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Meta-Analysis
. 2013 Feb 26:346:f540.
doi: 10.1136/bmj.f540.

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

Peter Bower  1 , Evangelos Kontopantelis, Alex Sutton, Tony Kendrick, David A Richards, Simon Gilbody, Sarah Knowles, Pim Cuijpers, Gerhard Andersson, Helen Christensen, Björn Meyer, Marcus Huibers, Filip Smit, Annemieke van Straten, Lisanne Warmerdam, Michael Barkham, Linda Bilich, Karina Lovell, Emily Tung-Hsueh Liu
Affiliations
Meta-Analysis

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

Peter Bower et al. BMJ. .

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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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: BM is currently a full time employee of GAIA AG, Hamburg, Germany, a company that owns and developed one of the low intensity interventions considered in this paper. PB has acted as a paid scientific consultant to the British Association of Counselling and Psychotherapy. All other authors declare no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work .

Figures

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Fig 1 Inclusion of studies in the review
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Fig 2 Funnel plot of studies included in analysis with pseudo 95% confidence intervals. Egger’s regression intercept −2.39 (SE 0.8), P=0.007
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Fig 3 Baseline severity data of studies included in the review. Box and whisker plots show median, interquartile range, minimum and maximum scores, and outliers
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Fig 4 Forest plot of interactions between baseline severity of depression and effect of low intensity interventions
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Fig 5 How baseline severity of depression moderates the effect of low intensity interventions on depression
See this image and copyright information in PMC

References

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