Dataset Information

Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis.

ABSTRACT:

Background

Previous meta-analyses comparing the efficacy of psychotherapeutic interventions for depression were clouded by a limited number of within-study treatment comparisons. This study used network meta-analysis, a novel methodological approach that integrates direct and indirect evidence from randomised controlled studies, to re-examine the comparative efficacy of seven psychotherapeutic interventions for adult depression.

Methods and findings

We conducted systematic literature searches in PubMed, PsycINFO, and Embase up to November 2012, and identified additional studies through earlier meta-analyses and the references of included studies. We identified 198 studies, including 15,118 adult patients with depression, and coded moderator variables. Each of the seven psychotherapeutic interventions was superior to a waitlist control condition with moderate to large effects (range d?=?-0.62 to d?=?-0.92). Relative effects of different psychotherapeutic interventions on depressive symptoms were absent to small (range d?=?0.01 to d?=?-0.30). Interpersonal therapy was significantly more effective than supportive therapy (d?=?-0.30, 95% credibility interval [CrI] [-0.54 to -0.05]). Moderator analysis showed that patient characteristics had no influence on treatment effects, but identified aspects of study quality and sample size as effect modifiers. Smaller effects were found in studies of at least moderate (?d?=?0.29 [-0.01 to 0.58]; p?=?0.063) and large size (?d?=?0.33 [0.08 to 0.61]; p?=?0.012) and those that had adequate outcome assessment (?d?=?0.38 [-0.06 to 0.87]; p?=?0.100). Stepwise restriction of analyses by sample size showed robust effects for cognitive-behavioural therapy, interpersonal therapy, and problem-solving therapy (all d>0.46) compared to waitlist. Empirical evidence from large studies was unavailable or limited for other psychotherapeutic interventions.

Conclusions

Overall our results are consistent with the notion that different psychotherapeutic interventions for depression have comparable benefits. However, the robustness of the evidence varies considerably between different psychotherapeutic treatments.

SUBMITTER: Barth J

PROVIDER: S-EPMC3665892 | biostudies-literature | 2013

REPOSITORIES: biostudies-literature

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Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis.

Barth Jürgen J Munder Thomas T Gerger Heike H Nüesch Eveline E Trelle Sven S Znoj Hansjörg H Jüni Peter P Cuijpers Pim P

PLoS medicine 20130528 5

<h4>Background</h4>Previous meta-analyses comparing the efficacy of psychotherapeutic interventions for depression were clouded by a limited number of within-study treatment comparisons. This study used network meta-analysis, a novel methodological approach that integrates direct and indirect evidence from randomised controlled studies, to re-examine the comparative efficacy of seven psychotherapeutic interventions for adult depression.<h4>Methods and findings</h4>We conducted systematic literat ...[more]

PMID: 23723742

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Project description:INTRODUCTION:Major depression is a leading cause of disability and has been associated with adverse effects in older persons. While many pharmacological and non-pharmacological interventions have been shown to be effective to address major depression in older persons, there has not been a meta-analysis that consolidates all the available interventions and compare the relative benefits of these available interventions. In this study, we aim to conduct a systematic review and network meta-analysis to compare the efficacy and acceptability of all the known pharmacological and non-pharmacological interventions for major depression in older persons. METHODS AND ANALYSIS:We will search Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health, Cochrane Central Register of Controlled Trials and references of other review articles for articles related to the keywords of 'randomised trial', 'major depression', 'older persons' and 'treatments'. Two reviewers will independently select the eligible articles. For each included article, the two reviewers will independently extract the data and assess the risk of bias using the Cochrane revised tool for risk of bias. Bayesian network meta-analyses will be conducted to pool the depression scores (based on standardised mean difference) and the all-cause discontinuation across all included studies. The ranking probabilities for all interventions will be estimated and the hierarchy of each intervention will be summarised as surface under the cumulative ranking curve (SUCRA). Meta-regression and sub-group analyses will also be performed to evaluate the effect of study-level covariates. The quality of the evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION:The results will be disseminated through conference presentations and peer-reviewed publications. They will provide the consolidated evidence to inform clinicians on the best choice of intervention to address major depression in older persons. PROSPERO REGISTRATION NUMBER:CRD42017075756.

