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The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size

Published online by Cambridge University Press:  03 June 2009

P. Cuijpers ,
A. van Straten ,
E. Bohlmeijer ,
S. D. Hollon  and
G. Andersson
P. Cuijpers*
Affiliation:
Department of Clinical Psychology, VU University Amsterdam, The Netherlands EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
A. van Straten
Affiliation:
Department of Clinical Psychology, VU University Amsterdam, The Netherlands EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands
E. Bohlmeijer
Affiliation:
Technical University Twente, Deventer, The Netherlands
S. D. Hollon
Affiliation:
Department of Psychology, Vanderbilt University, Nashville, TN, USA
G. Andersson
Affiliation:
Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linköping University, Sweden Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet, Stockholm, Sweden
*
*Address for correspondence: P. Cuijpers, Ph.D., Professor of Clinical Psychology, Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. (Email: p.cuijpers@psy.vu.nl)
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Abstract

Background

No meta-analytical study has examined whether the quality of the studies examining psychotherapy for adult depression is associated with the effect sizes found. This study assesses this association.

Method

We used a database of 115 randomized controlled trials in which 178 psychotherapies for adult depression were compared to a control condition. Eight quality criteria were assessed by two independent coders: participants met diagnostic criteria for a depressive disorder, a treatment manual was used, the therapists were trained, treatment integrity was checked, intention-to-treat analyses were used, N⩾50, randomization was conducted by an independent party, and assessors of outcome were blinded.

Results

Only 11 studies (16 comparisons) met the eight quality criteria. The standardized mean effect size found for the high-quality studies (d=0.22) was significantly smaller than in the other studies (d=0.74, p<0.001), even after restricting the sample to the subset of other studies that used the kind of care-as-usual or non-specific controls that tended to be used in the high-quality studies. Heterogeneity was zero in the group of high-quality studies. The numbers needed to be treated in the high-quality studies was 8, while it was 2 in the lower-quality studies.

Conclusions

We found strong evidence that the effects of psychotherapy for adult depression have been overestimated in meta-analytical studies. Although the effects of psychotherapy are significant, they are much smaller than was assumed until now, even after controlling for the type of control condition used.

Keywords

Depressionmajor depressive disordermeta-analysispsychotherapypsychological treatments
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 2 , February 2010 , pp. 211 - 223
Copyright
Copyright © Cambridge University Press 2009

