The Contribution of “Individual Participant Data” Meta-Analyses of Psychotherapies for Depression to the Development of Personalized Treatments: A Systematic Review

Cuijpers, Pim; Čihařová, Markéta; Quero, Soledad; Miguel, Clara; Driessen, Ellen; Harrer, Mathias; Purgato, Marianna; Ebert, David Daniel; Karyotaki, Eirini

doi:10.3390/jpm12010093

Cited by 29 publications

(28 citation statements)

References 28 publications

(47 reference statements)

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“…Our results provide a strong foundation to initiate these efforts. Motivated by the recent calls for precision psychiatry approaches, a number of studies have investigated potential moderators of clinical effects of face-to-face 29,30 and digital CBT treatments 23,30,31 with the aim to increase clinical effectiveness and to facilitate the adoption of digital tools for clinical scenarios or populations in which they are most successful.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of digital and face-to-face cognitive behavioral therapy for depression

et al. 2022

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Cognitive behavioral therapy (CBT) represents one of the major treatment options for depressive disorders besides pharmacological interventions. While newly developed digital CBT approaches hold important advantages due to higher accessibility, their relative effectiveness compared to traditional CBT remains unclear. We conducted a systematic literature search to identify all studies that conducted a CBT-based intervention (face-to-face or digital) in patients with major depression. Random-effects meta-analytic models of the standardized mean change using raw score standardization (SMCR) were computed. In 106 studies including n = 11854 patients face-to-face CBT shows superior clinical effectiveness compared to digital CBT when investigating depressive symptoms (p < 0.001, face-to-face CBT: SMCR = 1.97, 95%-CI: 1.74–2.13, digital CBT: SMCR = 1.20, 95%-CI: 1.08–1.32) and adherence (p = 0.014, face-to-face CBT: 82.4%, digital CBT: 72.9%). However, after accounting for differences between face-to-face and digital CBT studies, both approaches indicate similar effectiveness. Important variables with significant moderation effects include duration of the intervention, baseline severity, adherence and the level of human guidance in digital CBT interventions. After accounting for potential confounders our analysis indicates comparable effectiveness of face-to-face and digital CBT approaches. These findings underline the importance of moderators of clinical effects and provide a basis for the future personalization of CBT treatment in depression.

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Section: Discussionmentioning

confidence: 99%

A systematic review of digital and face-to-face cognitive behavioral therapy for depression

et al. 2022

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“…A systematic review of meta-analyses reported that in two meta-analyses, higher age was associated with a better outcome of psychotherapy for adult depression. 29 In this study, it is also possible that it was the higher level of baseline work disability rather than age that contributed to the steeper decline. Moreover, 29% of participants in the youngest age group and 3% in the oldest age group were students.…”

Section: Discussionmentioning

confidence: 80%

Psychotherapy and change in mental health-related work disability: a prospective Finnish population-level register-based study with a quasi-experimental design

Kausto

Gluschkoff

Turunen

et al. 2022

J Epidemiol Community Health

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Background Mental disorders are a major cause of work disability among the working-age population. Psychotherapy has shown to be an effective treatment for mental disorders, but the evidence is mainly based on small-scale randomised trials with relatively short follow-ups. We used population-based register data to examine the association between statutory rehabilitative psychotherapy and change in depression or anxietyrelated work disability. Methods We drew a nationally representative sample of the working-age population (aged 18-55 in 2010). The study group comprised all those who started rehabilitative psychotherapy in 2011-2014. A total of 10 436 participants who were followed from 3 years prior to 4 years after the onset of rehabilitative psychotherapy. This resulted in 83 488 observations. The annual total number of mental health-related work disability months (0 to 12) was calculated from the total number of annual compensated sickness absence and disability pension days. A quasi-experimental interrupted time series analysis was applied. ResultsThe onset of rehabilitative psychotherapy marked a decline in work disability in comparison to the counterfactual trend. Specifically, a 20% decrease in the level (incidence rate ratio, IRR 0.80; 95% CI 0.76 to 0.85) and a 48% decrease in the slope (IRR 0.52; 95% CI 0.50 to 0.54) of work disability were detected in comparison to the counterfactual scenario. No significant gender differences were observed. The decline in work disability was the steepest in the oldest age group. Conclusions This study suggests that statutory psychotherapy may decrease work disability at the population level. However, further evidence of causal inference and the potential heterogeneity of the association is required.

