Life events and treatment prognosis for depression: A systematic review and individual patient data meta-analysis

Joshua E J Buckman*, Rob Saunders, Laura-Louise Arundell, Iyinoluwa D Oshinowo, Zachary D Cohen, Ciaran O'Driscoll, Phoebe Barnett, Joshua Stott, Gareth Ambler, Simon Gilbody, Steven D Hollon, Tony Kendrick, Edward Watkins, Thalia C Eley, Megan Skelton, Nicola Wiles, David Kessler, Robert J DeRubeis, Glyn Lewis, Stephen Pilling

*Corresponding author for this work

Research output: Contribution to journalReview article (Academic Journal)peer-review

7 Citations (Scopus)
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OBJECTIVE: To investigate associations between major life events and prognosis independent of treatment type: (1) after adjusting for clinical prognostic factors and socio-demographics; (2) amongst patients with depressive episodes at least six-months long; and (3) patients with a first life-time depressive episode.

METHODS: Six RCTs of adults seeking treatment for depression in primary care met eligibility criteria, individual patient data (IPD) were collated from all six (n = 2858). Participants were randomized to any treatment and completed the same baseline assessment of life events, demographics and clinical prognostic factors. Two-stage random effects meta-analyses were conducted.

RESULTS: Reporting any major life events was associated with poorer prognosis regardless of treatment type. Controlling for baseline clinical factors, socio-demographics and social support resulted in minimal residual evidence of associations between life events and treatment prognosis. However, removing factors that might mediate the relationships between life events and outcomes reporting: arguments/disputes, problem debt, violent crime, losing one's job, and three or more life events were associated with considerably worse prognoses (percentage difference in 3-4 months depressive symptoms compared to no reported life events =30.3%(95%CI: 18.4-43.3)).

CONCLUSIONS: Assessing for clinical prognostic factors, social support, and socio-demographics is likely to be more informative for prognosis than assessing self-reported recent major life events. However, clinicians might find it useful to ask about such events, and if they are still affecting the patient, consider interventions to tackle problems related to those events (e.g. employment support, mediation, or debt advice). Further investigations of the efficacy of such interventions will be important.

Original languageEnglish
Pages (from-to)298-308
Number of pages11
JournalJournal of Affective Disorders
Early online date14 Dec 2021
Publication statusPublished - 15 Feb 2022

Bibliographical note

Funding Information:
This research was funded by the Wellcome Trust [20129/Z/16/Z], the MQ Foundation (for ZC: MQDS16/72), the Higher Education Funding Council for England (RS, PB, l-LA, IO, C'OD, and SP), the National Institute of Health Research (NIHR), NIHR University College London Hospitals Biomedical Research Centre (RS, PB, l-LA, IO, and SP), University College London (GA, GL), University College London (SDH), University of Southampton (TK), University of Exeter (EW), and University of York (SG). NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (NW: The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care). Alzheimer's Society (grant code: 457 (AS-PG-18–013) for JS). National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London (TE and MS: The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health).

Publisher Copyright:
© 2021


  • Depression
  • Treatment outcome
  • Stressful life events
  • Individual patient data meta-analysis
  • Systematic review


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