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Influence of initial severity of depression on effectiveness of low intensity interventions: meta-analysis of individual patient data

Influence of initial severity of depression on effectiveness of low intensity interventions: meta-analysis of individual patient data
Influence of initial severity of depression on effectiveness of low intensity interventions: meta-analysis of individual patient data
OBJECTIVE: To assess how initial severity of depression affects the benefit derived from low intensity interventions for depression.

DESIGN: Meta-analysis of individual patient data from 16 datasets comparing low intensity interventions with usual care.

SETTING: Primary care and community settings.

PARTICIPANTS: 2470 patients with depression.

INTERVENTIONS: Low intensity interventions for depression (such as guided self help by means of written materials and limited professional support, and internet delivered interventions).

MAIN OUTCOME MEASURES: Depression outcomes (measured with the Beck Depression Inventory or Center for Epidemiologic Studies Depression Scale), and the effect of initial depression severity on the effects of low intensity interventions.

RESULTS: Although patients were referred for low intensity interventions, many had moderate to severe depression at baseline. We found a significant interaction between baseline severity and treatment effect (coefficient -0.1 (95% CI -0.19 to -0.002)), suggesting that patients who are more severely depressed at baseline demonstrate larger treatment effects than those who are less severely depressed. However, the magnitude of the interaction (equivalent to an additional drop of around one point on the Beck Depression Inventory for a one standard deviation increase in initial severity) was small and may not be clinically significant.

CONCLUSIONS: The data suggest that patients with more severe depression at baseline show at least as much clinical benefit from low intensity interventions as less severely depressed patients and could usefully be offered these interventions as part of a stepped care model.
0959-8138
1-11
Bower, P.
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Kontopantelis, E.
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Sutton, A.
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Kendrick, T.
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Richards, D.A.
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Gilbody, S.
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Knowles, S.
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Cuijpers, P.
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Andersson, G.
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Christensen, H.
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Meyer, Bjorn
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Huibers, M.
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Smit, F.
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van Straten, A.
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Warmerdam, L.
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Barkham, M.
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Bilich, L.
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Lovell, K.
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Liu, E.T.-H.
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Bower, P.
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Kontopantelis, E.
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Sutton, A.
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Kendrick, T.
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Richards, D.A.
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Gilbody, S.
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Knowles, S.
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Cuijpers, P.
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Andersson, G.
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Christensen, H.
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Meyer, Bjorn
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Huibers, M.
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Smit, F.
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van Straten, A.
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Warmerdam, L.
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Barkham, M.
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Bilich, L.
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Lovell, K.
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Liu, E.T.-H.
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Bower, P., Kontopantelis, E., Sutton, A., Kendrick, T., Richards, D.A., Gilbody, S., Knowles, S., Cuijpers, P., Andersson, G., Christensen, H., Meyer, Bjorn, Huibers, M., Smit, F., van Straten, A., Warmerdam, L., Barkham, M., Bilich, L., Lovell, K. and Liu, E.T.-H. (2013) Influence of initial severity of depression on effectiveness of low intensity interventions: meta-analysis of individual patient data. British Medical Journal, 346 (f540), 1-11. (doi:10.1136/bmj.f540). (PMID:23444423)

Record type: Article

Abstract

OBJECTIVE: To assess how initial severity of depression affects the benefit derived from low intensity interventions for depression.

DESIGN: Meta-analysis of individual patient data from 16 datasets comparing low intensity interventions with usual care.

SETTING: Primary care and community settings.

PARTICIPANTS: 2470 patients with depression.

INTERVENTIONS: Low intensity interventions for depression (such as guided self help by means of written materials and limited professional support, and internet delivered interventions).

MAIN OUTCOME MEASURES: Depression outcomes (measured with the Beck Depression Inventory or Center for Epidemiologic Studies Depression Scale), and the effect of initial depression severity on the effects of low intensity interventions.

RESULTS: Although patients were referred for low intensity interventions, many had moderate to severe depression at baseline. We found a significant interaction between baseline severity and treatment effect (coefficient -0.1 (95% CI -0.19 to -0.002)), suggesting that patients who are more severely depressed at baseline demonstrate larger treatment effects than those who are less severely depressed. However, the magnitude of the interaction (equivalent to an additional drop of around one point on the Beck Depression Inventory for a one standard deviation increase in initial severity) was small and may not be clinically significant.

CONCLUSIONS: The data suggest that patients with more severe depression at baseline show at least as much clinical benefit from low intensity interventions as less severely depressed patients and could usefully be offered these interventions as part of a stepped care model.

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Published date: 26 February 2013
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 353083
URI: https://eprints.soton.ac.uk/id/eprint/353083
ISSN: 0959-8138
PURE UUID: 13ba15bc-2a20-4a57-97ad-3dada5e05be5
ORCID for T. Kendrick: ORCID iD orcid.org/0000-0003-1618-9381

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Date deposited: 29 May 2013 11:37
Last modified: 15 Oct 2019 00:50

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Contributors

Author: P. Bower
Author: E. Kontopantelis
Author: A. Sutton
Author: T. Kendrick ORCID iD
Author: D.A. Richards
Author: S. Gilbody
Author: S. Knowles
Author: P. Cuijpers
Author: G. Andersson
Author: H. Christensen
Author: Bjorn Meyer
Author: M. Huibers
Author: F. Smit
Author: A. van Straten
Author: L. Warmerdam
Author: M. Barkham
Author: L. Bilich
Author: K. Lovell
Author: E.T.-H. Liu

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