Limits...
Behavioural activation for depression; an update of meta-analysis of effectiveness and sub group analysis.

Ekers D, Webster L, Van Straten A, Cuijpers P, Richards D, Gilbody S - PLoS ONE (2014)

Bottom Line: It has been over 5 years since our meta-analyses summarised the evidence supporting and this systematic review updates those findings and examines moderators of treatment effect.There was no indication of publication bias and subgroup analysis showed limited association between moderators and effect size.Further high quality research with longer term follow-up is needed to strengthen the evidence base.

View Article: PubMed Central - PubMed

Affiliation: Durham University/Tees Esk and Wear Valleys NHS Foundation Trust, Department of Medicine, Pharmacy & Health, Durham University, Stockton on Tees, United Kingdom.

ABSTRACT

Background: Depression is a common, disabling condition for which psychological treatments are recommended. Behavioural activation has attracted increased interest in recent years. It has been over 5 years since our meta-analyses summarised the evidence supporting and this systematic review updates those findings and examines moderators of treatment effect.

Method: Randomised trials of behavioural activation for depression versus controls or anti-depressant medication were identified using electronic database searches, previous reviews and reference lists. Data on symptom level and study level moderators were extracted and analysed using meta-analysis, sub-group analysis and meta-regression respectively.

Results: Twenty six randomised controlled trials including 1524 subjects were included in this meta-analysis. A random effects meta-analysis of symptom level post treatment showed behavioural activation to be superior to controls (SMD -0.74 CI -0.91 to -0.56, k = 25, N = 1088) and medication (SMD -0.42 CI -0.83 to-0.00, k = 4, N = 283). Study quality was low in the majority of studies and follow- up time periods short. There was no indication of publication bias and subgroup analysis showed limited association between moderators and effect size.

Conclusions: The results in this meta-analysis support and strengthen the evidence base indicating Behavioural Activation is an effective treatment for depression. Further high quality research with longer term follow-up is needed to strengthen the evidence base.

Show MeSH

Related in: MedlinePlus

Behavioural Activation vs. control post treatment (ordered by effect size high to low).
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4061095&req=5

pone-0100100-g002: Behavioural Activation vs. control post treatment (ordered by effect size high to low).

Mentions: BA for depression was compared to controls in 25 studies including 31 comparisons and 1088 participants. The SMD (g) at post treatment was −0.74 (95% CI −0.91 to −0.56 p<0.001 NNT 2.5), representing a large effect size (fig. 2). Sensitivity analysis replacing mid-range imputed standard deviations with lowest and highest observed values had minimal influence on results (g = −0.89, 95% CI −1.14 to −0.64 and g = −0.67 95% CI −0.83 to −0.50 respectively). There was moderate between-study heterogeneity of treatment effects beyond what would be expected due to sampling error (Q 51.64 p 0.008 I2 41.91%). Subgroup analysis was used to explore this dispersion further. We found a significant association with effect size and subgroup in two areas, control type and baseline depression severity. All other subgroup comparisons identified similar SMD across groups (see table 3). Study quality was sub optimal in all but six studies, subgroup analysis indicated no significant relationship between study quality and effect size. The SMD (g) of comparisons in low quality studies at post treatment was −0.77 and in high quality studies −0.67 with similar levels of statistical heterogeneity (see table 3). The median number of clinical sessions with a therapist was eight (range one to 16). Meta-regression using session number as a mediator resulted in a slope of 0.03 (95% CI −0.01 to 0.06, Q total 51.92 p = 0.01, Q session number 2.08 p = 0.15), indicating no significant influence on effect size. Meta-regression using BA components as a mediator resulted in a non-significant slope of 0.04 (95% CI −0.11 to 0.20, Q total 51.64 p = 0.01, Q session number 0.32 p = 0.57), indicating minimal influence on effect size.


Behavioural activation for depression; an update of meta-analysis of effectiveness and sub group analysis.

Ekers D, Webster L, Van Straten A, Cuijpers P, Richards D, Gilbody S - PLoS ONE (2014)

Behavioural Activation vs. control post treatment (ordered by effect size high to low).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061095&req=5

pone-0100100-g002: Behavioural Activation vs. control post treatment (ordered by effect size high to low).
Mentions: BA for depression was compared to controls in 25 studies including 31 comparisons and 1088 participants. The SMD (g) at post treatment was −0.74 (95% CI −0.91 to −0.56 p<0.001 NNT 2.5), representing a large effect size (fig. 2). Sensitivity analysis replacing mid-range imputed standard deviations with lowest and highest observed values had minimal influence on results (g = −0.89, 95% CI −1.14 to −0.64 and g = −0.67 95% CI −0.83 to −0.50 respectively). There was moderate between-study heterogeneity of treatment effects beyond what would be expected due to sampling error (Q 51.64 p 0.008 I2 41.91%). Subgroup analysis was used to explore this dispersion further. We found a significant association with effect size and subgroup in two areas, control type and baseline depression severity. All other subgroup comparisons identified similar SMD across groups (see table 3). Study quality was sub optimal in all but six studies, subgroup analysis indicated no significant relationship between study quality and effect size. The SMD (g) of comparisons in low quality studies at post treatment was −0.77 and in high quality studies −0.67 with similar levels of statistical heterogeneity (see table 3). The median number of clinical sessions with a therapist was eight (range one to 16). Meta-regression using session number as a mediator resulted in a slope of 0.03 (95% CI −0.01 to 0.06, Q total 51.92 p = 0.01, Q session number 2.08 p = 0.15), indicating no significant influence on effect size. Meta-regression using BA components as a mediator resulted in a non-significant slope of 0.04 (95% CI −0.11 to 0.20, Q total 51.64 p = 0.01, Q session number 0.32 p = 0.57), indicating minimal influence on effect size.

Bottom Line: It has been over 5 years since our meta-analyses summarised the evidence supporting and this systematic review updates those findings and examines moderators of treatment effect.There was no indication of publication bias and subgroup analysis showed limited association between moderators and effect size.Further high quality research with longer term follow-up is needed to strengthen the evidence base.

View Article: PubMed Central - PubMed

Affiliation: Durham University/Tees Esk and Wear Valleys NHS Foundation Trust, Department of Medicine, Pharmacy & Health, Durham University, Stockton on Tees, United Kingdom.

ABSTRACT

Background: Depression is a common, disabling condition for which psychological treatments are recommended. Behavioural activation has attracted increased interest in recent years. It has been over 5 years since our meta-analyses summarised the evidence supporting and this systematic review updates those findings and examines moderators of treatment effect.

Method: Randomised trials of behavioural activation for depression versus controls or anti-depressant medication were identified using electronic database searches, previous reviews and reference lists. Data on symptom level and study level moderators were extracted and analysed using meta-analysis, sub-group analysis and meta-regression respectively.

Results: Twenty six randomised controlled trials including 1524 subjects were included in this meta-analysis. A random effects meta-analysis of symptom level post treatment showed behavioural activation to be superior to controls (SMD -0.74 CI -0.91 to -0.56, k = 25, N = 1088) and medication (SMD -0.42 CI -0.83 to-0.00, k = 4, N = 283). Study quality was low in the majority of studies and follow- up time periods short. There was no indication of publication bias and subgroup analysis showed limited association between moderators and effect size.

Conclusions: The results in this meta-analysis support and strengthen the evidence base indicating Behavioural Activation is an effective treatment for depression. Further high quality research with longer term follow-up is needed to strengthen the evidence base.

Show MeSH
Related in: MedlinePlus