Effect sizes in cumulative meta-analyses of mental health randomized trials evolved over time

Trikalinos, Thomas A; Churchill, Rachel; Ferri, Marica; Leucht, Stefan; Tuunainen, Arja; Wahlbeck, Kristian; Ioannidis, John P. A.

doi:10.1016/j.jclinepi.2004.02.018

Cited by 158 publications

(111 citation statements)

References 17 publications

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“…Furthermore, we found that the drugplacebo difference diminished over time. This effect had already been reported in an analysis of psychiatric trials by Trikalinos et al 57 Cohen 58 described an ES of À0.50 as large enough to be visible to the naked eye, for example, the difference between 14-year-old and 18-year-old girls (about 1 inch) or the difference in IQ between clerical and semiskilled workers. We pooled the (usually earlier) studies using the BPRS and found an absolute difference of nine BPRS points between SGA drugs and placebo, which we translate into a difference of one point on the Clinical Global Impression Scale.…”

Section: Discussionmentioning

confidence: 57%

How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trials

et al. 2008

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We conducted a systematic review and meta-analysis of randomized controlled trials that compared second-generation antipsychotic (SGA) drugs with placebo in schizophrenic patients and which considered 13 different outcome measures. Thirty-eight randomized controlled trials with 7323 participants were included. All SGA drugs were more effective than placebo, but the pooled effect size (ES) for overall symptoms (primary outcome) was moderate (À0.51). The absolute difference (RD) in responder rates was at 18% (41% responded to drug compared with 24% to placebo, number needed to treat = 6). Similar ESs were found for the other efficacy parameters: negative symptoms (ES = À0.39), positive symptoms (ES = À0.48), depression (ES = À0.26), relapse (RD 20%) and discontinuation due to inefficacy (RD 17%). Curiously, the efficacy of haloperidol for negative and depressive symptoms was similar to that of the SGA drugs. In contrast to haloperidol, there was no difference in terms of EPS between any SGA drugs and placebo, and there was also no difference in terms of dropouts due to adverse events. Meta-regression showed a decline in treatment response over time, and a funnel plot suggested the possibility of publication bias. We conclude that the drug versus placebo difference of SGA drugs and haloperidol in recent trials was moderate, and that there is much room for more efficacious compounds. Whether methodological issues account in part for the relatively low efficacy ESs and the scarcity of adverse event differences compared with placebo needs to be established.

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Section: Discussionmentioning

confidence: 57%

How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trials

et al. 2008

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“…Alternatively, effect sizes may reduce with the accumulation of more data. For example, Trikalinos, Churchill and Ferri (2004) found that the magnitude of effect sizes in meta-analyses investigating therapeutic and preventative interventions in mental health reduce over time as methods were refined and sources of biases were identified and controlled for. Either way, it seems important to investigate the possibility that publication date will influence the effect of self-help interventions on psychosis.…”

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confidence: 99%

Self-help interventions for psychosis: A meta-analysis

Webb

Rowse

2015

Clinical Psychology Review

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Self-help has been shown to be an effective intervention for a wide range of mental health problems. However, there is less evidence on the efficacy of self-help for psychosis and, to date, there has been no systematic review. A search of bibliographic databases identified 24 relevant studies with a total sample size of N = 1816. Ten studies adopted a repeated measures design and 14 an independent group design (including RCTs and quasiexperimental studies). Self-help interventions had, on average, a small-to-medium-sized effect on overall symptoms (d + = 0.33, 95% CI: 0.17 to 0.48). Sub-analyses revealed that selfhelp interventions had a small-to-medium-sized effect on positive symptoms (d + = 0.42, 95% CI: 0.13 to 0.72), a small-to-medium-sized effect on negative symptoms (d + = 0.37, 95% CI: 0.07 to 0.66), and a small-sized effect on outcomes associated with the symptoms of psychosis such as quality of life (d + = 0.13, 95% CI: 0.02 to 0.24). Moderation analysis identified a number of factors that influenced treatment effects including the complexity of the intervention and amount of contact time. Self-help interventions for psychosis have a lot of potential and recommendations for further research are discussed. Word count: 190Key words: Self-help, psychosis, meta-analysis P r e P u b l i c a t i o n C o p y Self-help interventions for psychosis 3 Self-help interventions for psychosis: A meta-analysis "A massive, systematic, and yet largely silent revolution is occurring in mental health today and is gathering steam for tomorrow" (Norcross, 2000, p. 370) In the quote above, Norcross (2000) refers to the proliferation of self-help approaches for mental health conditions, an approach that has gathered momentum with practitioners, researchers, and policy makers placing an increasing emphasis on self-help for treating mental health problems (Lewis et al., 2003). Self-help interventions are defined as those that are "designed to be conducted predominantly independently of professional contact" (Bower, Richards, & Lovell, 2001, p. 839). Self-help interventions can be administered through a variety of mediums such as face-to-face or group meetings, through computers, mobile, and online platforms. Self-help typically involves working independently through a guide that describes the steps to be taken in order to apply a psychological treatment. A slight variation is guided self-help, which is distinguished "by the support that is given by a professional therapist or coach to the patient when working through the standardized treatment" (Cuijpers, Donker, van Straten, & Andersson, 2010, p. 1934. The support offered can range from assisting the person to work through the self-help program to emotional support and can be provided in a range of ways (e.g., face-to-face, telephone, or email). Most self-help interventions are based on standardized psychological treatments, with the most common interventions being those based on cognitive behavioral therapy (CBT: Cuijpers & Schuurmans, 2007). Self-help inter...

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“…Making it even more difficult to determine whether a study's conclusions are valid is that claims from highly cited studies continue to be repeated in the literature, even after subsequent evidence suggests that these claims are untrue [22,42]. For example, the first studies published on a topic tend to find larger effects than later trials [16,44], yet the earlier, more positive effects continue to be cited [22]. Indeed, ''contradiction and initially stronger effects are not unusual in highly cited research of clinical interventions and their outcomes'' [22].…”

Section: Introductionmentioning

confidence: 99%

Role of Technology Assessment in Orthopaedics

Turkelson

Jacobs

2009

Clinical Orthopaedics &Amp; Related Research

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A technology assessment is a literature-based research project that seeks to determine whether a medical device, drug, procedure, or biologic is effective or to summarize literature on a given technology. A well-conducted assessment is a form of secondary research that employs the same steps used in primary research studies (ie, well-designed clinical trials). The primary difference is that in technology assessment the investigator does not collect the raw data. Rather, (s)he must use data collected by someone else. Nevertheless, a well-designed assessment, like a well-designed study, employs the scientific method, which is a method designed to combat bias. When there is little available information, such as with new technologies, unbiased examinations can typically show that enthusiasm for that technology is not backed by much data. When there is more information, assessments can not only determine whether a technology is effective, but also how effective it is. Technology assessments can provide busy orthopaedic surgeons (who do not have the time to keep up with and critically evaluate current literature) with succinct information that enables them to rapidly determine what is and what is not known about any given medical technology.

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Effect sizes in cumulative meta-analyses of mental health randomized trials evolved over time

Cited by 158 publications

References 17 publications

How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trials

How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trials

Self-help interventions for psychosis: A meta-analysis

Role of Technology Assessment in Orthopaedics

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