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Different control conditions can produce different effect estimates in psychotherapy trials for depression.

Authors
  • Michopoulos, Ioannis1
  • Furukawa, Toshi A2
  • Noma, Hisashi3
  • Kishimoto, Sanae4
  • Onishi, Akira5
  • Ostinelli, Edoardo G6
  • Ciharova, Marketa7
  • Miguel, Clara7
  • Karyotaki, Eirini8
  • Cuijpers, Pim7
  • 1 Eating Disorders Unit, 2nd Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece. Electronic address: [email protected] , (Greece)
  • 2 Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan. , (Japan)
  • 3 Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan. , (Japan)
  • 4 Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan. , (Japan)
  • 5 Department of Rheumatology and Clinical Immunology, Kobe University Graduate School of Medicine, Hyogo, Japan. , (Japan)
  • 6 Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK; Department of Psychiatry, University of Oxford, Oxford, UK.
  • 7 Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. , (Netherlands)
  • 8 Department of Global Health and Social Medicine, Harvard Medical School, Boston MA, USA; Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. , (Netherlands)
Type
Published Article
Journal
Journal of clinical epidemiology
Publication Date
Dec 15, 2020
Volume
132
Pages
59–70
Identifiers
DOI: 10.1016/j.jclinepi.2020.12.012
PMID: 33338564
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Control conditions' influence on effect estimates of active psychotherapeutic interventions for depression has not been fully elucidated. We used network meta-analysis to estimate the differences between control conditions. We have conducted a comprehensive literature search of randomized trials of psychotherapies for adults with depression up to January 1, 2019 in four major databases (PubMed, PsycINFO, Embase, and Cochrane). The network meta-analysis included broadly conceived cognitive behavior therapies in comparison with the following control conditions: Waiting List (WL), No Treatment (NT), Pill Placebo (PillPlacebo), Psychological Placebo (PsycholPlacebo). 123 studies with 12,596 participants were included. The I-squared was 55.9% (95% CI: 45.9%; to 64.0%) (moderate heterogeneity). The design-by-treatment global test of inconsistency was not significant (P = 0.44). Different control conditions led to different estimates of efficacy for the same intervention. WL appears to be the weakest control (odds ratio of response against NT = 1.93 (1.30 to 2.86), PsycholPlacebo = 2.03 (1.21 to 3.39), and PillPlacebo = 2.66 (1.45 to 4.89), respectively). Different control conditions produce different effect estimates in psychotherapy randomized controlled trials for depression. WL was the weakest, followed by NT, PsycholPlacebo, and PillPlacebo in this order. When conducting meta-analyses of psychotherapy trials, different control conditions should not be lumped into a single group. Copyright © 2020 Elsevier Inc. All rights reserved.

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