Project description:ObjectiveTo describe the comparative efficacy of drug and non-drug interventions for reducing symptoms of depression in people with dementia who experience depression as a neuropsychiatric symptom of dementia or have a diagnosis of a major depressive disorder.DesignSystematic review and meta-analysis.Data sourcesMedline, Embase, the Cochrane Library, CINAHL, PsycINFO, and grey literature between inception and 15 October 2020.Eligibility criteria for study selectionRandomised trials comparing drug or non-drug interventions with usual care or any other intervention targeting symptoms of depression in people with dementia.Main outcome measuresPairs of reviewers screened studies, abstracted aggregate level data, and appraised risk of bias with the Cochrane risk of bias tool, which facilitated the derivation of standardised mean differences and back transformed mean differences (on the Cornell scale for depression in dementia) from bayesian random effects network meta-analyses and pairwise meta-analyses.ResultsOf 22 138 citations screened, 256 studies (28 483 people with dementia) were included. Missing data posed the greatest risk to review findings. In the network meta-analysis of studies including people with dementia without a diagnosis of a major depressive disorder who were experiencing symptoms of depression (213 studies; 25 177 people with dementia; between study variance 0.23), seven interventions were associated with a greater reduction in symptoms of depression compared with usual care: cognitive stimulation (mean difference -2.93, 95% credible interval -4.35 to -1.52), cognitive stimulation combined with a cholinesterase inhibitor (-11.39, -18.38 to -3.93), massage and touch therapy (-9.03, -12.28 to -5.88), multidisciplinary care (-1.98, -3.80 to -0.16), occupational therapy (-2.59, -4.70 to -0.40), exercise combined with social interaction and cognitive stimulation (-12.37, -19.01 to -5.36), and reminiscence therapy (-2.30, -3.68 to -0.93). Except for massage and touch therapy, cognitive stimulation combined with a cholinesterase inhibitor, and cognitive stimulation combined with exercise and social interaction, which were more efficacious than some drug interventions, no statistically significant difference was found in the comparative efficacy of drug and non-drug interventions for reducing symptoms of depression in people with dementia without a diagnosis of a major depressive disorder. Clinical and methodological heterogeneity precluded network meta-analysis of studies comparing the efficacy of interventions specifically for reducing symptoms of depression in people with dementia and a major depressive disorder (22 studies; 1829 patients).ConclusionsIn this systematic review, non-drug interventions were found to be more efficacious than drug interventions for reducing symptoms of depression in people with dementia without a major depressive disorder.Systematic review registrationPROSPERO CRD42017050130.

Project description:ImportancePosttraumatic stress disorder (PTSD) is a prevalent mental disorder, with a high risk of chronicity, comorbidity, and functional impairment; PTSD is complicated to treat, and the debate on the best treatment approach is ongoing.ObjectiveTo examine comparative outcomes and acceptability of psychotherapeutic and pharmacological treatments and their combinations in adults with PTSD.Data sourcesEmbase, MEDLINE, PsycINFO, Cochrane Controlled Trials Register, and PSYNDEX were searched for studies published from January 1, 1980, to February 28, 2018. Reference lists of included studies and of previously published guidelines and systematic reviews were also searched.Study selectionOf 11 417 records identified, 12 published randomized clinical trials (RCTs) comprising 922 participants, contributing 23 direct comparisons between psychotherapeutic and pharmacological treatments or their combinations were included.Data extraction and synthesisStandardized mean differences (SMDs) and odds ratios were aggregated using random-effects network and pairwise meta-analyses. Risk of bias and indirectness was rated for each study, and network confidence was rated using the Confidence in Network Meta-Analysis framework.Main outcomes and measuresThe primary outcome was the comparative benefit between 2 treatment approaches to PTSD symptom improvement, and secondary outcome was the comparative acceptability of the treatment approaches, as indicated by patient dropout rates before treatment termination.ResultsNo treatment approach was found to be superior at the end of treatment (for all, 95% CI included 0). At the last follow-up, psychotherapeutic treatments showed greater benefit than pharmacological treatments in both network (SMD, -0.83; 95% CI, -1.59 to -0.07) and pairwise (SMD, -0.63; 95% CI, -1.18 to -0.09, 3 RCTs) meta-analyses. No difference was found between combined treatments and psychotherapeutic treatments at long-term follow-up, and combined treatments were associated with better outcomes than pharmacological treatments in the network meta-analysis (SMD, -0.96; 95% CI, -1.87 to -0.04), but not in the pairwise meta-analysis, which included 2 RCTs (SMD, -1.02; 95% CI, -2.77 to 0.72). No evidence was found for differential acceptability of the 3 treatment approaches.Conclusions and relevanceThese results suggest superiority of psychotherapeutic treatments over pharmacological treatments; network, but not pairwise, meta-analyses suggest superiority of combined treatments over pharmacological treatments in improving PTSD symptom severity in the long term. The scarcity of reported long-term findings hampers definite conclusions and demonstrates the need for robust evidence from large-scaled comparative trials providing long-term follow-up data.

