Psychological intervention in individuals with subthreshold depression: individual participant data meta-analysis of treatment effects and moderators
The British Journal of Psychiatry, vol. 229, pp. 78–91
Abstract
Background 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. Aims To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers. Method 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. Results 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 ( P > 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). Conclusions 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.
Authors 71
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Mathias Harrer corresponding
Technical University of Munich · Vrije Universiteit Amsterdam
Affiliation as printed
Vrije Universiteit Amsterdam
Section for Evidence-Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of Medicine and Health, Technical University of Munich, Munich, Germany; and Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Otto-von-Guericke-Universität Magdeburg
Affiliation as printed
Otto-von-Guericke-University Magdeburg
Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
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Technical University of Munich
Affiliation as printed
Technical University of Munich
Section for Evidence-Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of Medicine and Health, Technical University of Munich, Munich, Germany
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Amsterdam Public Health · Vrije Universiteit Amsterdam
Affiliation as printed
Vrije Universiteit Amsterdam
Department of Health Sciences and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Affiliation as printed
University of Pittsburgh
Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Affiliation as printed
Allart Supervisie
Allart Supervisie, Nijmegen, The Netherlands
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The University of Western Australia · The University of Notre Dame Australia
Affiliation as printed
University of Notre Dame Australia
University of Western Australia
Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
Medical School, University of Western Australia, Western Australia, Australia
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The University of Western Australia · University of Exeter
Affiliation as printed
University of Exeter
University of Western Australia
Department of Psychology, University of Exeter, Exeter, UK
School of Psychological Science, University of Western Australia, Western Australia, Australia
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Amsterdam University Medical Centers
Affiliation as printed
Amsterdam University Medical Centre
Amsterdam University Medical Centre, Amsterdam, The Netherlands
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Australian National University
Affiliation as printed
The Australian National University
Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
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Affiliation as printed
Ulm University
Department of Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
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Affiliation as printed
University of Bern
Institute of Psychology, University of Bern, Bern, Switzerland
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Universidade de Santiago de Compostela
Affiliation as printed
University of Santiago de Compostela
Department of Evolutionary and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
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Affiliation as printed
University of Oslo
Department of Psychology, University of Oslo, Oslo, Norway
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Affiliation as printed
Sidney Kimmel Medical College of Thomas Jefferson University
Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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Chinese University of Hong Kong
Affiliation as printed
The Chinese University of Hong Kong
School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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Black Dog Institute · UNSW Sydney
Affiliation as printed
University of New South Wales
Black Dog Institute, Sydney, New South Wales, Australia and School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Amsterdam Public Health · Vrije Universiteit Amsterdam
Affiliation as printed
Vrije Universiteit Amsterdam
Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Affiliation as printed
University of Exeter
SMART Lab, Mood Disorders Centre, Department of Psychology, University of Exeter, Exeter, UK
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The University of Texas at San Antonio
Affiliation as printed
University of Texas at San Antonio
UT School of Public Health, University of Texas at San Antonio, San Antonio, TX, USA
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Affiliation as printed
University of Denver
Department of Psychology, University of Denver, Denver, CO, USA
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Affiliation as printed
University of Calgary
Department of Psychology, University of Calgary, Calgary, Alberta, Canada
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Affiliation as printed
Specialized Mental Health Care
GGZ inGeest, Specialized Mental Health Care, Amsterdam, The Netherlands
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Affiliation as printed
University of York
York Mental Health & Addictions Research Group (MHARG), University of York, York, UK
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University of Illinois Urbana-Champaign
Affiliation as printed
University of Illinois Urbana-Champaign
Department of Psychology, University of Illinois Urbana-Champaign, Champaign, IL, USA
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Rimke Haringsma Aachen Division of Clinical and Health Psychology Faculty of Social and Behavioral Sciences
Affiliation as printed
Leiden University
Division of Clinical and Health Psychology, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, The Netherlands
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Affiliation as printed
University of Ghent
Department of Experimental Clinical and Health Psychology, University of Ghent, Ghent, Belgium
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University of California, Los Angeles · University of California System
Affiliation as printed
David Geffen School of Medicine, University of California
University of California
Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Vrije Universiteit Amsterdam
Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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OsloMet – Oslo Metropolitan University
Affiliation as printed
Oslo Metropolitan University
Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Amsterdam Public Health · Vrije Universiteit Amsterdam
Affiliation as printed
Vrije Universiteit Amsterdam
Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Affiliation as printed
The University of Tokyo
Department of Digital Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Affiliation as printed
University of Lübeck
Centre for Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
Department of Psychiatry, Psychosomatics and Psychotherapy, University of Lübeck, Lübeck, Germany
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Affiliation as printed
University of Calgary
Department of Psychology, University of Calgary, Calgary, Alberta, Canada
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Affiliation as printed
The University of Tokyo
Department of Digital Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Affiliation as printed
University of Oslo
Department of Psychology, University of Oslo, Oslo, Norway
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Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz
Affiliation as printed
Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz
Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
