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Life events and treatment prognosis for depression: A systematic review and individual patient data meta-analysis

Life events and treatment prognosis for depression: A systematic review and individual patient data meta-analysis
Life events and treatment prognosis for depression: A systematic review and individual patient data meta-analysis

Objective: to investigate associations between major life events and prognosis independent of treatment type: (1) after adjusting for clinical prognostic factors and socio-demographics; (2) amongst patients with depressive episodes at least six-months long; and (3) patients with a first life-time depressive episode.

Methods: six RCTs of adults seeking treatment for depression in primary care met eligibility criteria, individual patient data (IPD) were collated from all six (n = 2858). Participants were randomized to any treatment and completed the same baseline assessment of life events, demographics and clinical prognostic factors. Two-stage random effects meta-analyses were conducted.

Results: reporting any major life events was associated with poorer prognosis regardless of treatment type. Controlling for baseline clinical factors, socio-demographics and social support resulted in minimal residual evidence of associations between life events and treatment prognosis. However, removing factors that might mediate the relationships between life events and outcomes reporting: arguments/disputes, problem debt, violent crime, losing one's job, and three or more life events were associated with considerably worse prognoses (percentage difference in 3-4 months depressive symptoms compared to no reported life events =30.3%(95%CI: 18.4-43.3)).

Conclusions: assessing for clinical prognostic factors, social support, and socio-demographics is likely to be more informative for prognosis than assessing self-reported recent major life events. However, clinicians might find it useful to ask about such events, and if they are still affecting the patient, consider interventions to tackle problems related to those events (e.g. employment support, mediation, or debt advice). Further investigations of the efficacy of such interventions will be important.

Depression, Humans, Primary Health Care, Prognosis, Randomized Controlled Trials as Topic, Social Support
0165-0327
298-308
Buckman, Joshua E J
72f4352d-7903-416f-82df-f69d90308129
Saunders, Rob
14f8666e-a131-4130-a7b1-a358d84d5cb2
Arundell, Laura-Louise
524da148-b2b7-4618-b319-18d2fab24e44
Oshinowo, Iyinoluwa D
d29e0337-66ba-4a5c-953c-dc888557192a
Cohen, Zachary D
2ac2bcd9-b47b-458c-a241-cccd311c1e8a
O'Driscoll, Ciaran
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Barnett, Phoebe
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Stott, Joshua
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Ambler, Gareth
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Gilbody, Simon
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Hollon, Steven D
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Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Watkins, Edward
4474dca0-035b-4aba-b3fb-b6d7180abfb9
Eley, Thalia C
d9e3a546-3c35-4207-b074-2ced31f91f94
Skelton, Megan
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Wiles, Nicola
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Kessler, David
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DeRubeis, Robert J
311dbb2e-7779-4c26-95fb-895a3853284c
Lewis, Glyn
11aed8f6-3905-455e-8e89-34147a5e5d26
Pilling, Stephen
f8b9c11e-7720-493c-8739-7813980ff3e4
Buckman, Joshua E J
72f4352d-7903-416f-82df-f69d90308129
Saunders, Rob
14f8666e-a131-4130-a7b1-a358d84d5cb2
Arundell, Laura-Louise
524da148-b2b7-4618-b319-18d2fab24e44
Oshinowo, Iyinoluwa D
d29e0337-66ba-4a5c-953c-dc888557192a
Cohen, Zachary D
2ac2bcd9-b47b-458c-a241-cccd311c1e8a
O'Driscoll, Ciaran
17f26b26-596b-4ef1-a207-ae715498294e
Barnett, Phoebe
5a3eafb0-059f-4fe8-96e8-b0ae46c1b505
Stott, Joshua
80bc99ca-a7c6-4280-84d6-81f009f963a6
Ambler, Gareth
3b9b18c5-1f7b-4608-b86f-30491d1c2418
Gilbody, Simon
6d135882-a8df-444c-85aa-980dddef45a5
Hollon, Steven D
faca54db-7076-4c3c-955e-03333b2e7a54
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Watkins, Edward
4474dca0-035b-4aba-b3fb-b6d7180abfb9
Eley, Thalia C
d9e3a546-3c35-4207-b074-2ced31f91f94
Skelton, Megan
9198abed-dc96-4861-aa93-c349130bb3bb
Wiles, Nicola
fcec2769-de78-4b86-b9c1-eab754a02837
Kessler, David
3659e526-e667-46cb-bd9c-02bce7d58d41
DeRubeis, Robert J
311dbb2e-7779-4c26-95fb-895a3853284c
Lewis, Glyn
11aed8f6-3905-455e-8e89-34147a5e5d26
Pilling, Stephen
f8b9c11e-7720-493c-8739-7813980ff3e4