Project description:BackgroundDepressive disorders (DDs) are a public health problem. Face-to-face psychotherapeutic interventions are a first-line option for their treatment in adults. There is a growing interest in eHealth interventions to maximize accessibility for effective treatments. Thus, the number of randomized controlled trials (RCTs) of eHealth psychotherapeutic interventions has increased, and these interventions are being offered to patients. However, it is unknown whether patients with DDs differ in internet-based and face-to-face intervention trials. This information is essential to gain knowledge about eHealth trials' external validity.ObjectiveWe aimed to compare the baseline characteristics of patients with DDs included in the RCTs of eHealth and face-to-face psychotherapeutic interventions with a cognitive component.MethodsIn this meta-epidemiological study, we searched 5 databases between 1990 and November 2017 (MEDLINE, Embase, PsycINFO, Google Scholar, and the database of Cuijpers et al). We included RCTs of psychotherapeutic interventions with a cognitive component (eg, cognitive therapy, cognitive behavioral therapy [CBT], or interpersonal therapy) delivered face-to-face or via the internet to adults with DDs. Each included study had a matching study for predefined criteria to allow a valid comparison of characteristics and was classified as a face-to-face (CBT) or eHealth (internet CBT) intervention trial. Two authors selected the studies, extracted data, and resolved disagreements by discussion. We tested whether predefined baseline characteristics differed in face-to-face and internet-based trials using a mixed-effects model and testing for differences with z tests (statistical significance set at .05). For continuous outcomes, we also estimated the difference in means between subgroups with 95% CI.ResultsWe included 58 RCTs (29 matching pairs) with 3846 participants (female: n=2803, 72.9%) and mean ages ranging from 20-74 years. White participants were the most frequent (from 63.6% to 100%). Other socioeconomic characteristics were poorly described. The participants presented DDs of different severity measured with heterogeneous instruments. Internet CBT trials had a longer depression duration at baseline (7.19 years higher, CI 95% 2.53-11.84; 10.0 vs 2.8 years; P=.002), but the proportion of patients with previous depression treatment was lower (24.8% vs 42%; P=.04). Subgroup analyses found no evidence of differences for the remaining baseline characteristics: age, gender, education, living area, depression severity, history of depression, actual antidepressant medication, actual physical comorbidity, actual mental comorbidity, study dropout, quality of life, having children, family status, and employment. We could not compare proficiency with computers due to the insufficient number of studies.ConclusionsThe baseline characteristics of patients with DDs included in the RCTs of eHealth and face-to-face psychotherapeutic interventions are generally similar. However, patients in eHealth trials had a longer duration of depression, and a lower proportion had received previous depression treatment, which might indicate that eHealth trials attract patients who postpone earlier treatment attempts.Trial registrationPROSPERO CRD42019085880; https://tinyurl.com/4xufwcyr.

