of increased symptoms, even when similar treatments are applied.
“This finding is broadly consistent with the data within previous psychotherapy studies showing increased effect sizes with samples of increased symptoms, even when similar treatments are applied [20,29,32].”
From Measurement of Symptom Change Following Web-Based Psychotherapy: Statistical Characteristics and Analytical Methods for Measuring and Interpreting Change (2018) · cites this paper as [32]
The rate of change would systematically depend on an individual's symptoms at baseline.
“and that the rate of change would systematically depend on an individual’s symptoms at baseline [32,33].”
From Measurement of Symptom Change Following Web-Based Psychotherapy: Statistical Characteristics and Analytical Methods for Measuring and Interpreting Change (2018) · cites this paper as [32]
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- Authors
- Driessen, E., Cuijpers, P., Hollon, S. D., & Dekker, J. J. M.
- Affiliations
- Vrije Universiteit Amsterdam (NL)
- Vanderbilt University (US)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2010
- Volume
- 78
- Issue
- 5
- Pages
- 668-680
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- OpenAlex
- W2062645441
- Cited by
- 208
- References
- 54
- Citations by year
- 2026: 11 · 2025: 11 · 2024: 13 · 2023: 5 · 2022: 13 · 2021: 16 · 2020: 13 · 2019: 9 · 2018: 9 · 2017: 18 · 2016: 13 · 2015: 14 · 2014: 15 · 2013: 17 · 2012: 24
- FWCI
- 16.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- VU Research Portal (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- depression, psychological intervention, pretreatment severity, treatment response, outpatient depression, depressive symptoms, psychotherapy efficacy
- MeSH terms
- Adult, Ambulatory Care, Behavior Therapy, Major Depressive Disorder, Female, Humans, Male, Person-Centered Psychotherapy, Problem Solving, Psychotherapy, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome, Retreatment, Evidence-Based Medicine, Mood Disorders
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