Introduction
Methods
Search strategy and selection criteria
Quality assessment and data extraction
Outcome measures
Meta-analyses
Results
Selection and inclusion of studies
Characteristics of included studies
Study | A/C | Clin | Diag | Mage | Prop wom | Type | Frm | Nse | Ctr | Outcome | FU | Cou | sg | ac | ba | itt | rob |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Ackerson 1998 | A | – | CO | 16.0 | 0.64 | cbt | oth | 4 | wl | HAMD | 2 (±1) | US | – | – | – | – | 0 |
Bolton 2007 | A | – | CO | 15.0 | 0.57 | ipt | grp | 16 | oth | depr scale | 4–6 | Oth | + | – | + | + | 3 |
Charkandeh 2016 | A | + | DD | 15.3 | 0.54 | cbt | ind | 24 | wl | CDI | 2 (±1) | Oth | + | – | sr | – | 2 |
Clarke 1995 | A | – | SD | 15.3 | 0.61 | cbt | grp | 15 | cau | HAMD | 2 (±1) | US | – | – | – | – | 0 |
Clarke 1999-cwd | A | – | DD | 16.2 | 0.71 | cbt | grp | 16 | wl | HAMD | 2 (±1) | US | – | – | + | – | 1 |
Clarke 1999-cwd+p | cbt | grp | 16 | HAMD | |||||||||||||
Clarke 2001 | A | – | SD | 14.6 | 0.64 | cbt | grp | 15 | cau | HAMD | 2 (±1) | US | + | + | + | – | 3 |
Clarke 2002 | A | – | DD | 15.3 | 0.69 | cbt | grp | 16 | cau | HAMD | 2 (±1) | US | – | – | + | + | 2 |
De Cuyper 2004 | C | – | SD | 10.0 | 0.75 | cbt | grp | 16 | wl | CDI | 4-6 | EU | – | – | sr | – | 1 |
De Jonge-Heesen 2020 | A | – | CO | 13.6 | 0.64 | cbt | grp | 8 | oth | CDI-A | 2 (±1) | EU | + | + | sr | + | 4 |
Diamond 2002 | A | – | DD | 14.9 | 0.78 | oth | ind | 8 | wl | BDI | 2 (±1) | US | – | – | + | – | 1 |
Esposito-Smythers 2019 | A | + | DD | 14.9 | 0.76 | cbt | Oth | 41 | cau | CDI-II | 4-6 | US | + | + | sr | + | 4 |
Gillham 2006 | C | – | SD | 11.5 | 0.53 | cbt | grp | 12 | cau | CDI | 4-6 | US | + | – | – | + | 2 |
Idsoe 2019 | A | – | CO | 16.7 | 0.88 | cbt | grp | 8 | cau | CESD | 4-6 | EU | – | + | sr | + | 3 |
Israel 2013 | A | + | DD | 15.6 | 0.55 | oth | ind | 11 | cau | HAMD | 2 (±1) | EU | + | + | + | + | 4 |
Kahn. 1990-cbt | C | – | DD | 12.1 | 0.51 | cbt | grp | 12 | wl | CDI | 2 (±1) | US | – | – | – | + | 1 |
Kahn 1990-other | oth | ind | 12 | wl | CDI | ||||||||||||
Kitchen 2020 | A | + | DD | 15.7 | 0.82 | bat | ind | 8 | cau | MFQ-C | 2 (±1) | UK | + | + | sr | – | 3 |
Lewinsohn 1990-cwd | A | – | DD | 16.2 | 0.61 | cbt | grp | 14 | wl | BDI | 2 (±1) | US | – | – | sr | – | 1 |
Lewinsohn 1990-cwd/p | cbt | grp | 14 | wl | BDI | ||||||||||||
Liddle 1990 | C | – | CO | 9.2 | 0.32 | cbt | grp | 8 | wl | CDI | 2 (±1) | Oth | – | – | sr | + | 2 |