Project description:Acne has several effects on physical symptoms, but the main impacts are on the quality of life, which can be improved by treatment. There are several acne treatments but less evidence comparing their relative efficacy. Thus, we assessed the comparative efficacy of pharmacological and nonpharmacological interventions for acne. We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials from inception to April 2019, to include randomized controlled trials for acne that compared topical antibiotics (TA), benzoyl peroxide (BPO), topical retinoids (TR), oral antibiotics (OA), lasers, light devices including LED device (LED), photodynamic therapy (PDT), and intense pulsed light, chemical peels (CP), miscellaneous therapies or complementary and alternative medicine (MTCAM), or their combinations. We performed Bayesian network meta-analysis with random effects for all treatments compared with placebo and each other. Mean differences (MDs) of lesions count and risk ratios of adverse events with their 95% credible intervals (CrIs) were calculated, and all interventions were ranked by the Surface Under the Cumulative Ranking (SUCRA) values. Additional frequentist additive network meta-analysis was performed to detect the robustness of results and potential interaction effects. Sensitivity analyses were carried out with different priors, and metaregression was to adjust for nine potential effect modifiers. In the result, seventy-three randomized controlled trials (27,745 patients with mild to moderate acne), comparing 30 grouped intervention categories, were included with low to moderate risk of bias. For adverse effects, OA had more risk in combination treatment with others. For noninflammatory lesions reduction, seventeen interventions had significant differences comparing with placebo and three interventions (TR+BPO: MD = -21.89, 95%CrI [-28.97, -14.76]; TR+BPO+MTCAM: -22.48 [-34.13, -10.70]; TA+BPO+CP: -20.63 [-33.97, -7.13]) were superior to others with 94, 94, and 91% SUCRA values, respectively. For inflammatory lesions reduction, nineteen interventions were significantly better than placebo, and three interventions (TR+BPO: MD = -12.13, 95%CrI [-18.41, -5.80]; TR+BPO+MTCAM: -13.21 [-.39, -3.04]; LED: -11.30 [-18.34, -4.42]) were superior to others (SUCRA: 81, 81, and 77%, respectively). In summary of noninflammatory and inflammatory lesions results, TR+BPO and TA+BPO were the best options compared to others. The frequentist model showed similar results as above. In summary, current evidence supports the suggestion that TR+BPO and TA+BPO are the best options for mild to moderate acne. LED is another option for inflammatory lesions when drug resistance occurs. All the combinations involved with OA showed more risk of adverse events than others. However, the evidence of this study should be cautiously used due to the limitations.

Project description:IntroductionFamily interventions are effective and are strongly recommended for psychotic disorders. However, there is a variety of intervention types, and their differential efficacy is widely unclear. The aim of the planned network meta-analysis (NMA) is to compare the efficacy of family interventions that differ in content (eg, psychoeducation, mutual support, skills training) and format (eg, number of sessions, inclusion of patients, form of delivery).Methods and analysisWe will include randomised controlled trials comparing psychosocial interventions directed at the adult relatives, friends or non-professional carers of people with a diagnosis of a psychotic disorder (schizophrenia spectrum) to any kind of control condition. The main outcomes will be global clinical state for the patients and coping with psychosis as well as attitudes towards psychosis for the relatives. Additional outcomes will be severity of symptoms, functioning, burden and compliance/drop-out. We conducted a comprehensive search of Cochrane Central Register of Controlled Trials, MEDLINE(R), PsycINFO, Cumulative Index to Nursing & Allied Health Literature (8 August 2019) and reference lists of review articles. Full-text assessment of eligibility, data extraction and risk-of-bias assessment will be done by two independent reviewers. An NMA will be conducted for any of the planned outcomes and intervention characteristics for which sufficient and appropriate data are available. The analyses will make use of a random effects model within a frequentist framework. Estimates for all pairwise treatment effects will be obtained using standardised mean differences for continuous outcomes and risk ratios for dichotomous outcomes. Interventions will be ranked according to their relative efficacy. We will address the assumption of transitivity, heterogeneity and inconsistency using theoretical and statistical approaches. The possibility of publication bias and the strength of evidence will also be examined.Ethics and disseminationThere are no ethical concerns. Results will be published in peer-reviewed journals and presented at practitioners' conferences.Prospero registration numberCRD42020148728.

