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Effectiveness of psychological interventions in preventing recurrence of depressive disorder: meta-analysis and meta-regression.

Abstract：

BACKGROUND:Major depression is probably best seen as a chronically recurrent disorder, with patients experiencing another depressive episode after remission. Therefore, attention to reduce the risk of relapse or recurrence after remission is warranted. The aim of this review is to meta-analytically examine the effectiveness of psychological interventions to reduce relapse or recurrence rates of depressive disorder. METHODS:We systematically reviewed the pertinent trial literature until May 2014. The random-effects model was used to compute the pooled relative risk of relapse or recurrence (RR). A distinction was made between two comparator conditions: (1) treatment-as-usual and (2) the use of antidepressants. Other sources of heterogeneity in the data were explored using meta-regression. RESULTS:Twenty-five randomised trials met inclusion criteria. Preventive psychological interventions were significantly better than treatment-as-usual in reducing the risk of relapse or recurrence (RR=0.64, 95% CI=0.53-0.76, z=4.89, p<0.001, NNT=5) and also more successful than antidepressants (RR=0.83, 95% CI=0.70-0.97, z=2.40, p=0.017, NNT=13). Meta-regression showed homogeneity in effect size across a range of study, population and intervention characteristics, but the preventive effect of psychological intervention was usually better when the prevention was preceded by treatment in the acute phase (b=-1.94, SEb=0.68, z=-2.84, p=0.005). LIMITATIONS:Differences between the primary studies in methodological design, composition of the patient groups and type of intervention may have caused heterogeneity in the data, but could not be evaluated in a meta-regression owing to poor reporting. CONCLUSIONS:We conclude that there is supporting evidence that preventive psychological interventions reduce the risk of relapse or recurrence in major depression.

journal_name

J Affect Disord

journal_title

Journal of affective disorders

authors

Biesheuvel-Leliefeld KE,Kok GD,Bockting CL,Cuijpers P,Hollon SD,van Marwijk HW,Smit F

doi

10.1016/j.jad.2014.12.016

subject

Has Abstract

pub_date

2015-03-15 00:00:00

pages

400-10

eissn

0165-0327

issn

1573-2517

pii

S0165-0327(14)00802-7

journal_volume

174

pub_type

杂志文章,meta分析,评审

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Effectiveness of psychological interventions in preventing recurrence of depressive disorder: meta-analysis and meta-regression.