Listug-Lunde 2013 | C | – | CO | 12.4 | 0.38 | cbt | grp | 13 | cau | CDI | 2 (±1) | US | – | – | sr | – | 1 |
Luby 2012 | C | – | DD | 4.3 | 0.37 | oth | ind | 14 | oth | BDI-II | 2 (±1) | US | + | – | + | + | 3 |
Martinovic 2006 | A | + | SD | 17.4 | 0.68 | cbt | grp | 6 | cau | HAMD | 4-6 | EU | + | – | + | + | 3 |
McCarty 2013 | C | – | CO | 12.7 | 0.60 | cbt | grp | 12 | oth | MFQ C | 4-6 | US | + | + | + | + | 4 |
Moeini 2019 | A | – | CO | 16.4 | 1.00 | oth | Oth | 8 | cau | CESD | 2 (±1) | Oth | – | – | sr | + | 2 |
Mufson 1999 | A | + | DD | 15.8 | 0.73 | ipt | ind | 12 | oth | HAMD | 2 (±1) | US | + | – | + | + | 3 |
Mufson 2004 | A | + | DD | 15.1 | 0.84 | ipt | ind | 12 | cau | HAMD | 4-6 | US | + | – | + | + | 3 |
Reynolds 1986 | A | – | CO | 15.7 | 0.63 | cbt | grp | 10 | wl | BDI | 2 (±1) | US | – | – | – | – | 0 |
Rohde 2004 | A | – | DD | 15.1 | 0.48 | cbt | grp | 16 | oth | HAMD | 2 (±1) | US | + | – | + | + | 3 |
Rosello 1999-CBT | A | – | DD | 14.7 | 0.54 | cbt | Oth | 12 | wl | CDI | 2 (±1) | US | – | – | + | + | 2 |
Rosello 1999-IPT | ipt | Oth | 12 | wl | CDI | ||||||||||||
Santomauro 2016 | A | – | CO | 15.7 | 0.40 | cbt | grp | 11 | wl | DASS | 2 (±1) | Oth | + | – | sr | + | 3 |
Stark 1987-pst | C | – | CO | 11.2 | 0.43 | oth | grp | 12 | wl | CDRS-R | 2 (±1) | US | – | – | + | – | 1 |
Stark 1987-selfcontrol | pst | grp | 12 | wl | CDRS-R | ||||||||||||
Stice 2008-cbt | A | – | SD | 15.6 | 0.56 | cbt | grp | 4 | cau | CDI | 2 (±1) | US | + | + | + | + | 4 |
Stice 2008-supp-expr | sup | grp | 4 | cau | CDI | ||||||||||||
Szigethy 2007 | A | – | SD | 15.0 | 0.51 | cbt | ind | 10 | cau | CDI-CP | 2 (±1) | US | – | – | + | + | 2 |
TADS 2004 | A | – | DD | 14.6 | 0.54 | cbt | ind | 15 | oth | CDRS-C | 2 (±1) | US | + | + | + | + | 4 |
Topooco 2019 | A | – | CO | 17.5 | 0.96 | cbt | Oth | 8 | oth | BDIII | 2 (±1) | EU | + | + | sr | + | 4 |
Vostanis 1996a | C | + | DD | 12.7 | 0.56 | cbt | ind | 9 | oth | MFQ C | 2 (±1) | UK | – | – | + | – | 1 |
Weisz 1997 | C | – | CO | 9.6 | 0.46 | cbt | grp | 8 | cau | CDRS-R | 2 (±1) | US | – | – | + | – | 1 |
Wright 2020 | A | + | CO | 15.0 | 0.64 | cbt | Oth | 8 | oth | BDI | 2 (±1) | UK | + | + | sr | + | 4 |
Young 2006 | A | – | CO | 13.4 | 0.85 | ipt | Oth | 10 | oth | CESD | 2 (±1) | US | + | – | + | + | 3 |
Young 2016 | A | – | CO | 14.6 | 0.60 | ipt | Oth | 10 | oth | CESD | 2 (±1) | US | + | – | + | + | 3 |
Yu 2002 | C | – | CO | 11.8 | 0.45 | cbt | grp | 10 | cau | CDI | 2 (±1) | Oth | – | – | sr | – | 1 |
