Modifiers in Effects of Combined Pharmacotherapy and Psychotherapy versus Pharmacotherapy Alone for Adult Depression: An Individual Participant Data Meta-Analysis.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Ciharova Marketa, Karyotaki Eirini, Harrer Mathias, Weitz Erica, Miguel Clara, Amarnath Arpana, Furukawa Toshi A, Plessen Constantin Yves, Driessen Ellen, Buntrock Claudia, Tong Lingyao, Hellerstein David, Samstag Lisa W, Chen Ying, Rentala Sreevani, Hemanny Curt, Reis de Oliveira Irismar, Blom Marc B J, Burnand Yvonne, Andreoli Antonio, Wittenborn Andrea K, Delucchi Kevin L, Husain Nusrat, DeRubeis Robert J, Town Joel M, Röhricht Frank, Choi Han, Dekker Jack, Dozois David J A, Keller Martin B, Lam Raymond W, Lespérance François, Maina Giuseppe, Rosso Gianluca, Milgrom Jeanette, Ravindran Arun, Reynolds Iii Charles F, Wiles Nicola, Gaudiano Brandon A, Hartmann de Souza Livia, Nakagawa Atsuo, Vega Beatriz Rodríguez, Palao Angela, Rodríguez Jaime López, Salcedo Valerio Villamil, Zobel Ingo, Schramm Elisabeth, Hollon Steven D, Riper Heleen, Cuijpers Pim
Аннотация
METHODS: Randomized trials comparing combined treatment with pharmacotherapy alone were identified on September 1, 2024, and individual participant data (IPD) requested from the authors. One-stage IPD meta-analyses were conducted to estimate effects on depressive symptoms at posttreatment and follow-up, response, remission, and reliable improvement and to assess effect modifiers.
RESULTS: Of 75 eligible studies, 31 (41.33%) provided their IPD (3,703 participants). Combined treatment was more effective in reducing depressive symptoms at posttreatment (SMD = 0.45, 95% confidence interval [95% CI]: 0.27-0.64), 6- (SMD = 0.55, 95% CI: 0.25-0.85) and 12-month follow-up (SMD = 0.22, 95% CI: 0.02-0.43). The effect size was smaller in studies that provided IPD than in those that did not. No patient-level effect modifiers were identified. No difference between the two arms was found in studies using SSRIs (as opposed to other antidepressants) and recruiting specific target groups (versus unselected adult populations), and the difference between combined treatment and pharmacotherapy alone was larger if pharmacotherapy was not administered adequately, but these findings were not confirmed in sensitivity analyses. Several patient-level characteristics predicted higher depressive symptoms at posttreatment, regardless of treatment condition.
CONCLUSION: Combined treatment outperforms pharmacotherapy alone regardless of individual characteristics. Thus, its delivery does not have to be limited to specific patient subgroups. However, IPD were available for only 41% of eligible studies, thus limiting this sample's representativeness.