Mathias Harrer,Antonia A Sprenger,Susan Illing,Marcel C Adriaanse,Steven M Albert,Esther Allart,Osvaldo P Almeida,Julian Basanovic,Kim M P van Bastelaar,Philip J Batterham,Harald Baumeister,Thomas Berger,Vanessa Blanco,Ragnhild Bø,Robin J Casten,Dicken Chan,Helen Christensen,Marketa Ciharova,Lorna Cook,John Cornell,Elysia P Davis,Keith S Dobson,Elsien Dozeman,Simon Gilbody,Benjamin L Hankin,Rimke Haringsma,Kristof Hoorelbeke,Michael R Irwin,Femke Jansen,Rune Jonassen,Eirini Karyotaki,Norito Kawakami,J Philipp Klein,Candace Konnert,Kotaro Imamura,Nils Inge Landrø,María Asunción Lara,Huynh-Nhu Le,Dirk Lehr,Juan V Luciano,Steffen Moritz,Jana M Mossey,Ricardo F Muñoz,Anna Muntingh,Stephanie Nobis,Richard Olmstead,Patricia Otero,Mirjana Pibernik-Okanović,Anne Margriet Pot,Charles F Reynolds,Barry W Rovner,Juan P Sanabria-Mazo,Lasse B Sander,Filip Smit,Frank J Snoek,Viola Spek,Philip Spinhoven,Liza Stelmach,Yannik Terhorst,Fernando L Vázquez,Irma Verdonck-de Leeuw,Ed Watkins,Wenhui Yang,Samuel Yeung Shan Wong,Johannes Zimmermann,Masatsugu Sakata,Toshi A Furukawa,Stefan Leucht,Pim Cuijpers,Claudia Buntrock,David Daniel Ebert
{"title":"Psychological intervention in individuals with subthreshold depression: individual participant data meta-analysis of treatment effects and moderators.","authors":"Mathias Harrer,Antonia A Sprenger,Susan Illing,Marcel C Adriaanse,Steven M Albert,Esther Allart,Osvaldo P Almeida,Julian Basanovic,Kim M P van Bastelaar,Philip J Batterham,Harald Baumeister,Thomas Berger,Vanessa Blanco,Ragnhild Bø,Robin J Casten,Dicken Chan,Helen Christensen,Marketa Ciharova,Lorna Cook,John Cornell,Elysia P Davis,Keith S Dobson,Elsien Dozeman,Simon Gilbody,Benjamin L Hankin,Rimke Haringsma,Kristof Hoorelbeke,Michael R Irwin,Femke Jansen,Rune Jonassen,Eirini Karyotaki,Norito Kawakami,J Philipp Klein,Candace Konnert,Kotaro Imamura,Nils Inge Landrø,María Asunción Lara,Huynh-Nhu Le,Dirk Lehr,Juan V Luciano,Steffen Moritz,Jana M Mossey,Ricardo F Muñoz,Anna Muntingh,Stephanie Nobis,Richard Olmstead,Patricia Otero,Mirjana Pibernik-Okanović,Anne Margriet Pot,Charles F Reynolds,Barry W Rovner,Juan P Sanabria-Mazo,Lasse B Sander,Filip Smit,Frank J Snoek,Viola Spek,Philip Spinhoven,Liza Stelmach,Yannik Terhorst,Fernando L Vázquez,Irma Verdonck-de Leeuw,Ed Watkins,Wenhui Yang,Samuel Yeung Shan Wong,Johannes Zimmermann,Masatsugu Sakata,Toshi A Furukawa,Stefan Leucht,Pim Cuijpers,Claudia Buntrock,David Daniel Ebert","doi":"10.1192/bjp.2025.56","DOIUrl":null,"url":null,"abstract":"BACKGROUND\r\nIt 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.\r\n\r\nAIMS\r\nTo synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.\r\n\r\nMETHOD\r\nRandomised 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.\r\n\r\nRESULTS\r\nIPD 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).\r\n\r\nCONCLUSIONS\r\nPsychological 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.","PeriodicalId":22495,"journal":{"name":"The British Journal of Psychiatry","volume":"91 1","pages":"1-14"},"PeriodicalIF":0.0000,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"The British Journal of Psychiatry","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1192/bjp.2025.56","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
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.
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