Response rates in psychotherapy and control conditions at 2 (±1) months after baseline
Psychotherapy | Control groups | ||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
N | Rate | 95% CI | I2 | 95% CI | N | Rate | 95% CI | I2 | 95% CI | N | RR | 95% CI | I2 | 95% CI | NNT | 95% CI | |||
All psychotherapies | 38 | 0.39 | 0.34–0.45 | 75 | 66–82 | 32 | 0.24 | 0.19–0.28 | 59 | 40–72 | 38 | 1.67 | 1.42–1.96 | 17 | 0–45 | 6.2 | 4.3–9.9 | ||
Completers only | 38 | 0.43 | 0.37–0.49 | 74 | 65–81 | 32 | 0.25 | 0.21–0.30 | 56 | 35–70 | 38 | 1.68 | 1.45–1.95 | 2 | 0–39 | 5.9 | 4.2–8.9 | ||
All drop-outs responders | 38 | 0.47 | 0.40–0.53 | 78 | 70–84 | 32 | 0.30 | 0.25–0.36 | 66 | 51–77 | 38 | 1.54 | 1.36–1.75 | 0 | 0–37 | 6.2 | 4.4–9.3 | ||
Outliers excluded | 32 | 0.40 | 0.36–0.45 | 49 | 22–66 | 30 | 0.24 | 0.21–0.29 | 42 | 10–63 | 37 | 1.72 | 1.47–2.01 | 4 | 0–32 | 5.8 | 4.1–8.9 | ||
Only low Risk of Bias | 7 | 0.28 | 0.18–0.42 | 87 | 75–93 | 6 | 0.16 | 0.11–0.23 | 57 | 0–83 | 7 | 1.56 | 1.03–2.37 | 12 | 0–74 | 11.2 | 4.6–208.3 | ||
Adjusted for publication bias | 38 | 0.39 | 0.34–0.45 | 75 | 66–82 | 42 | 0.29 | 0.23–0.34 | 69 | 58–78 | 50 | 1.43 | 1.17–1.75 | 33 | 4–53 | 8.0 | 4.6–20.3 | ||
Long-term outcomes | |||||||||||||||||||
Longer therapies (4–6 months) | 7 | 0.29 | 0.21–0.39 | 74 | 45–88 | 7 | 0.19 | 0.14–0.25 | 47 | 0–78 | 7 | 1.52 | 0.99–2.32 | 28 | 0–69 | 10.1 | n.s. | ||
Follow-up at 6–12 months | 12 | 0.44 | 0.37–0.51 | 64 | 34–81 | 11 | 0.33 | 0.24–0.43 | 80 | 64–88 | 12 | 1.39 | 1.11–1.74 | 44 | 0–72 | 7.8 | 4.1–27.5 | ||
Follow-up at 13–24 months | 9 | 0.39 | 0.29–0.49 | 85 | 74–92 | 8 | 0.38 | 0.24–0.54 | 91 | 85–95 | 9 | 1.02 | 0.84–1.24 | 30 | 0–67 | 131.6 | n.s. | ||
Reliable improvement | 38 | 0.54 | 0.46–0.62 | 85 | 81–89 | 32 | 0.32 | 0.26–0.39 | 78 | 69–84 | 38 | 1.59 | 1.35–1.88 | 69 | 56–78 | 5.3 | 3.6–8.9 | ||
Reliable deterioration | 38 | 0.06 | 0.05–0.08 | 0 | 0–35 | 32 | 0.13 | 0.11–0.16 | 14 | 0–44 | 38 | 0.40 | 0.28–0.57 | 0 | 0–0 | 12.8 | 10.7–17.9 | ||
Recovery | 8 | 0.58 | 0.49–0.67 | 52 | 0–79 | 6 | 0.36 | 0.22–0.54 | 76 | 45–89 | 8 | 1.84 | 0.99–3.44 | 45 | 0–75 | 3.3 | n.s. |
Other outcomes
Psychotherapy | Control groups | |||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
N | Rate | 95% CI | I2 | 95% CI | N | Rate | 95% CI | I2 | 95% CI | N | RR | 95% CI | I2 | 95% CI | NNT | 95% CI | ||||
