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The contribution of depressive 'disorder characteristics' to determinations of prognosis for adults with depression: an individual patient data meta-analysis

The contribution of depressive 'disorder characteristics' to determinations of prognosis for adults with depression: an individual patient data meta-analysis
The contribution of depressive 'disorder characteristics' to determinations of prognosis for adults with depression: an individual patient data meta-analysis

BACKGROUND: This study aimed to investigate general factors associated with prognosis regardless of the type of treatment received, for adults with depression in primary care.

METHODS: We searched Medline, Embase, PsycINFO and Cochrane Central (inception to 12/01/2020) for RCTs that included the most commonly used comprehensive measure of depressive and anxiety disorder symptoms and diagnoses, in primary care depression RCTs (the Revised Clinical Interview Schedule: CIS-R). Two-stage random-effects meta-analyses were conducted.

RESULTS: Twelve (n = 6024) of thirteen eligible studies (n = 6175) provided individual patient data. There was a 31% (95%CI: 25 to 37) difference in depressive symptoms at 3-4 months per standard deviation increase in baseline depressive symptoms. Four additional factors: the duration of anxiety; duration of depression; comorbid panic disorder; and a history of antidepressant treatment were also independently associated with poorer prognosis. There was evidence that the difference in prognosis when these factors were combined could be of clinical importance. Adding these variables improved the amount of variance explained in 3-4 month depressive symptoms from 16% using depressive symptom severity alone to 27%. Risk of bias (assessed with QUIPS) was low in all studies and quality (assessed with GRADE) was high. Sensitivity analyses did not alter our conclusions.

CONCLUSIONS: When adults seek treatment for depression clinicians should routinely assess for the duration of anxiety, duration of depression, comorbid panic disorder, and a history of antidepressant treatment alongside depressive symptom severity. This could provide clinicians and patients with useful and desired information to elucidate prognosis and aid the clinical management of depression.

Depression, individual patient data meta-analysis, prognosis, systematic review, treatment outcome
0033-2917
1068-1081
Buckman, Joshua E J
72f4352d-7903-416f-82df-f69d90308129
Saunders, Rob
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Cohen, Zachary D
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Barnett, Phoebe
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Clarke, Katherine
cddc1aed-8a81-4870-8806-c9621c7ab782
Ambler, Gareth
3b9b18c5-1f7b-4608-b86f-30491d1c2418
DeRubeis, Robert J
311dbb2e-7779-4c26-95fb-895a3853284c
Gilbody, Simon
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Hollon, Steven D
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Kendrick, Tony
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Watkins, Edward
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Wiles, Nicola
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Kessler, David
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Richards, David
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Sharp, Deborah
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Brabyn, Sally
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Littlewood, Elizabeth
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Salisbury, Chris
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White, Ian R
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Lewis, Glyn
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Pilling, Stephen
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Buckman, Joshua E J
72f4352d-7903-416f-82df-f69d90308129
Saunders, Rob
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Cohen, Zachary D
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Barnett, Phoebe
5a3eafb0-059f-4fe8-96e8-b0ae46c1b505
Clarke, Katherine
cddc1aed-8a81-4870-8806-c9621c7ab782
Ambler, Gareth
3b9b18c5-1f7b-4608-b86f-30491d1c2418
DeRubeis, Robert J
311dbb2e-7779-4c26-95fb-895a3853284c
Gilbody, Simon
6d135882-a8df-444c-85aa-980dddef45a5
Hollon, Steven D
faca54db-7076-4c3c-955e-03333b2e7a54
Kendrick, Tony
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Watkins, Edward
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Wiles, Nicola
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Kessler, David
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Richards, David
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Sharp, Deborah
5be021f2-ec75-4317-bf7d-f02328a50107
Brabyn, Sally
aae0a41d-5239-46e8-a5d5-a54809f7afb2
Littlewood, Elizabeth
49eaf7da-20eb-4857-b5f4-67c06ecbb199
Salisbury, Chris
50e9a5a0-c074-4af8-9b1b-e1e8408aae3c
White, Ian R
dd2d3538-6baf-4da9-8083-2447abbed4fb
Lewis, Glyn
11aed8f6-3905-455e-8e89-34147a5e5d26
Pilling, Stephen
f8b9c11e-7720-493c-8739-7813980ff3e4

Buckman, Joshua E J, Saunders, Rob, Cohen, Zachary D, Barnett, Phoebe, Clarke, Katherine, Ambler, Gareth, DeRubeis, Robert J, Gilbody, Simon, Hollon, Steven D, Kendrick, Tony, Watkins, Edward, Wiles, Nicola, Kessler, David, Richards, David, Sharp, Deborah, Brabyn, Sally, Littlewood, Elizabeth, Salisbury, Chris, White, Ian R, Lewis, Glyn and Pilling, Stephen (2021) The contribution of depressive 'disorder characteristics' to determinations of prognosis for adults with depression: an individual patient data meta-analysis. Psychological Medicine, 51 (7), 1068-1081. (doi:10.1017/S0033291721001367).

