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Meta-Analysis
. 2021 May;51(7):1068-1081.
doi: 10.1017/S0033291721001367. Epub 2021 Apr 14.

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

Joshua E J Buckman  1   2 , Rob Saunders  1 , Zachary D Cohen  3 , Phoebe Barnett  1 , Katherine Clarke  1 , Gareth Ambler  4 , Robert J DeRubeis  5 , Simon Gilbody  6 , Steven D Hollon  7 , Tony Kendrick  8 , Edward Watkins  9 , Nicola Wiles  10 , David Kessler  11 , David Richards  12 , Deborah Sharp  11 , Sally Brabyn  6 , Elizabeth Littlewood  6 , Chris Salisbury  11 , Ian R White  13 , Glyn Lewis  14 , Stephen Pilling  1   15
Affiliations
Meta-Analysis

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

Joshua E J Buckman et al. Psychol Med. 2021 May.

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.

Keywords: Depression; individual patient data meta-analysis; prognosis; systematic review; treatment outcome.

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Conflict of interest statement

None.

Figures

Fig. 1.
Fig. 1.
Flowchart of studies through selection process for IPD meta-analysis.
See this image and copyright information in PMC

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