Buckman, Joshua E J, Saunders, Rob, Arundell, Laura-Louise, Oshinowo, Iyinoluwa D, Cohen, Zachary D, O'Driscoll, Ciaran, Barnett, Phoebe, Stott, Joshua, Ambler, Gareth, Gilbody, Simon, Hollon, Steven D, Kendrick, Tony, Watkins, Edward, Eley, Thalia C, Skelton, Megan, Wiles, Nicola, Kessler, David, DeRubeis, Robert J, Lewis, Glyn and Pilling, Stephen (2021) Life events and treatment prognosis for depression: A systematic review and individual patient data meta-analysis. Journal of Affective Disorders, 299, 298-308. (doi:10.1016/j.jad.2021.12.030).

Record type: Review

Abstract

Objective: to investigate associations between major life events and prognosis independent of treatment type: (1) after adjusting for clinical prognostic factors and socio-demographics; (2) amongst patients with depressive episodes at least six-months long; and (3) patients with a first life-time depressive episode.

Methods: six RCTs of adults seeking treatment for depression in primary care met eligibility criteria, individual patient data (IPD) were collated from all six (n = 2858). Participants were randomized to any treatment and completed the same baseline assessment of life events, demographics and clinical prognostic factors. Two-stage random effects meta-analyses were conducted.

Results: reporting any major life events was associated with poorer prognosis regardless of treatment type. Controlling for baseline clinical factors, socio-demographics and social support resulted in minimal residual evidence of associations between life events and treatment prognosis. However, removing factors that might mediate the relationships between life events and outcomes reporting: arguments/disputes, problem debt, violent crime, losing one's job, and three or more life events were associated with considerably worse prognoses (percentage difference in 3-4 months depressive symptoms compared to no reported life events =30.3%(95%CI: 18.4-43.3)).

Conclusions: assessing for clinical prognostic factors, social support, and socio-demographics is likely to be more informative for prognosis than assessing self-reported recent major life events. However, clinicians might find it useful to ask about such events, and if they are still affecting the patient, consider interventions to tackle problems related to those events (e.g. employment support, mediation, or debt advice). Further investigations of the efficacy of such interventions will be important.

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Accepted/In Press date: 12 December 2021
e-pub ahead of print date: 14 December 2021
Additional Information: Role of the funding source This research was funded by the Wellcome Trust [20129/Z/16/Z], the MQ Foundation (for ZC: MQDS16/72), the Higher Education Funding Council for England (RS, PB, l-LA, IO, C'OD, and SP), the National Institute of Health Research (NIHR), NIHR University College London Hospitals Biomedical Research Centre (RS, PB, l-LA, IO, and SP), University College London (GA, GL), University College London (SDH), University of Southampton (TK), University of Exeter (EW), and University of York (SG). NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (NW: The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care). Alzheimer's Society (grant code: 457 (AS-PG-18–013) for JS). National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London (TE and MS: The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health). The studies that individual patient data for this study were funded by: 1 COBALT: This research was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme (project number 06/404/02). 2 GENPOD: Medical Research Council and supported by the Mental Health Research Network. 3 IPCRESS: BUPA Foundation 4 MIR: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (project 11/129/76) and supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol 5 PANDA: NIHR Programme Grant for Applied Research 6 TREAD: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Keywords: Depression, Humans, Primary Health Care, Prognosis, Randomized Controlled Trials as Topic, Social Support

Identifiers

Local EPrints ID: 454524
URI: http://eprints.soton.ac.uk/id/eprint/454524
ISSN: 0165-0327
PURE UUID: c8390290-e2c2-40be-bb7c-b6053f428d4b
ORCID for Tony Kendrick: ORCID iD orcid.org/0000-0003-1618-9381

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Date deposited: 15 Feb 2022 17:37
Last modified: 28 Apr 2022 01:43

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Contributors

Author: Joshua E J Buckman
Author: Rob Saunders
Author: Laura-Louise Arundell
Author: Iyinoluwa D Oshinowo
Author: Zachary D Cohen
Author: Ciaran O'Driscoll
Author: Phoebe Barnett
Author: Joshua Stott
Author: Gareth Ambler
Author: Simon Gilbody
Author: Steven D Hollon
Author: Tony Kendrick ORCID iD
Author: Edward Watkins
Author: Thalia C Eley
Author: Megan Skelton
Author: Nicola Wiles
Author: David Kessler
Author: Robert J DeRubeis
Author: Glyn Lewis
Author: Stephen Pilling

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