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Affiliation as printed
George Washington University
Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
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Leuphana University of Lüneburg
Affiliation as printed
Leuphana University Lueneburg
Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University Lueneburg, Lueneburg, Germany
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Universitat Autònoma de Barcelona · Centro de Investigación Biomédica en Red · Parc Sanitari Sant Joan de Déu · Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública
Affiliation as printed
Parc Sanitari Sant Joan de Déu, St Boi de Llobregat, Spain; and CIBER of Epidemiology and Public Health (CIBERESP)
Universitat Autònoma de Barcelona
Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
Parc Sanitari Sant Joan de Déu, St Boi de Llobregat, Spain; and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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University Medical Center Hamburg-Eppendorf
Affiliation as printed
University Medical Centre Hamburg-Eppendorf
Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Affiliation as printed
Drexel University
Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA, USA
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Palo Alto University · University of California, San Francisco
Affiliation as printed
Palo Alto University
University of California
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
Department of Psychology, Palo Alto University, Palo Alto, CA, USA
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Amsterdam Public Health · GGZ inGeest · Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Amsterdam Public Health
Amsterdam UMC location Vrije Universiteit Amsterdam
GGZ inGeest Mental Health Care
Department for Anxiety and Depression, GGZ inGeest Mental Health Care, Amsterdam, The Netherlands
Department of Psychiatry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Mental Health Programme, Amsterdam Public Health, Amsterdam, The Netherlands
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Affiliation as printed
Klinikum Osnabrück
Klinikum Osnabrück, Osnabrück, Germany
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University of California, Los Angeles · University of California System
Affiliation as printed
David Geffen School of Medicine, University of California
University of California
Cousins Center for Psychoneuroimmunology, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Affiliation as printed
University of La Coruña
Department of Psychology, University of La Coruña, La Coruña, Spain
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Affiliation as printed
Merkur University Hospital
Vuk Vrhovac University Clinic for Diabetes, Merkur University Hospital, Zagreb, Croatia
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Affiliation as printed
Erasmus University of Rotterdam
Erasmus School of Health Policy and Management, Erasmus University of Rotterdam, Rotterdam, The Netherlands
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Affiliation as printed
University of Pittsburgh School of Medicine
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Affiliation as printed
Sidney Kimmel Medical College of Thomas Jefferson University
Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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Centro de Investigación Biomédica en Red · Parc Sanitari Sant Joan de Déu · Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública
Affiliation as printed
Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; and CIBER of Epidemiology and Public Health (CIBERESP)
Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; and CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Affiliation as printed
University of Freiburg
Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Trimbos Institute · Amsterdam University Medical Centers
Affiliation as printed
Amsterdam University Medical Centre
Trimbos Institute
Department of Epidemiology and Biostatistics, Amsterdam University Medical Centre, Amsterdam, The Netherlands
Department of Mental Health and Prevention, Trimbos Institute, Utrecht, The Netherlands
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Amsterdam Public Health · Amsterdam University Medical Centers
Affiliation as printed
Amsterdam Public Health
Amsterdam University Medical Centres, Amsterdam Public Health, Amsterdam, The Netherlands
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Fontys University of Applied Sciences
Affiliation as printed
Fontys University of Applied Sciences
Fontys University of Applied Sciences, Eindhoven, The Netherlands
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Philip Spinhoven Aachen Institute of Psychology, Leiden University Department of Clinical Psychology
Affiliation as printed
Institute of Psychology, Leiden University
Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
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Affiliation as printed
Carewest
Carewest, Calgary, Alberta, Canada
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Deutsches Zentrum für Psychische Gesundheit · Ludwig-Maximilians-Universität München
Affiliation as printed
Ludwig Maximilian University of Munich
Partner-Site Munich-Augsburg
Department of Psychology, Ludwig Maximilian University of Munich, Munich, Germany
German Centre for Mental Health (DZPG), Partner-Site Munich-Augsburg, Munich, Germany
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Universidade de Santiago de Compostela
Affiliation as printed
University of Santiago de Compostela
Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
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Amsterdam University Medical Centers · Vrije Universiteit Amsterdam
Affiliation as printed
Vrije Universiteit Amsterdam
Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Affiliation as printed
University of Exeter
SMART Lab, Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, UK
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Affiliation as printed
Hunan Normal University
Department of Psychology, Hunan Normal University, Changsha, China
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Chinese University of Hong Kong
Affiliation as printed
The Chinese University of Hong Kong
Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Affiliation as printed
University of Kassel
Department of Psychology, University of Kassel, Kassel, Germany
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Kyoto University · Nagoya City University
Affiliation as printed
Kyoto University Graduate School of Medicine/School of Public Health
Nagoya City University Graduate School of Medical Sciences
Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
Department of Neurodevelopmental Disorders, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Affiliation as printed
Kyoto University Office of Institutional Advancement and Communications
Kyoto University Office of Institutional Advancement and Communications, Kyoto, Japan
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Technical University of Munich
Affiliation as printed
Technical University of Munich
Section for Evidence-Based Medicine in Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, School of Medicine and Health, Technical University of Munich, Munich, Germany
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Amsterdam Public Health · Vrije Universiteit Amsterdam
Affiliation as printed
Vrije Universiteit Amsterdam
Department of Clinical, Neuro- and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Otto-von-Guericke-Universität Magdeburg
Affiliation as printed
Otto-von-Guericke-University Magdeburg
Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
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Technical University of Munich
Affiliation as printed
Technical University of Munich
Psychology and Digital Mental Health Care, School of Medicine and Health, Technical University of Munich, Munich, Germany
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