The contribution of depressive 'disorder characteristics' to determinations of prognosis for adults with depression: an individual patient data meta-analysis

Joshua E J Buckman; Rob Saunders; Zachary D Cohen; Phoebe Barnett; Katherine Clarke; Gareth Ambler; Robert J DeRubeis; Simon Gilbody; Steven D Hollon; Tony Kendrick; Edward Watkins; Nicola Wiles; David Kessler; David Richards; Deborah Sharp; Sally Brabyn; Elizabeth Littlewood; Chris Salisbury; Ian R White; Glyn Lewis; Stephen Pilling

doi:10.1017/S0033291721001367

The contribution of depressive 'disorder characteristics' to determinations of prognosis for adults with depression: an individual patient data meta-analysis

Joshua E J Buckman, Rob Saunders, Zachary D Cohen, Phoebe Barnett, Katherine Clarke, Gareth Ambler, Robert J DeRubeis, Simon Gilbody, Steven D Hollon, Tony Kendrick, Edward Watkins, Nicola Wiles, David Kessler, David Richards, Deborah Sharp, Sally Brabyn, Elizabeth Littlewood, Chris Salisbury, Ian R White, Glyn LewisStephen Pilling

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Abstract

BACKGROUND: This study aimed to investigate general factors associated with prognosis regardless of the type of treatment received, for adults with depression in primary care.

METHODS: We searched Medline, Embase, PsycINFO and Cochrane Central (inception to 12/01/2020) for RCTs that included the most commonly used comprehensive measure of depressive and anxiety disorder symptoms and diagnoses, in primary care depression RCTs (the Revised Clinical Interview Schedule: CIS-R). Two-stage random-effects meta-analyses were conducted.

RESULTS: Twelve (n = 6024) of thirteen eligible studies (n = 6175) provided individual patient data. There was a 31% (95%CI: 25 to 37) difference in depressive symptoms at 3-4 months per standard deviation increase in baseline depressive symptoms. Four additional factors: the duration of anxiety; duration of depression; comorbid panic disorder; and a history of antidepressant treatment were also independently associated with poorer prognosis. There was evidence that the difference in prognosis when these factors were combined could be of clinical importance. Adding these variables improved the amount of variance explained in 3-4 month depressive symptoms from 16% using depressive symptom severity alone to 27%. Risk of bias (assessed with QUIPS) was low in all studies and quality (assessed with GRADE) was high. Sensitivity analyses did not alter our conclusions.

CONCLUSIONS: When adults seek treatment for depression clinicians should routinely assess for the duration of anxiety, duration of depression, comorbid panic disorder, and a history of antidepressant treatment alongside depressive symptom severity. This could provide clinicians and patients with useful and desired information to elucidate prognosis and aid the clinical management of depression.

Original language	English
Pages (from-to)	1068-1081
Number of pages	14
Journal	Psychological Medicine
Volume	51
Issue number	7
Early online date	14 Apr 2021
DOIs	https://doi.org/10.1017/S0033291721001367
Publication status	Published - May 2021

Bibliographical note

Funding Information:
This study was supported by the Wellcome Trust through a Clinical Research Fellowship to JB (201292/Z/16/Z), Medical Research Council (Programme for IW: MC-UU-12023/21), MQ Foundation (for ZC: MQDS16/72), the Higher Education Funding Council for England, the National Institute of Health Research (NIHR), NIHR University College London Hospitals Biomedical Research Centre (RS, KC, PB and SP), NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (NW and DK), University College London (GA and GL), University of Pennsylvania (RDR), Vanderbilt University (SDH), University of Southampton (TK), University of Exeter (EW) and University of York (SG). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
The studies that make up the Dep-GP IPD database were funded by:

1. AHEAD: Health Technology Assessment programme of the National Health Service Research and Development Directorate.

2. CADET: UK Medical Research Council (MRC; reference G0701013), managed by the National Institute for Health Research (NIHR) on behalf of the MRC-NIHR partnership.

3. COBALT: The National Institute for Health Research Health Technology Assessment (NIHR HTA) programme (project number 06/404/02).

4. GENPOD: Medical Research Council and supported by the Mental Health Research Network.

5. HEALTHLINES: NIHR under its Programme Grant for Applied Research (Grant Reference Number RP-PG-0108-10011).

6. IPCRESS: BUPA Foundation.

7. ITAS: Primary Secondary Care Interface initiative of the United Kingdom National Health Service Research and Development Programme (PSI 2-58).

8. MIR: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (project 11/129/76) and supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol.

9. PANDA: NIHR Programme Grant for Applied Research (RP-PG-0610-10048).

10. REEACT: UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (project 06/43/05).

11. RESPOND: HTA programme as project number 02/07/04.

12. TREAD: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme.

The funders of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. All authors were fully independent of their respective funders and had responsibility for the decision to submit for this manuscript for publication.