Adolescents | 28 | 0.41 | 0.34–0.48 | 80 | 71–86 | 24 | 0.24 | 0.19–0.30 | 64 | 45–77 | 28 | 1.68 | 1.38–2.04 | 28 | 0–55 | 6.1 | 4.0–11.0 | |||
Children | 10 | 0.35 | 0.26–0.45 | 44 | 0–73 | 8 | 0.22 | 0.15–0.31 | 35 | 0–71 | 10 | 1.65 | 1.18–2.32 | 0 | 0–51 | 7.0 | 3.4–25.3 | |||
Only clinical samples | 6 | 0.31 | 0.17–0.50 | 81 | 60–91 | 6 | 0.19 | 0.08–0.38 | 70 | 30–87 | 6 | 1.93 | 0.68–5.49 | 0 | 0–74 | 5.7 | n.s. | |||
Other recruitment | 32 | 0.41 | 0.35–0.47 | 73 | 62–81 | 26 | 0.24 | 0.20–0.29 | 58 | 35–73 | 32 | 1.65 | 1.40–1.94 | 22 | 0–50 | 6.4 | 4.4–10.4 | |||
Depressive disorder | 18 | 0.43 | 0.33–0.54 | 80 | 69–87 | 14 | 0.23 | 0.15–0.33 | 72 | 52–84 | 18 | 1.87 | 1.44–2.43 | 23 | 0–56 | 5.0 | 3.0–9.9 | |||
Subthreshold depression | 5 | 0.40 | 0.33–0.49 | 53 | 0–83 | 4 | 0.32 | 0.25–0.40 | 29 | 0–74 | 5 | 1.34 | 0.85–2.11 | 54 | 0–83 | 9.2 | n.s | |||
Cut-off | 15 | 0.34 | 0.25–0.43 | 70 | 49–82 | 14 | 0.21 | 0.17–0.26 | 25 | 0–60 | 15 | 1.64 | 1.25–2.15 | 0 | 0–44 | 7.4 | 4.1–19.0 | |||
CBT | 25 | 0.39 | 0.31–0.46 | 79 | 70–86 | 23 | 0.23 | 0.18–0.29 | 67 | 50–79 | 25 | 1.64 | 1.30–2.07 | 36 | 0–61 | 6.8 | 4.1–14.5 | |||
IPT | 4 | 0.59 | 0.36–0.79 | 84 | 60–94 | 3 | 0.32 | 0.24–0.40 | 0 | 0–68 | 4 | 1.72 | 1.10–2.70 | 0 | 0–83 | 4.3 | 1.8–31.3 | |||
Other | 9 | 0.35 | 0.28–0.42 | 18 | 0–60 | 6 | 0.23 | 0.16–0.31 | 0 | 0–73 | 9 | 1.72 | 1.29–2.28 | 0 | 0–16 | 6.0 | 3.4–15.0 | |||
Individual | 10 | 0.37 | 0.23–0.53 | 84 | 72–91 | 9 | 0.21 | 0.11–0.35 | 71 | 42–85 | 10 | 1.83 | 1.20–2.79 | 0 | 0–49 | 5.7 | 2.7–23.8 | |||
Group | 20 | 0.41 | 0.34–0.48 | 67 | 47–79 | 16 | 0.26 | 0.20–0.32 | 58 | 26–76 | 20 | 1.55 | 1.23–1.95 | 35 | 0–62 | 7.0 | 4.0–16.7 | |||
Guided self-help/other | 8 | 0.41 | 0.29–0.54 | 79 | 59–89 | 7 | 0.22 | 0.16–0.30 | 42 | 0–76 | 8 | 1.81 | 1.21–2.71 | 2 | 0–68 | 5.6 | 2.7–21.6 | |||
Low | 7 | 0.28 | 0.18–0.42 | 87 | 75–93 | 6 | 0.16 | 0.11–0.23 | 57 | 0–83 | 7 | 1.56 | 1.03–2.37 | 12 | 0–74 | 11.2 | 4.6–208.3 | |||
Other | 31 | 0.43 | 0.37–0.49 | 67 | 52–78 | 26 | 0.27 | 0.22–0.32 | 48 | 18–67 | 31 | 1.70 | 1.41–2.05 | 20 | 0–49 | 5.3 | 3.5–9.0 | |||
Waiting list | 16 | 0.42 | 0.33–0.53 | 65 | 41–80 | 11 | 0.20 | 0.12–0.31 | 36 | 0–68 | 16 | 2.21 | 1.60–3.04 | 0 | 0–48 | 4.1 | 2.5–8.3 | |||
Usual care | 12 | 0.37 | 0.31–0.44 | 49 | 1–74 | 11 | 0.28 | 0.22–0.36 | 60 | 22–79 | 12 | 1.34 | 1.07–1.68 | 6 | 0–61 | 10.5 | 5.3–51.0 | |||
Other | 10 | 0.40 | 0.27–0.56 | 89 | 82–93 | 10 | 0.22 | 0.16–0.29 | 68 | 39–84 | 10 | 1.66 | 1.23–2.23 | 29 | 0–66 | 6.5 | 3.7–19.8 |