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References

Altman, DG (2002). Poor-quality medical research: what can journals do? Journal of the American Medical Association 287, 2765–2767.Google Scholar
Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.Google Scholar
Bledsoe, SE, Grote, NK (2006). Treating depression during pregnancy and the postpartum: a preliminary meta-analysis. Research on Social Work Practice 16, 109–120.Google Scholar
Chambless, DL, Hollon, SD (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology 66, 7–18.CrossRefGoogle ScholarPubMed
Churchill, R, Hunot, V, Corney, R, Knapp, M, McGuire, H, Tylee, A, Wessely, S (2001). A systematic review of controlled trials of the effectiveness and cost-effectiveness of brief psychological treatments for depression. Health Technology Assessment 5, 35.Google Scholar
Cooper, P, Murray, L, Wilson, A, Romaniuk, H (2003). Controlled trial of the short- and long-term effect of psychological treatment of past-partum depression. I. Impact on maternal mood. British Journal Psychiatry 182, 412–419.Google Scholar
Cuijpers, P, Dekker, J (2005). Psychological treatment of depression: a systematic review of meta-analyses. Dutch Journal of Medicine 149, 1892–1897.Google Scholar
Cuijpers, P, van Straten, A, Warmerdam, L, Andersson, G (2008 a). Psychological treatment of depression: a meta-analytic database of randomized studies. BMC Psychiatry 8, 36.CrossRefGoogle ScholarPubMed
Cuijpers, P, van Straten, A, Warmerdam, L, Smits, N (2008 b). Characteristics of effective psychological treatments of depression: a meta-regression analysis. Psychotherapy Research 18, 225–236.Google Scholar
Cuijpers, P, van Straten, A, Warmerdam, L (2007 a). Behavioral treatment of depression: a meta-analysis of activity scheduling. Clinical Psychology Review 27, 318–326.Google Scholar
Cuijpers, P, van Straten, A, Warmerdam, L (2007 b). Problem solving therapies for depression: a meta-analysis. European Psychiatry 22, 9–15.Google Scholar
De Mello, MF, De Jesus Mari, J, Bacaltchuk, J, Verdeli, H, Neugebauer, R (2005). A systematic review of research findings on the efficacy of interpersonal therapy for depressive disorders. European Archives of Psychiatry and Clinical Neuroscience 255, 75–82.Google Scholar
DeRubeis, RJ, Hollon, SD, Amsterdam, JD, Shelton, RC, Young, PR, Salomon, RM, O'Reardon, JP, Lovett, ML, Gladis, MM, Brown, LL, Gallop, R (2005). Cognitive therapy vs. medications in the treatment of moderate to severe depression. Archives of General Psychiatry 62, 409–416.CrossRefGoogle ScholarPubMed
Dimidjian, S, Hollon, SD, Dobson, KS, Schmaling, KB, Kohlenberg, RJ, Addis, ME, Gallop, R, McGlinchey, JB, Markley, DK, Gollan, JK, Atkins, DC, Dunner, DL, Jacobson, NS (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology 74, 658–670.Google Scholar
Dowrick, C, Dunn, G, Ayuso-Mateos, JL, Dalgard, OS, Page, H, Lehtinen, V, Casey, P, Wilkinson, C, Vazquez Barquero, JL, Wilkinson, G, the Outcomes of Depression International Network (ODIN) Group (2000). Problem solving treatment and group psychoeducation for depression: multicentre randomised controlled trial. Outcomes of Depression International Network (ODIN) Group. British Medical Journal 321, 1450–1454.Google Scholar
Dunn, NJ, Rehm, LP, Schillaci, J, Soucheck, J, Mehta, P, Ashton, CM, Yanasak, E, Hamilton, JD (2007). A randomized trial of self-management and psychoeducational group therapies for comorbid chronic posttraumatic stress disorder and depressive disorder. Journal of Traumatic Stress 20, 221–237.Google Scholar
Ekers, D, Richards, D, Gilbody, S (2008). A meta-analysis of randomized trials of behavioural treatment of depression. Psychological Medicine 38, 611–623.Google Scholar
Elkin, I, Shea, MT, Watkins, JT, Imber, SD, Sotsky, SM, Collins, JF, Glass, DR, Pilkonis, PA, Leber, WA, Docherty, JP, Fiester, SJ, Parloff, MB (1989). Treatment of depression collaborative research program. Archives of General Psychiatry 46, 971–982.Google Scholar
Gellatly, J, Bower, P, Hennessy, S, Richards, D, Gilbody, S, Lovell, K (2007). What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychological Medicine 37, 1217–1228.Google Scholar
Gloaguen, V, Cottraux, J, Cucherat, M, Blackburn, IM (1998). A meta-analysis of the effects of cognitive therapy in depressed patients. Journal of Affective Disorders 49, 59–72.Google Scholar
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–62.CrossRefGoogle ScholarPubMed