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“…We intend to conduct several exploratory moderator and subgroup analyses within this IPD-MA. If feasible the following potential moderators of indirect effects (i.e., moderated mediation) on participant-, study-, and intervention-level are to be investigated as suggested by prior research ( 16 , 19 , 21 , 41 , 44 , 62 , 78 , 79 ): (a) participant characteristics (e.g., age, sex/gender), (b) baseline symptom severity, (c) comorbidity, (d) low vs. high-quality studies in regard to quality criteria for process research, (e) studies evaluating the temporal ordering of changes in mediators and outcomes vs. studies that did not, (f) type of psychotherapeutic approach/theoretical orientation of the intervention, (g) delivery mode, and (h) type of guidance (e.g., fully self-guided/unguided, automated encouragement, human support). Furthermore, (i) other potential moderators, as analysable with the final sample of eligible primary studies, might be exploratory examined.…”

Section: Methodsmentioning

confidence: 99%

“…Second, they allow for the harmonization of variables (e.g., mediator and outcome instruments, measurement points) and standardization of analyses across studies (e.g., imputation strategies), facilitating investigations on multiple levels not possible in conventional meta-analyses ( 40 ). Third, IPD-MA go beyond analyses of aggregated data on study level and enable moderator analyses on the individual level that can generate important information for the personalization of psychotherapy ( 41 ). Fourth, data of published studies can be verified, missing data can be consistently accounted for at the individual level, and results of unpublished studies can be incorporated, reducing the problem of biased findings ( 38 , 40 ).…”

Section: Introductionmentioning

confidence: 99%

Unveiling mechanisms of change in digital interventions for depression: Study protocol for a systematic review and individual participant data meta-analysis

et al. 2022

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IntroductionThe efficacy and effectiveness of digital interventions for depression are both well-established. However, precise effect size estimates for mediators transmitting the effects of digital interventions are not available; and integrative insights on the specific mechanisms of change in internet- and mobile-based interventions (IMIs)—as related to key features like delivery type, accompanying support and theoretical foundation—are largely pending.ObjectiveWe will conduct a systematic review and individual participant data meta-analysis (IPD-MA) evaluating the mediators associated with therapeutic change in various IMIs for depression in adults.MethodsWe will use three electronic databases (i.e., Embase, Medline/PubMed, PsycINFO) as well as an already established database of IPD to identify relevant published and unpublished studies. We will include (1) randomized controlled trials that examine (2) mediators of (3) guided and unguided (4) IMIs with (5) various theoretical orientations for (6) adults with (7) clinically relevant symptoms of depression (8) compared to an active or passive control condition (9) with depression symptom severity as primary outcome. Study selection, data extraction, as well as quality and risk of bias (RoB) assessment will be done independently by two reviewers. Corresponding authors of eligible primary studies will be invited to share their IPD for this meta-analytic study. In a 1-stage IPD-MA, mediation analyses (e.g., on potential mediators like self-efficacy, emotion regulation or problem solving) will be performed using a multilevel structural equation modeling approach within a random-effects framework. Indirect effects will be estimated, with multiple imputation for missing data; the overall model fit will be evaluated and statistical heterogeneity will be assessed. Furthermore, we will investigate if indirect effects are moderated by different variables on participant- (e.g., age, sex/gender, symptom severity), study- (e.g., quality, studies evaluating the temporal ordering of changes in mediators and outcomes), and intervention-level (e.g., theoretical foundation, delivery type, guidance).DiscussionThis systematic review and IPD-MA will generate comprehensive information on the differential strength of mediators and associated therapeutic processes in digital interventions for depression. The findings might contribute to the empirically-informed advancement of psychotherapeutic interventions, leading to more effective interventions and improved treatment outcomes in digital mental health. Besides, with our novel approach to mediation analyses with IPD-MA, we might also add to a methodological progression of evidence-synthesis in psychotherapy process research.Study registration with Open Science Framework (OSF)https://osf.io/md7pq/.

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The Contribution of “Individual Participant Data” Meta-Analyses of Psychotherapies for Depression to the Development of Personalized Treatments: A Systematic Review

Cited by 29 publications

References 28 publications

A systematic review of digital and face-to-face cognitive behavioral therapy for depression

A systematic review of digital and face-to-face cognitive behavioral therapy for depression

Psychotherapy and change in mental health-related work disability: a prospective Finnish population-level register-based study with a quasi-experimental design

Unveiling mechanisms of change in digital interventions for depression: Study protocol for a systematic review and individual participant data meta-analysis

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