Influence of initial severity of depression on effectiveness of low intensity interventions: meta-analysis of individual patient data

Abstract

Objective To assess how initial severity of depression affects the benefit derived from low intensity interventions for depression.Design Meta-analysis of individual patient data from 16 datasets comparing low intensity interventions with usual care.Setting Primary care and community settings.Participants 2470 patients with depression.Interventions Low intensity interventions for depression (such as guided self help by means of written materials and limited professional support, and internet delivered interventions).Main outcome measures Depression outcomes (measured with the Beck Depression Inventory or Center for Epidemiologic Studies Depression Scale), and the effect of initial depression severity on the effects of low intensity interventions.Results Although patients were referred for low intensity interventions, many had moderate to severe depression at baseline. We found a significant interaction between baseline severity and treatment effect (coefficient −0.1 (95% CI −0.19 to −0.002)), suggesting that patients who are more severely depressed at baseline demonstrate larger treatment effects than those who are less severely depressed. However, the magnitude of the interaction (equivalent to an additional drop of around one point on the Beck Depression Inventory for a one standard deviation increase in initial severity) was small and may not be clinically significant.Conclusions The data suggest that patients with more severe depression at baseline show at least as much clinical benefit from low intensity interventions as less severely depressed patients and could usefully be offered these interventions as part of a stepped care model.

Efficacy of an internet-based problem-solving training for teachers: results of a randomized controlled trial

“…A recent study found that mild depressive symptoms were associated with lower effect sizes in low-intensity interventions when compared to effects for individuals with at least moderate symptoms (68). Moderator analyses should thus clarify which subgroups of participants benefit the most and the extent to which they benefit from iPST.…”

Predicting outcome of Internet-based treatment for depressive symptoms

“…However, in another study baseline severity of depression was not related to the effect of computerized CBT (Proudfoot et al, 2003). A recent meta-analysis of individual patient data assessed the effect of depression severity at baseline for low-intensity interventions such as guided self-help via books and the Internet (Bower et al, 2013). Results showed that patients with more severe depression at baseline demonstrate larger treatment effects than those who are less severely depressed.…”

“…Results showed that patients with more severe depression at baseline demonstrate larger treatment effects than those who are less severely depressed. However, high initial scores would mean that many patients remain symptomatic after treatment and do not meet criteria for recovery (Bower et al, 2013).…”

A secondary analysis of internet-delivered cognitive-behaviour treatment for adults with severe depressive symptoms (Preprint)

“…The results demonstrate comparative effect sizes of improvement in severe depressive symptoms to those experienced in a mild to moderately depressed group, supporting the use of iCBT for severe depression [12,21]. Over half of the participants who provided pre and post treatment data experienced reliable improvement by participating in the intervention (n = 21), supporting the potential for iCBT as an effective measure in this population.…”

“…Innovative attempts to overcome these barriers have led to the development of internet-delivered psychological interventions, primarily based on cognitive-behavioural principles (iCBT) for the treatment of depression and other mental health disorders [12]. Internet-delivered interventions overcome some barriers associated with traditional treatment methods [13].…”