A primer on network meta-analysis with emphasis on mental health
Open accessAbstract
Objective: A quantitative synthesis of evidence via standard pair-wise meta-analysis lies on the top of the hierarchy for evaluating the relative effectiveness or safety between two interventions. In most healthcare problems, however, there is a plethora of competing interventions. Network meta-analysis allows to rank competing interventions and evaluate their relative effectiveness even if they have not been compared in an individual trial. The aim of this paper is to explain and discuss the main features of this statistical technique. Methods: We present the key assumptions underlying network meta-analysis and the graphical methods to visualise results and information in the network. We used one illustrative example that compared the relative effectiveness of 15 antimanic drugs and placebo in acute mania. Results: A network plot allows to visualise how information flows in the network and reveals important information about network geometry. Discrepancies between direct and indirect evidence can be detected using inconsistency plots. Relative effectiveness or safety of competing interventions can be presented in a league table. A contribution plot reveals the contribution of each direct comparison to each network estimate. A comparison-adjusted funnel plot is an extension of simple funnel plot to network meta-analysis. A rank probability matrix can be estimated to present the probabilities of all interventions assuming each rank and can be represented using rankograms and cumulative probability plots. Conclusions: Network meta-analysis is very helpful in comparing the relative effectiveness and acceptability of competing treatments. Several issues, however, still need to be addressed when conducting a network meta-analysis for the results to be valid and correctly interpreted.
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Previous pairwise meta-analyses could not answer these clinical questions because few trials have directly compared different types of psychotherapies.
“However, previous pairwise meta-analyses could not answer these clinical questions,13,14 because few trials have directly compared different types of psychotherapies.15”
From Different Types and Acceptability of Psychotherapies for Acute Anxiety Disorders in Children and Adolescents: A Network Meta-analysis (2019) · cites this paper as [14]
The Introduction explains that network meta-analysis can use indirect comparisons when interventions have not been compared directly. It does not say that few trials directly compare different types of psychotherapies; searches for psychotherapy and head-to-head comparisons found no passage establishing that claim. (LLM, conf=0.70)
Experimental — accuracy not yet measuredNetwork meta-analyses can combine multiple comparisons, use direct and indirect evidence, make better estimates, have more statistical power, and present consolidated comparisons.
“Network metaanalyses can combine multiple comparisons in one analysis, are able to use direct and indirect evidence, and thus make optimal use of all available evidence.These analyses consequently make better estimates of the differences between treatments, have more statistical power to examine moderators of outcome, and can present consolidated comparisons among alternative treatments 16 .”
From A network meta‐analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression (2020) · cites this paper as [16]
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- Authors
- Mavridis, D., Giannatsi, M., Cipriani, A., & Salanti, G.
- Affiliations
- University of Ioannina (GR)
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece;
- University of Oxford (GB)
- Corresponding author
- Mavridis, Dimitris
- Venue
- Evidence Based Mental Health
- Publisher
- BMJ
- Published
- 2015-04-23
- Volume
- 18
- Issue
- 2
- Pages
- 40-46
- ISSN
- 1362-0347 (ISSN-L)
- 1468-960X
- PMC
- PMC11234956
- OpenAlex
- W2085805157
- Cited by
- 198
- References
- 31
- Citations by year
- 2026: 9 · 2025: 8 · 2024: 13 · 2023: 14 · 2022: 24 · 2021: 29 · 2020: 21 · 2019: 22 · 2018: 23 · 2017: 11 · 2016: 22 · 2015: 1 · 2013: 1
- FWCI
- 17.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Evidence-Based Mental Health (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institute for Health and Care Research
- FP7 Ideas: European Research Council (260559)
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- network meta-analysis, mental health interventions, acute mania, antimanic drugs, relative effectiveness, league tables, contribution plots, placebo comparison
- MeSH terms
- Data Interpretation, Statistical, Humans, Mental Health, Meta-Analysis as Topic, Evidence-Based Medicine
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