Abstract
OBJECTIVES: Control conditions' influence on effect estimates of active psychotherapeutic interventions for depression has not been fully elucidated. We used network meta-analysis to estimate the differences between control conditions.
STUDY DESIGN AND SETTING: We have conducted a comprehensive literature search of randomized trials of psychotherapies for adults with depression up to January 1, 2019 in four major databases (PubMed, PsycINFO, Embase, and Cochrane). The network meta-analysis included broadly conceived cognitive behavior therapies in comparison with the following control conditions: Waiting List (WL), No Treatment (NT), Pill Placebo (PillPlacebo), Psychological Placebo (PsycholPlacebo).
RESULTS: 123 studies with 12,596 participants were included. The I-squared was 55.9% (95% CI: 45.9%; to 64.0%) (moderate heterogeneity). The design-by-treatment global test of inconsistency was not significant (P = 0.44). Different control conditions led to different estimates of efficacy for the same intervention. WL appears to be the weakest control (odds ratio of response against NT = 1.93 (1.30 to 2.86), PsycholPlacebo = 2.03 (1.21 to 3.39), and PillPlacebo = 2.66 (1.45 to 4.89), respectively).
CONCLUSIONS: Different control conditions produce different effect estimates in psychotherapy randomized controlled trials for depression. WL was the weakest, followed by NT, PsycholPlacebo, and PillPlacebo in this order. When conducting meta-analyses of psychotherapy trials, different control conditions should not be lumped into a single group.
| Original language | English |
|---|---|
| Pages (from-to) | 59-70 |
| Number of pages | 12 |
| Journal | Journal of clinical epidemiology |
| Volume | 132 |
| Early online date | 15 Dec 2020 |
| DOIs | |
| Publication status | Published - Apr 2021 |
Bibliographical note
Copyright © 2020 Elsevier Inc. All rights reserved.Funding
This research was supported in part by Matsumae Foundation Research Fellowship 2019 to IM, and JSPS, Japan Grant-in-Aid for Scientific Research (Grant Number 17K19808 ) to TAF. EO is supported by the National Institute for Health Research (NIHR) Oxford Cognitive Health Clinical Research Facility and by the NIHR Oxford Health Biomedical Research Centre (grant BRC-1215-20005). The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the UK Department of Health. Toshiaki Furukawa reports personal fees from Mitsubishi-Tanabe, MSD and Shionogi, and a grant from Mitsubishi-Tanabe, outside the submitted work; TAF has a patent 2018-177688 pending. Ioannis Michopoulos has received consultancy fees from Lundbeck. Pim Cuijpers reports support for unrelated grants from the European Commission, and ZonMw, expense allowances for his membership of the Board of Directors of the “Mind.nl,” “Fonds Psychische Gezondheid,” and “Korrelatie,” for being Chair of the PACO Committee of the “Raad voor Civiel-militaire Zorg en Onderzoek” of the Dutch Ministry of Defense, and for being Chair of the Mental Health Priority Area of the Welcome Trust in London, UK, and he receives royalties for books and for occasional workshops and invited addresses. Edoardo Ostinelli has received research and consultancy fees from Angelini Pharma. All other authors report no financial or other conflicts of interest. This research was supported in part by Matsumae Foundation Research Fellowship 2019 to IM, and JSPS, Japan Grant-in-Aid for Scientific Research (Grant Number 17K19808) to TAF. EO is supported by the National Institute for Health Research (NIHR) Oxford Cognitive Health Clinical Research Facility and by the NIHR Oxford Health Biomedical Research Centre (grant BRC-1215-20005). The views expressed are those of the authors and not necessarily those of the UK National Health Service, the NIHR, or the UK Department of Health.
| Funders | Funder number |
|---|---|
| Dutch Ministry of Defense | |
| Matsumae Foundation | |
| National Health Service | |
| Oxford Cognitive Health Clinical Research Facility | |
| Raad voor Civiel-militaire Zorg en Onderzoek | |
| Welcome Trust | |
| National Institute for Health Research | |
| European Commission | |
| Japan Society for the Promotion of Science | 17K19808 |
| Matsumae International Foundation | |
| ZonMw | |
| Shionogi | |
| NIHR Oxford Biomedical Research Centre | BRC-1215-20005 |
