Supported self-help to prevent relapse or recurrence of depression: Who benefits most?

Sandra MA Dijkstra-Kersten, Karolien EM Biesheuvel-Leliefeld, Johannes C. van der Wouden, Digna JF van Schaik, Judith E. Bosmans, Harm WJ van Marwijk, Henriette E. van der Horst

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Background: This study aimed to identify subgroups for whom supported self-help preventive cognitive therapy (S-PCT) is more (cost)effective than treatment as usual (TAU) in preventing relapse and recurrence of major depression. Methods: We conducted a randomized controlled trial in which 248 remitted, recurrently depressed participants were randomized to S-PCT (n = 124) or TAU (n = 124). Clinical outcome was relapse or recurrence of major depressive disorder (SCID-I). We tested the moderating effects on relapse or recurrence of age, gender, education level, residual depressive symptoms, number of previous episodes, age of onset, antidepressant medication, somatization, and self-efficacy with logistic regression analyses adjusted for baseline values of depressive symptoms. We examined moderating effects on costs using linear regression analyses adjusted for baseline costs. A stratified cost-effectiveness analysis was performed to tease out differences in cost-effectiveness between subgroups. Results: We found no moderating effect on relapse or recurrence for any of the potential moderators. For costs, the number of previous depressive episodes was identified as a moderator. At a willingness-to-pay of 16,000€, the probability that S-PCT was cost-effective compared to TAU was 95% for participants with 2–3 episodes and 11% for participants with ≥4 episodes. Limitations: Participants and counselors were not blinded. The study was primarily designed to assess the (cost)effectiveness of S-PCT and not to conduct moderation analyses. Conclusions: S-PCT was effective in preventing relapse or recurrence of depressive disorders in a broad range of participants, but is more likely to be cost-effective in participants with 2–3 episodes than ≥4 episodes. This indicates that S-PCT can best be offered to participants with fewer previous depressive episodes.

Original languageEnglish
Pages (from-to)180-186
Number of pages7
JournalJournal of Affective Disorders
Volume257
Early online date4 Jul 2019
DOIs
Publication statusPublished - 1 Oct 2019

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Depression
Cognitive Therapy
Recurrence
Costs and Cost Analysis
Cost-Benefit Analysis
Regression Analysis
Major Depressive Disorder
Self Efficacy
Depressive Disorder
Age of Onset
Health Care Costs
Antidepressive Agents
Linear Models
Randomized Controlled Trials
Logistic Models
Education
Therapeutics

Keywords

  • Cognitive therapy
  • Depressive disorders
  • Moderation
  • Prevention
  • Recurrence
  • Relapse

Cite this

Dijkstra-Kersten, S. MA., Biesheuvel-Leliefeld, K. EM., van der Wouden, J. C., van Schaik, D. JF., Bosmans, J. E., van Marwijk, H. WJ., & van der Horst, H. E. (2019). Supported self-help to prevent relapse or recurrence of depression: Who benefits most? Journal of Affective Disorders, 257, 180-186. https://doi.org/10.1016/j.jad.2019.07.006
Dijkstra-Kersten, Sandra MA ; Biesheuvel-Leliefeld, Karolien EM ; van der Wouden, Johannes C. ; van Schaik, Digna JF ; Bosmans, Judith E. ; van Marwijk, Harm WJ ; van der Horst, Henriette E. / Supported self-help to prevent relapse or recurrence of depression : Who benefits most?. In: Journal of Affective Disorders. 2019 ; Vol. 257. pp. 180-186.
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abstract = "Background: This study aimed to identify subgroups for whom supported self-help preventive cognitive therapy (S-PCT) is more (cost)effective than treatment as usual (TAU) in preventing relapse and recurrence of major depression. Methods: We conducted a randomized controlled trial in which 248 remitted, recurrently depressed participants were randomized to S-PCT (n = 124) or TAU (n = 124). Clinical outcome was relapse or recurrence of major depressive disorder (SCID-I). We tested the moderating effects on relapse or recurrence of age, gender, education level, residual depressive symptoms, number of previous episodes, age of onset, antidepressant medication, somatization, and self-efficacy with logistic regression analyses adjusted for baseline values of depressive symptoms. We examined moderating effects on costs using linear regression analyses adjusted for baseline costs. A stratified cost-effectiveness analysis was performed to tease out differences in cost-effectiveness between subgroups. Results: We found no moderating effect on relapse or recurrence for any of the potential moderators. For costs, the number of previous depressive episodes was identified as a moderator. At a willingness-to-pay of 16,000€, the probability that S-PCT was cost-effective compared to TAU was 95{\%} for participants with 2–3 episodes and 11{\%} for participants with ≥4 episodes. Limitations: Participants and counselors were not blinded. The study was primarily designed to assess the (cost)effectiveness of S-PCT and not to conduct moderation analyses. Conclusions: S-PCT was effective in preventing relapse or recurrence of depressive disorders in a broad range of participants, but is more likely to be cost-effective in participants with 2–3 episodes than ≥4 episodes. This indicates that S-PCT can best be offered to participants with fewer previous depressive episodes.",
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Dijkstra-Kersten, SMA, Biesheuvel-Leliefeld, KEM, van der Wouden, JC, van Schaik, DJF, Bosmans, JE, van Marwijk, HWJ & van der Horst, HE 2019, 'Supported self-help to prevent relapse or recurrence of depression: Who benefits most?' Journal of Affective Disorders, vol. 257, pp. 180-186. https://doi.org/10.1016/j.jad.2019.07.006

Supported self-help to prevent relapse or recurrence of depression : Who benefits most? / Dijkstra-Kersten, Sandra MA; Biesheuvel-Leliefeld, Karolien EM; van der Wouden, Johannes C.; van Schaik, Digna JF; Bosmans, Judith E.; van Marwijk, Harm WJ; van der Horst, Henriette E.

In: Journal of Affective Disorders, Vol. 257, 01.10.2019, p. 180-186.

Research output: Contribution to JournalArticleAcademicpeer-review

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Dijkstra-Kersten SMA, Biesheuvel-Leliefeld KEM, van der Wouden JC, van Schaik DJF, Bosmans JE, van Marwijk HWJ et al. Supported self-help to prevent relapse or recurrence of depression: Who benefits most? Journal of Affective Disorders. 2019 Oct 1;257:180-186. https://doi.org/10.1016/j.jad.2019.07.006