Record type: Article

Abstract

BACKGROUND: This study aimed to investigate general factors associated with prognosis regardless of the type of treatment received, for adults with depression in primary care.

METHODS: We searched Medline, Embase, PsycINFO and Cochrane Central (inception to 12/01/2020) for RCTs that included the most commonly used comprehensive measure of depressive and anxiety disorder symptoms and diagnoses, in primary care depression RCTs (the Revised Clinical Interview Schedule: CIS-R). Two-stage random-effects meta-analyses were conducted.

RESULTS: Twelve (n = 6024) of thirteen eligible studies (n = 6175) provided individual patient data. There was a 31% (95%CI: 25 to 37) difference in depressive symptoms at 3-4 months per standard deviation increase in baseline depressive symptoms. Four additional factors: the duration of anxiety; duration of depression; comorbid panic disorder; and a history of antidepressant treatment were also independently associated with poorer prognosis. There was evidence that the difference in prognosis when these factors were combined could be of clinical importance. Adding these variables improved the amount of variance explained in 3-4 month depressive symptoms from 16% using depressive symptom severity alone to 27%. Risk of bias (assessed with QUIPS) was low in all studies and quality (assessed with GRADE) was high. Sensitivity analyses did not alter our conclusions.

CONCLUSIONS: When adults seek treatment for depression clinicians should routinely assess for the duration of anxiety, duration of depression, comorbid panic disorder, and a history of antidepressant treatment alongside depressive symptom severity. This could provide clinicians and patients with useful and desired information to elucidate prognosis and aid the clinical management of depression.

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More information

Accepted/In Press date: 2021
e-pub ahead of print date: 14 April 2021
Published date: 14 April 2021
Additional Information: Funding Information: 3. COBALT: The National Institute for Health Research Health Technology Assessment (NIHR HTA) programme (project number 06/404/02). Funding Information: 4. GENPOD: Medical Research Council and supported by the Mental Health Research Network. Funding Information: 5. HEALTHLINES: NIHR under its Programme Grant for Applied Research (Grant Reference Number RP-PG-0108-10011). Funding Information: Financial support. This study was supported by the Wellcome Trust through a Clinical Research Fellowship to JB (201292/Z/16/Z), Medical Research Council (Programme for IW: MC_UU_12023/21), MQ Foundation (for ZC: MQDS16/72), the Higher Education Funding Council for England, the National Institute of Health Research (NIHR), NIHR University College London Hospitals Biomedical Research Centre (RS, KC, PB and SP), NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (NW and DK), University College London (GA and GL), University of Pennsylvania (RDR), Vanderbilt University (SDH), University of Southampton (TK), University of Exeter (EW) and University of York (SG). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The studies that make up the Dep-GP IPD database were funded by: Publisher Copyright: Copyright © The Author(s), 2021. Published by Cambridge University Press. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: Depression, individual patient data meta-analysis, prognosis, systematic review, treatment outcome

Identifiers

Local EPrints ID: 449548
URI: http://eprints.soton.ac.uk/id/eprint/449548
ISSN: 0033-2917
PURE UUID: 4d443f86-29cf-409a-89ee-f31a742474c9
ORCID for Tony Kendrick: ORCID iD orcid.org/0000-0003-1618-9381

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Date deposited: 07 Jun 2021 16:31
Last modified: 27 Apr 2022 01:40

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Contributors

Author: Joshua E J Buckman
Author: Rob Saunders
Author: Zachary D Cohen
Author: Phoebe Barnett
Author: Katherine Clarke
Author: Gareth Ambler
Author: Robert J DeRubeis
Author: Simon Gilbody
Author: Steven D Hollon
Author: Tony Kendrick ORCID iD
Author: Edward Watkins
Author: Nicola Wiles
Author: David Kessler
Author: David Richards
Author: Deborah Sharp
Author: Sally Brabyn
Author: Elizabeth Littlewood
Author: Chris Salisbury
Author: Ian R White
Author: Glyn Lewis
Author: Stephen Pilling

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