Initial severity of depression and efficacy of cognitive-behavioural therapy: individual-participant data meta-analysis of pill-placebo-controlled trials.
Br J Psychiatry
; 210(3): 190-196, 2017 03.
Article
en En
| MEDLINE
| ID: mdl-28104735
ABSTRACT
BackgroundThe 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.AimsTo 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.MethodA 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.ResultsWe 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%).ConclusionsPatients 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.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Índice de Severidad de la Enfermedad
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Terapia Cognitivo-Conductual
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Ensayos Clínicos Controlados Aleatorios como Asunto
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Evaluación de Resultado en la Atención de Salud
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Trastorno Depresivo Mayor
Tipo de estudio:
Clinical_trials
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Prognostic_studies
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Systematic_reviews
Límite:
Humans
Idioma:
En
Revista:
Br J Psychiatry
Año:
2017
Tipo del documento:
Article