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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.

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Related in: MedlinePlus

Behavioural Activation vs. Antidepressant medication.
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pone-0100100-g003: Behavioural Activation vs. Antidepressant medication.

Mentions: BA for depression was compared to antidepressant medication in four studies including 283 participants. The SMD (g) at post treatment was −0.42 (95% CI −0.83 to −0.00 p 0.05 NNT 4.27), representing a moderate effect size in favour of BA (see fig. 3). There was moderate between-study heterogeneity of treatment effects beyond what would be expected due to sampling error (Q 8.34 p 0.04, I2 64.02%). Two studies used SSRI [82], [89] with two studies tricyclic antidepressant medication [68], [72] with no apparent association between drug type and effect size (see table 2). There were insufficient studies to allow further exploration of subgroups or potential publication bias. We conducted sensitivity analysis on study quality by removing the two low quality studies from the analysis [68], [72] resulting in a non-significant effect size in favour of BA of −0.38 (95% CI −1.23 to 0.47 p 0.38).


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. Antidepressant medication.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0100100-g003: Behavioural Activation vs. Antidepressant medication.
Mentions: BA for depression was compared to antidepressant medication in four studies including 283 participants. The SMD (g) at post treatment was −0.42 (95% CI −0.83 to −0.00 p 0.05 NNT 4.27), representing a moderate effect size in favour of BA (see fig. 3). There was moderate between-study heterogeneity of treatment effects beyond what would be expected due to sampling error (Q 8.34 p 0.04, I2 64.02%). Two studies used SSRI [82], [89] with two studies tricyclic antidepressant medication [68], [72] with no apparent association between drug type and effect size (see table 2). There were insufficient studies to allow further exploration of subgroups or potential publication bias. We conducted sensitivity analysis on study quality by removing the two low quality studies from the analysis [68], [72] resulting in a non-significant effect size in favour of BA of −0.38 (95% CI −1.23 to 0.47 p 0.38).

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