The effects of psychotherapies for major depression in adults on remission, recovery and improvement: A meta-analysis

Cuijpers, Pim; Karyotaki, Eirini; Weitz, Erica; Andersson, Gerhard; Hollon, Steven D.; Straten, Annemieke van

doi:10.1016/j.jad.2014.02.026

Cited by 442 publications

(332 citation statements)

References 26 publications

Supporting

Mentioning

292

Contrasting

Unclassified

Order By: Relevance

“…Numbers-needed-to-be-treated (NNT) were calculated using the formulae provided by Furukawa 29 , in which the control group's event rate was set at a conservative 19% (based on the pooled response rate of 50% reduction of symptoms across trials in psychotherapies for depression) 30 . As a test of homogeneity of effect sizes, we calculated the I 2 statistic, which is an indicator of heterogeneity in percentages.…”

Section: Meta-analysesmentioning

confidence: 99%

Psychotherapies for depression in low‐ and middle‐income countries: a meta‐analysis

et al. 2018

Self Cite

View full text Add to dashboard Cite

Most psychotherapies for depression have been developed in high-income Western countries of North America, Europe and Australia. A growing number of randomized trials have examined the effects of these treatments in non-Western countries. We conducted a meta-analysis of these studies to examine whether these psychotherapies are effective and to compare their effects between studies from Western and nonWestern countries. We conducted systematic searches in bibliographical databases and included 253 randomized controlled trials, of which 32 were conducted in non-Western countries. The effects of psychotherapies in non-Western countries were large (g51.10; 95% CI: 0.91-1.30), with high heterogeneity (I 2 590; 95% CI: 87-92). After adjustment for publication bias, the effect size dropped to g50.73 (95% CI: 0.51-0.96). Subgroup analyses did not indicate that adaptation to the local situation was associated with the effect size. Comparisons with the studies in Western countries showed that the effects of the therapies were significantly larger in non-Western countries, also after adjusting for characteristics of the participants, the treatments and the studies. These larger effect sizes in non-Western countries may reflect true differences indicating that therapies are indeed more effective; or may be explained by the care-as-usual control conditions in non-Western countries, often indicating that no care was available; or may be the result of the relative low quality of many trials in the field. This study suggests that psychotherapies that were developed in Western countries may or may not be more effective in non-Western countries, but they are probably no less effective and can therefore also be used in these latter countries.

show abstract

Section: Meta-analysesmentioning

confidence: 99%

Psychotherapies for depression in low‐ and middle‐income countries: a meta‐analysis

et al. 2018

Self Cite

View full text Add to dashboard Cite

show abstract

“…Reviews of the literature suggest that about 40-60% of individuals respond to antidepressants or psychotherapy (Walsh et al 2002;Cuijpers et al 2014). This leaves a sizeable proportion of patients who are treatment non-responders.…”

Section: Placebo Responsesmentioning

confidence: 99%

Heterogeneity in the prognosis of major depression: from the common cold to a highly debilitating and recurrent illness

Lorenzo‐Luaces

2015

Epidemiol Psychiatr Sci

View full text Add to dashboard Cite

Two different and seemingly competing views on the diagnosis of major depressive disorder (MDD) exist. The first is that the diagnosis conflates adaptive sadness reactions with pathological states of depressed mood and that MDD is overdiagnosed and overtreated. The second is that MDD is an underdiagnosed and undertreated disorder, and one that is best characterised by a severe, chronic, recurrent or treatment-resistant course. Existing research suggests that both views are valid and merit being integrated. Anywhere from 30 to 50% of individuals will meet criteria for MDD at some point in their life. About half of these episodes are of brief duration and unlikely to recur. However, a remaining half is either chronic or recurrent. Data on the outpatient diagnosis of depression support the view that depression is simultaneously underdiagnosed and undertreated as well as overdiagnosed and overtreated. About one-third of the patients who meet criteria for MDD and receive placebos experience clinically significant and long-lasting improvement. Many other patients, however, are unresponsive to one or multiple active treatments. Thus, the diagnosis of MDD likely applies to individuals who are experiencing either normal periods of sadness or single-episode afflictions that are mild, unlikely to recur, and are placebo responsive, as well as to individuals with more severe clinical profiles. More research is needed that can help ascertain what contextual or biopsychological variables help distinguish between individuals who may be experiencing adaptive states of negative affect and those who experience severe, chronic, recurrent or treatment-resistant depressions. Depressive disorders are currently estimated to be the 11th leading cause of disability worldwide (Murray et al. 2013). One of most commonly cited estimates of the prevalence of major depressive disorder (MDD) is the 16.2% figure reported by Kessler et al. (2003). Taken at face value, this estimate is alarming. In effect, it has been met with some skepticism as it suggests a very high prevalence of MDD (Parker, 2007a). However, Angst et al. (2015) recently published data that suggest that this may be a conservative estimate. These researchers published data from a 30-year prospective study in which individuals were interviewed at least seven different times. In that sample, 32.5% of individuals met criteria for MDD at some point during the assessment period. Their findings suggest that the prevalence of MDD is underestimated by epidemiology studies that rely on retrospective assessment of lifetime disorder status. As noted by the authors, such a high cumulative lifetime prevalence from prospective assessments of MDD is not an empirical anomaly. For example, using data from a small sample of Australian teachers, Wilhelm et al. (2006) reported a 42% cumulative lifetime prevalence of MDD over a 25-year period (Wilhelm et al. 2006). In the Dunedin Multidisciplinary Health and Development Study in New Zealand, about 40% of the sample met criteria for MDD at some point...

