Initial severity of depression and efficacy of cognitive–behavioural therapy: Individual-participant data meta-analysis of pill-placebo-controlled trials
Open accessAbstract
Background: The influence of baseline severity has been examined for antidepressant medications but has not been studied properly for cognitive–behavioural therapy (CBT) in comparison with pill placebo. Aims: To synthesise evidence regarding the influence of initial severity on efficacy of CBT from all randomised controlled trials (RCTs) in which CBT, in face-to-face individual or group format, was compared with pill-placebo control in adults with major depression. Method: A systematic review and an individual-participant data meta-analysis using mixed models that included trial effects as random effects. We used multiple imputation to handle missing data. Results: We identified five RCTs, and we were given access to individual-level data (n= 509) for all five. The analyses revealed that the difference in changes in Hamilton Rating Scale for Depression between CBT and pill placebo was not influenced by baseline severity (interaction P= 0.43). Removing the non-significant interaction term from the model, the difference between CBT and pill placebo was a standardised mean difference of −0.22 (95% CI −0.42 to −0.02,P= 0.03,I2= 0%). Conclusions: Patients suffering from major depression can expect as much benefit from CBT across the wide range of baseline severity. This finding can help inform individualised treatment decisions by patients and their clinicians.
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The introduction and widespread use of SSRI and psychological therapy including CBT meant that well tolerated and effective treatments for depression and anxiety disorders became available in primary care, widening the group of individuals eligible for treatment.
“The introduction and widespread use of selective serotonine uptake inhibitors (SSRI) [22, 23] and psychological therapy including cognitive behavioral therapy (CBT) [24, 25] meant that well tolerated and effective treatments for depression and anxiety disorders became available in primary care, widening the group of individuals eligible for treatment.”
From Trends in psychiatric diagnoses, medications and psychological therapies in a large Swedish region: A population-based study (2020) · cites this paper as [24]
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- Authors
- Furukawa, T. A., Weitz, E. S., Tanaka, S., Hollon, S. D., Hofmann, S. G., Andersson, G., Twisk, J., DeRubeis, R. J., Dimidjian, S., Hegerl, U., Mergl, R., Jarrett, R. B., Vittengl, J. R., Watanabe, N., & Cuijpers, P.
- Affiliations
- Linköping University (SE)
- ORCID
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2017-03
- Volume
- 210
- Issue
- 3
- Pages
- 190-196
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- PMC
- PMC5331187
- OpenAlex
- W2573040034
- Cited by
- 73
- References
- 38
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 5 · 2023: 9 · 2022: 11 · 2021: 8 · 2020: 9 · 2019: 6 · 2018: 11 · 2017: 5
- FWCI
- 1.35
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- public-domain
- www.cambridge.org/core/terms (unspecified, 307 d)
- Locations
- The British Journal of Psychiatry (publishedVersion, public-domain)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- OpenBU (Boston University) (submittedVersion)
- VU Research Portal (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Bristol-Myers Squibb
- Eli Lilly and Company
- Pfizer
- Ministry of Health, Labour and Welfare
- Ministry of Education, Science and Technology
- Servier
- H. Lundbeck A/S
- National Institutes of Health
- Japan Society for the Promotion of Science (26670314)
- National Institute of Mental Health (R01MH099021, R34MH086668, R21MH102646, R34MH099311, MH60998, R01MH060713, R21MH101567, R01MH060998, K02MH001697, MH60713, K23MH100259, MH 01697)
- National Center for Complementary and Integrative Health (R01AT007257)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- major depressive disorder, cognitive behavioral therapy, baseline severity, treatment response, Hamilton Depression Rating Scale, antidepressant comparison
- MeSH terms
- Major Depressive Disorder, Humans, Severity of Illness Index, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Outcome Assessment, Health Care
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