A patient stratification approach to identifying the likelihood of continued chronic depression and relapse following treatment for depression
A patient stratification approach to identifying the likelihood of continued chronic depression and relapse following treatment for depression
BACKGROUND: Subgrouping methods have the potential to support treatment decision making for patients with depression. Such approaches have not been used to study the continued course of depression or likelihood of relapse following treatment.
METHOD: Data from individual participants of seven randomised controlled trials were analysed. Latent profile analysis was used to identify subgroups based on baseline characteristics. Associations between profiles and odds of both continued chronic depression and relapse up to one year post-treatment were explored. Differences in outcomes were investigated within profiles for those treated with antidepressants, psychological therapy, and usual care.
RESULTS: Seven profiles were identified; profiles with higher symptom severity and long durations of both anxiety and depression at baseline were at higher risk of relapse and of chronic depression. Members of profile five (likely long durations of depression and anxiety, moderately-severe symptoms, and past antidepressant use) appeared to have better outcomes with psychological therapies: antidepressants vs. psychological therapies (OR (95% CI) for relapse = 2.92 (1.24-6.87), chronic course = 2.27 (1.27-4.06)) and usual care vs. psychological therapies (relapse = 2.51 (1.16-5.40), chronic course = 1.98 (1.16-3.37)).
CONCLUSIONS: Profiles at greater risk of poor outcomes could benefit from more intensive treatment and frequent monitoring. Patients in profile five may benefit more from psychological therapies than other treatments.
Saunders, Rob
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Cohen, Zachary D
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Ambler, Gareth
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DeRubeis, Robert J
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Wiles, Nicola
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Kessler, David
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Gilbody, Simon
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Hollon, Steve D
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Kendrick, Tony
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Watkins, Ed
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Richards, David
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Brabyn, Sally
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Littlewood, Elizabeth
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Sharp, Debbie
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Lewis, Glyn
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Pilling, Steve
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Buckman, Joshua E J
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4 December 2021
Saunders, Rob
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Cohen, Zachary D
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Ambler, Gareth
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DeRubeis, Robert J
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Wiles, Nicola
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Kessler, David
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Gilbody, Simon
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Hollon, Steve D
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Kendrick, Tony
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Watkins, Ed
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Richards, David
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Brabyn, Sally
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Littlewood, Elizabeth
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Sharp, Debbie
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Lewis, Glyn
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Pilling, Steve
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Buckman, Joshua E J
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Saunders, Rob, Cohen, Zachary D, Ambler, Gareth, DeRubeis, Robert J, Wiles, Nicola, Kessler, David, Gilbody, Simon, Hollon, Steve D, Kendrick, Tony, Watkins, Ed, Richards, David, Brabyn, Sally, Littlewood, Elizabeth, Sharp, Debbie, Lewis, Glyn, Pilling, Steve and Buckman, Joshua E J
(2021)
A patient stratification approach to identifying the likelihood of continued chronic depression and relapse following treatment for depression.
Journal of Personalized Medicine, 11 (12).
(doi:10.3390/jpm11121295).
Abstract
BACKGROUND: Subgrouping methods have the potential to support treatment decision making for patients with depression. Such approaches have not been used to study the continued course of depression or likelihood of relapse following treatment.
METHOD: Data from individual participants of seven randomised controlled trials were analysed. Latent profile analysis was used to identify subgroups based on baseline characteristics. Associations between profiles and odds of both continued chronic depression and relapse up to one year post-treatment were explored. Differences in outcomes were investigated within profiles for those treated with antidepressants, psychological therapy, and usual care.
RESULTS: Seven profiles were identified; profiles with higher symptom severity and long durations of both anxiety and depression at baseline were at higher risk of relapse and of chronic depression. Members of profile five (likely long durations of depression and anxiety, moderately-severe symptoms, and past antidepressant use) appeared to have better outcomes with psychological therapies: antidepressants vs. psychological therapies (OR (95% CI) for relapse = 2.92 (1.24-6.87), chronic course = 2.27 (1.27-4.06)) and usual care vs. psychological therapies (relapse = 2.51 (1.16-5.40), chronic course = 1.98 (1.16-3.37)).
CONCLUSIONS: Profiles at greater risk of poor outcomes could benefit from more intensive treatment and frequent monitoring. Patients in profile five may benefit more from psychological therapies than other treatments.
Text
jpm-11-01295-v2
- Version of Record
More information
Accepted/In Press date: 17 November 2021
Published date: 4 December 2021
Additional Information:
Funding: This work was supported by the Wellcome Trust through a Clinical Research Fellowship
to J.E.J.B. (201292/Z/16/Z), the Royal College of Psychiatrists through a grant to J.E.J.B., R.S. and
S.P., MQ Foundation (for ZC: MQDS16/72), the Higher Education Funding Council for England and
the National Institute of Health Research (NIHR) University College London Hospitals Biomedical
Research Centre (S.P.), University College London (R.S., G.A., G.L.), Vanderbilt University (S.D.H.),
University of Southampton (T.K.), University of Exeter (E.W.) and University of York (S.G.), NIHR
Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust
and the University of Bristol (N.W.). The views expressed are those of the authors and not necessarily
those of the NIHR or the Department of Health and Social Care).
Identifiers
Local EPrints ID: 455285
URI: http://eprints.soton.ac.uk/id/eprint/455285
ISSN: 2075-4426
PURE UUID: 4e3f5a4a-3d94-4cc7-a329-ca3db85de4c4
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Date deposited: 16 Mar 2022 17:55
Last modified: 17 Mar 2024 02:47
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Contributors
Author:
Rob Saunders
Author:
Zachary D Cohen
Author:
Gareth Ambler
Author:
Robert J DeRubeis
Author:
Nicola Wiles
Author:
David Kessler
Author:
Simon Gilbody
Author:
Steve D Hollon
Author:
Ed Watkins
Author:
David Richards
Author:
Sally Brabyn
Author:
Elizabeth Littlewood
Author:
Debbie Sharp
Author:
Glyn Lewis
Author:
Steve Pilling
Author:
Joshua E J Buckman
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