show abstract

“…The study was insufficiently powered to statistically establish that the blended treatment was noninferior. However, there were other findings in data indicating that blended treatment was effective in reducing depression, and similar to the comparison treatment: there were no major differences between conditions for any of the outcome variables and MDD remission rates -including at six months follow-up, and response rates were observed for both conditions were in line with response rates face-to-face therapies including CBT and BT, reported in a meta-analysis (Cuijpers, Karyotaki et al, 2014).…”

Section: Clinical Effect Of Blended Treatmentsupporting

confidence: 63%

Blended cognitive behavior therapy : efficacy and acceptability for treating depression in the adult and adolescent population

Topooco¹

View full text Add to dashboard Cite

Depression is the most burdensome disorder worldwide in terms of health loss. The potential of internet and technologies to scale up psychological treatment resources is substantial. A blended treatment approach, reducing therapist time and combining sessions with online self-help components, could enhance availability of psychological treatment, while maintaining and possibly enhancing effect of treatment. The aim of this thesis was to develop and investigate the blended treatment approach, in terms of acceptance among key stakeholders, and clinical effect in treatment of depression in the adult and adolescent population.Study I investigated acceptance of the blended treatment approach among mental health care stakeholders by means of a European survey. The results demonstrated that the majority readily accepted blended treatment for management of mild and moderate depression.Study II evaluated blended treatment compared to standard face-toface psychotherapy in treatment of adult depression in a controlled non-inferiority trial. The results showed a similar decrease in depression from both interventions at post-treatment, with decreased levels maintained over six months. Non-inferiority for the blended treatment could not be statistically established.Study III was a controlled non-inferiority trial evaluating blended treatment compared to treatment as usual. The results indicated superiority for the blended treatment at post-treatment and partly at six months. After twelve months the outcomes in the two conditions were similar.Study IV evaluated blended treatment for adolescent depression in a controlled superiority trial, where the therapist time was not reduced, but sessions delivered via chat for improved reach and efficiency. Compared to attention control, the blended treatment significantly reduced depression symptoms, with effects indicated to be maintained over six months.Study V was a controlled superiority trial, evaluating an improved version of the blended treatment used in Study IV to similar methods and in a similar population. In comparison to minimal attention control, the blended treatment significantly reduced depression symptoms at post-treatment, corresponding to a large treatment effect.Across Study II to V, estimates indicated that the amount of therapist time that could be saved in blended treatment, compared to standard psychological treatment, was around 40%.In conclusion, a gradual, blended integration of technology into psychological treatment i) performed well in treatment of adult and adolescent populations, ii) could substantially reduce therapist time in comparison to standard face-to-face psychological treatment, and iii) was accepted by patients as well as other mental health care stakeholders.The thesis demonstrates the potentials of technology-assisted blended treatment models to deliver treatment of depression in the young and adult population in accordance with the current, urgent need to increase availability of psychological treatment as well as increase acceptance ...

show abstract

The effects of psychotherapies for major depression in adults on remission, recovery and improvement: A meta-analysis

Cited by 442 publications

References 26 publications

Psychotherapies for depression in low‐ and middle‐income countries: a meta‐analysis

Psychotherapies for depression in low‐ and middle‐income countries: a meta‐analysis

Heterogeneity in the prognosis of major depression: from the common cold to a highly debilitating and recurrent illness

Blended cognitive behavior therapy : efficacy and acceptability for treating depression in the adult and adolescent population

Contact Info

Product

Resources

About