Journal article
Psychological intervention in individuals with subthreshold depression: individual participant data meta-analysis of treatment effects and moderators
British journal of psychiatry, pp 1-14
14 May 2025
PMID: 40365980
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.
To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.
Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment-covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.
IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = -0.48 to -0.27). Effects could not be ascertained up to 24 months (s.m.d. = -0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27-2.79), reliable improvement (relative risk = 1.38-3.17), deterioration (relative risk = 0.67-0.54) and close-to-symptom-free status (relative risk = 1.41-2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (
> 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = -0.33 for PHQ-9 = 5).
Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.
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Details
- Title
- Psychological intervention in individuals with subthreshold depression: individual participant data meta-analysis of treatment effects and moderators
- Creators
- Mathias Harrer - Technical University of MunichAntonia A Sprenger - Otto-von-Guericke-Universität MagdeburgSusan Illing - Technical University of MunichMarcel C Adriaanse - Vrije Universiteit AmsterdamSteven M Albert - University of PittsburghEsther Allart - Allart Supervisie, Nijmegen, The NetherlandsOsvaldo P Almeida - The University of Western AustraliaJulian Basanovic - University of ExeterKim M P van Bastelaar - Amsterdam University Medical Centre, Amsterdam, The NetherlandsPhilip J Batterham - Australian National UniversityHarald Baumeister - Universität UlmThomas Berger - University of BernVanessa Blanco - Universidade de Santiago de CompostelaRagnhild Bø - University of OsloRobin J Casten - Thomas Jefferson UniversityDicken Chan - Chinese University of Hong KongHelen Christensen - Black Dog InstituteMarketa Ciharova - Vrije Universiteit AmsterdamLorna Cook - University of ExeterJohn Cornell - The University of Texas at San AntonioElysia P Davis - University of DenverKeith S Dobson - University of CalgaryElsien Dozeman - GGZ inGeestSimon Gilbody - University of YorkBenjamin L Hankin - University of Illinois Urbana-ChampaignRimke Haringsma - Leiden UniversityKristof Hoorelbeke - Department of Experimental Clinical and Health Psychology, University of Ghent, Ghent, BelgiumMichael R Irwin - University of California, Los AngelesFemke Jansen - Vrije Universiteit AmsterdamRune Jonassen - OsloMet – Oslo Metropolitan UniversityEirini Karyotaki - Vrije Universiteit AmsterdamNorito Kawakami - The University of TokyoJ Philipp Klein - University of LübeckCandace Konnert - University of CalgaryKotaro Imamura - The University of TokyoNils Inge Landrø - University of OsloMaría Asunción Lara - Instituto Nacional de Psiquiatría Ramón de la Fuente MuñizHuynh-Nhu Le - George Washington UniversityDirk Lehr - Leuphana University of LüneburgJuan V Luciano - Parc Sanitari Sant Joan de DéuSteffen Moritz - Universität HamburgJana M Mossey - Drexel UniversityRicardo F Muñoz - Palo Alto UniversityAnna Muntingh - GGZ inGeestStephanie Nobis - Klinikum OsnabrückRichard Olmstead - Neurobehavioral SystemsPatricia Otero - Universidade da CoruñaMirjana Pibernik-Okanović - Klinička bolnica MerkurAnne Margriet Pot - Erasmus University RotterdamCharles F Reynolds, 3rd - University of Pittsburgh School of MedicineBarry W Rovner - Thomas Jefferson UniversityJuan P Sanabria-Mazo - Parc Sanitari Sant Joan de DéuLasse B Sander - University Medical Center FreiburgFilip Smit - Trimbos InstituteFrank J Snoek - Amsterdam University Medical CentersViola Spek - Fontys University of Applied SciencesPhilip Spinhoven - Leiden UniversityLiza Stelmach - CARE CanadaYannik Terhorst - Ludwig-Maximilians-Universität MünchenFernando L Vázquez - Universidade de Santiago de CompostelaIrma Verdonck-de Leeuw - Vrije Universiteit AmsterdamEd Watkins - University of ExeterWenhui Yang - Hunan Normal UniversitySamuel Yeung Shan Wong - Hong Kong Jockey ClubJohannes Zimmermann - University of KasselMasatsugu Sakata - Nagoya City UniversityToshi A Furukawa - Kyoto UniversityStefan Leucht - Technical University of MunichPim Cuijpers - Vrije Universiteit AmsterdamClaudia Buntrock - Otto-von-Guericke-Universität MagdeburgDavid Daniel Ebert - Technical University of Munich
- Publication Details
- British journal of psychiatry, pp 1-14
- Publisher
- Cambridge University Press
- Number of pages
- 14
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- [Retired Faculty]; Epidemiology and Biostatistics
- Web of Science ID
- WOS:001487977800001
- Scopus ID
- 2-s2.0-105005716473
- Other Identifier
- 991022053729004721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Psychiatry