Psychological intervention in individuals with subthreshold depression: individual participant data meta-analysis of treatment effects and moderators.
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Harrer Mathias, Sprenger Antonia A, Illing Susan, Adriaanse Marcel C, Albert Steven M, Allart Esther, Almeida Osvaldo P, Basanovic Julian, van Bastelaar Kim M P, Batterham Philip J, Baumeister Harald, Berger Thomas, Blanco Vanessa, Bø Ragnhild, Casten Robin J, Chan Dicken, Christensen Helen, Ciharova Marketa, Cook Lorna, Cornell John, Davis Elysia P, Dobson Keith S, Dozeman Elsien, Gilbody Simon, Hankin Benjamin L, Haringsma Rimke, Hoorelbeke Kristof, Irwin Michael R, Jansen Femke, Jonassen Rune, Karyotaki Eirini, Kawakami Norito, Klein J Philipp, Konnert Candace, Imamura Kotaro, Landrø Nils Inge, Lara María Asunción, Le Huynh-Nhu, Lehr Dirk, Luciano Juan V, Moritz Steffen, Mossey Jana M, Muñoz Ricardo F, Muntingh Anna, Nobis Stephanie, Olmstead Richard, Otero Patricia, Pibernik-Okanović Mirjana, Pot Anne Margriet, Reynolds Charles F, Rovner Barry W, Sanabria-Mazo Juan P, Sander Lasse B, Smit Filip, Snoek Frank J, Spek Viola, Spinhoven Philip, Stelmach Liza, Terhorst Yannik, Vázquez Fernando L, Leeuw Irma Verdonck-de, Watkins Ed, Yang Wenhui, Wong Samuel Yeung Shan, Zimmermann Johannes, Sakata Masatsugu, Furukawa Toshi A, Leucht Stefan, Cuijpers Pim, Buntrock Claudia, Ebert David Daniel
Аннотация
AIMS: To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.
METHOD: Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment-covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.
RESULTS: IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = -0.48 to -0.27). Effects could not be ascertained up to 24 months (s.m.d. = -0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27-2.79), reliable improvement (relative risk = 1.38-3.17), deterioration (relative risk = 0.67-0.54) and close-to-symptom-free status (relative risk = 1.41-2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = -0.33 for PHQ-9 = 5).
CONCLUSIONS: Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.