Project description:Objective An estimated 3.8% of the global population experiences depression, according to the [2019] WHO report. Evidence supports the efficacy of exercise training (EX) for depression; however, its comparative efficacy to conventional, evidence-supported psychotherapies remains understudied. Therefore, we conducted a network meta-analysis to compare the efficacy of exercise training (EX), behavioral activation therapy (BA), cognitive-behavioral therapy (CBT), and non-directive supportive therapy (NDST). Methods Our search was performed in seven relevant databases (inception to March 10, 2020) and targeted randomized trials comparing psychological interventions head-to-head and/or to a treatment as usual (TAU) or waitlist (WL) control for the treatment of adults (18 years or older) with depression. Included trials assessed depression using a validated psychometric tool. Results From 28,716 studies, 133 trials with 14,493 patients (mean age of 45.8 years; 71.9% female) were included. All treatment arms significantly outperformed TAU (standard mean difference [SMD] range, −0.49 to −0.95) and WL (SMD range, −0.80 to −1.26) controls. According to surface under the cumulative ranking (SUCRA) probabilities, BA was mostly likely to have the highest efficacy (1.6), followed by CBT (1.9), EX (2.8), and NDST (3.8). Effect size estimates between BA and CBT (SMD = −0.09, 95% CI [−0.50 to 0.31]), BA and EX (−0.22, [−0.68 to 0.24]), and CBT and EX (−0.12, [−0.42 to 0.17]) were very small, suggesting comparable treatment effects of BA, CBT, and EX. With individual comparisons of EX, BA, and CBT to NDST, we found small to moderate effect sizes (0.09 to 0.46), suggesting EX, BA, and CBT may equally outperform NDST. Conclusions Findings provide preliminary yet cautionary support for the clinical use of exercise training for adult depression. High study heterogeneity and lack of sound investigations of exercise must be considered. Continued research is needed to position exercise training as an evidence-based therapy.

Project description:BackgroundThe effect of different music interventions on depression in older adults is varied. We aimed to explore the comparative effect of different music intervention features on depression in older adults.MethodsWe searched PubMed, EMBASE, CENTRAL, CINAHL, and ProQuest Dissertations&Theses from inception to October 2021 for randomized controlled trials (RCTs) of music interventions in participants aged ≥60 years. Music interventions were classified based on the TIP (theme, intensity, and provider/platform) framework. The theme was divided into: 1) active music therapy (ACT); 2) receptive music therapy (Recep); and 3) music medicine (MM). The intensity was classified as high (>60 minutes/week), and low (≤60 minutes/week). The provider was classified as a music therapist (MT) or a non-music therapist (NonMT). Summary standardized mean differences (SMD) of level of depression with 95% confidence interval (CI) were estimated using a frequentist framework with a random-effects model. The certainty of evidence was evaluated using the Confidence in Network Meta-Analysis (CINeMA) approach. This study was registered with PROSPERO (CRD42021247165).FindingsFifteen RCTs involving 1,144 older adults (mean age 67.9-86.6 years) were included. When compared with usual care, the most effective music intervention was active music therapy >60 minutes/week by music therapist (Act/High/MT) (SMD -3.00; 95%CI, -3.64,-2.35), followed by music medicine >60 minutes/week by non-music therapist (MM/High/NonMT) (SMD -2.06; 95%CI, -2.78,-1.35) with moderate and high certainty of evidence, respectively. Depression scores in older adults treated with ACT/High/MT was also significantly lower than all other interventions, except MM/High/NonMT. Low intensity music interventions other than Act/Low/MT had no impact on depression.InterpretationAlthough active music therapy >60 minutes/week by music therapist is the most effective intervention to alleviate depression in older adults, music medicine by listening to music of older adult's own preference >60 minutes/week is an alternative approach in settings with limited resources.FundingNone.

Dataset Information

Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis.

Background

Methods and findings

Conclusions

Publications

Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis.

Similar Datasets

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