Hedges, L, Olkin, I (1985). Statistical Methods for Meta-analysis. Academic Press: Orlando.Google Scholar
Higgins, JPT, Green, S (2006). Cochrane Handbook for Systematic Reviews of Interventions 4.2.6 (updated September 2006). In The Cochrane Library, Issue 4, 2006. John Wiley & Sons, Ltd: Chichester, UK.Google Scholar
Higgins, JPT, Thompson, SG, Deeks, JJ, Altman, DG (2003). Measuring inconsistency in meta-analyses. British Medical Journal 327, 557–560.Google Scholar
Jarrett, RB, Schaffer, M, McIntire, D, Witt-Browder, A, Kraft, D, Risser, RC (1999). Treatment of atypical depression with cognitive therapy or phenelzine: a double-blind, placebo-controlled trial. Archives of General Psychiatry 56, 431–437.Google Scholar
Kirsch, I, Deacon, BJ, Huedo-Medina, TB, Scoboria, A, Moore, TJ, Johnson, BT (2008). Initial severity and antidepressant benefits: a meta-analysis of data submitted to the food and drug administration. PLOS Medicine 5, e45.CrossRefGoogle ScholarPubMed
Klein, JS, Jacobs, RH, Reinecke, MA (2007). Cognitive-behavioral therapy for adolescent depression: a meta-analytic investigation of changes in effect-size estimates. Journal of the American Academy of Child and Adolescent Psychiatry 46, 1403–1413.Google Scholar
Kraemer, HC, Kupfer, DJ (2006). Size of treatment effects and their importance to clinical research and practice. Biological Psychiatry 59, 990–996.Google Scholar
Leichsenring, F, Rabung, S (2008). Effectiveness of long-term psychodynamic psychotherapy: a meta-analysis. Journal of the American Medical Association 300, 1551–1565.Google Scholar
Lipsey, MW (1990). Design Sensitivity; Statistical Power for Experimental Research. Newbury Park: Sage.Google Scholar
McDermut, W, Miller, IW, Brown, RA (2001). The efficacy of group psychotherapy for depression: a meta-analysis and review of the empirical research. Clinical Psychology: Science and Practice 8, 98–116.Google Scholar
Miranda, J, Chung, JY, Green, BL, Krupnick, J, Siddique, J, Revicki, DA, Belin, T (2003). Treating depression in predominantly low-income young minority women: a randomized controlled trial. Journal of the American Medical Association 290, 57–65.Google Scholar
Pinquart, M, Duberstein, PR, Lyness, JM (2006). Treatments for later-life depressive conditions: a meta-analytic comparison of pharmacotherapy and psychotherapy. American Journal of Psychiatry 163, 1493–1501.Google Scholar
Robinson, LA, Berman, JS, Neimeyer, RA (1990). Psychotherapy for the treatment of depression: a comprehensive review of controlled outcome research. Psychological Bulletin 108, 30–49.Google Scholar
Rosenthal, R, DiMatteo, MR (2001). Meta-analysis: recent developments in quantitative methods for literature reviews. Annual Review of Psychology 52, 59–82.Google Scholar
Sackett, DL, Strauss, SE, Richardson, WS, Rosenberg, W, Haynes, RB (2000). Evidence-based Medicine. How to Practice and Teach EBM, 2nd edn. Edinburgh: Churchill Livingstone.Google Scholar
Smit, A, Kluiter, H, Conradi, HJ, Van der Meer, K, Tiemens, BG, Jenner, JA, Van Os, TWDP, Ormel, J (2006). Short-term effects of enhanced treatment for depression in primary care: results from a randomized controlled trial. Psychological Medicine 36, 15–26.CrossRefGoogle ScholarPubMed
Turner, EH, Matthews, AM, Linardatos, E, Tell, RA, Rosenthal, R (2008). Selective publication of antidepressant trials and its influence on apparent efficacy. New England Journal of Medicine 358, 252–260.Google Scholar
Van Schaik, A, van Marwijk, H, Ader, H, van Dyck, R, de Haan, M, Penninx, B, van der Kooij, K, van Hout, H, Beekman, A (2006). Interpersonal psychotherapy for elderly patients in primary care. American Journal of Geriatric Psychiatry 14, 777–786.Google Scholar
Wampold, BE, Minami, T, Baskin, TW, Tierney, SC (2002). A meta-(re)analysis of the effects of cognitive therapy versus ‘other therapies’ for depression. Journal of Affective Disorders 68, 159–165.CrossRefGoogle ScholarPubMed
Weisz, JR, McCarty, CA, Valeri, SM (2006). Effects of psychotherapy for depression in children and adolescents: a meta-analysis. Psychological Bulletin 132, 132–149.Google Scholar
Williams, JW Jr., Oxman, T, Frank, E, Katon, W, Sullivan, M, Cornell, J, Sengupta, A (2000). Treatment of dysthymia and minor depression in primary care: a randomized controlled trial in older adolescents. Journal of the American Medical Association 284, 1519–1526.CrossRefGoogle Scholar