Keywords

depression
individual patient data meta-analysis
prognosis
systematic review
treatment outcome

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Buckman, J. E. J., Saunders, R., Cohen, Z. D., Barnett, P., Clarke, K., Ambler, G., DeRubeis, R. J., Gilbody, S., Hollon, S. D., Kendrick, T., Watkins, E., Wiles, N., Kessler, D., Richards, D., Sharp, D., Brabyn, S., Littlewood, E., Salisbury, C., White, I. R., ... Pilling, S. (2021). The contribution of depressive 'disorder characteristics' to determinations of prognosis for adults with depression: an individual patient data meta-analysis. Psychological Medicine, 51(7), 1068-1081. https://doi.org/10.1017/S0033291721001367

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title = "The contribution of depressive 'disorder characteristics' to determinations of prognosis for adults with depression: an individual patient data meta-analysis",

abstract = "BACKGROUND: This study aimed to investigate general factors associated with prognosis regardless of the type of treatment received, for adults with depression in primary care.METHODS: We searched Medline, Embase, PsycINFO and Cochrane Central (inception to 12/01/2020) for RCTs that included the most commonly used comprehensive measure of depressive and anxiety disorder symptoms and diagnoses, in primary care depression RCTs (the Revised Clinical Interview Schedule: CIS-R). Two-stage random-effects meta-analyses were conducted.RESULTS: Twelve (n = 6024) of thirteen eligible studies (n = 6175) provided individual patient data. There was a 31% (95%CI: 25 to 37) difference in depressive symptoms at 3-4 months per standard deviation increase in baseline depressive symptoms. Four additional factors: the duration of anxiety; duration of depression; comorbid panic disorder; and a history of antidepressant treatment were also independently associated with poorer prognosis. There was evidence that the difference in prognosis when these factors were combined could be of clinical importance. Adding these variables improved the amount of variance explained in 3-4 month depressive symptoms from 16% using depressive symptom severity alone to 27%. Risk of bias (assessed with QUIPS) was low in all studies and quality (assessed with GRADE) was high. Sensitivity analyses did not alter our conclusions.CONCLUSIONS: When adults seek treatment for depression clinicians should routinely assess for the duration of anxiety, duration of depression, comorbid panic disorder, and a history of antidepressant treatment alongside depressive symptom severity. This could provide clinicians and patients with useful and desired information to elucidate prognosis and aid the clinical management of depression.",

keywords = "depression, individual patient data meta-analysis, prognosis, systematic review, treatment outcome",

author = "Buckman, {Joshua E J} and Rob Saunders and Cohen, {Zachary D} and Phoebe Barnett and Katherine Clarke and Gareth Ambler and DeRubeis, {Robert J} and Simon Gilbody and Hollon, {Steven D} and Tony Kendrick and Edward Watkins and Nicola Wiles and David Kessler and David Richards and Deborah Sharp and Sally Brabyn and Elizabeth Littlewood and Chris Salisbury and White, {Ian R} and Glyn Lewis and Stephen Pilling",

note = "Funding Information: This study was supported by the Wellcome Trust through a Clinical Research Fellowship to JB (201292/Z/16/Z), Medical Research Council (Programme for IW: MC-UU-12023/21), MQ Foundation (for ZC: MQDS16/72), the Higher Education Funding Council for England, the National Institute of Health Research (NIHR), NIHR University College London Hospitals Biomedical Research Centre (RS, KC, PB and SP), NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (NW and DK), University College London (GA and GL), University of Pennsylvania (RDR), Vanderbilt University (SDH), University of Southampton (TK), University of Exeter (EW) and University of York (SG). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The studies that make up the Dep-GP IPD database were funded by: 1. AHEAD: Health Technology Assessment programme of the National Health Service Research and Development Directorate. 2. CADET: UK Medical Research Council (MRC; reference G0701013), managed by the National Institute for Health Research (NIHR) on behalf of the MRC-NIHR partnership. 3. COBALT: The National Institute for Health Research Health Technology Assessment (NIHR HTA) programme (project number 06/404/02). 4. GENPOD: Medical Research Council and supported by the Mental Health Research Network. 5. HEALTHLINES: NIHR under its Programme Grant for Applied Research (Grant Reference Number RP-PG-0108-10011). 6. IPCRESS: BUPA Foundation. 7. ITAS: Primary Secondary Care Interface initiative of the United Kingdom National Health Service Research and Development Programme (PSI 2-58). 8. MIR: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (project 11/129/76) and supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol. 9. PANDA: NIHR Programme Grant for Applied Research (RP-PG-0610-10048). 10. REEACT: UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (project 06/43/05). 11. RESPOND: HTA programme as project number 02/07/04. 12. TREAD: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme. The funders of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. All authors were fully independent of their respective funders and had responsibility for the decision to submit for this manuscript for publication.",

year = "2021",

month = may,

doi = "10.1017/S0033291721001367",

language = "English",

volume = "51",

pages = "1068--1081",

journal = "Psychological Medicine",

issn = "0033-2917",

publisher = "Cambridge University Press",

number = "7",

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Buckman, JEJ, Saunders, R, Cohen, ZD, Barnett, P, Clarke, K, Ambler, G, DeRubeis, RJ, Gilbody, S, Hollon, SD, Kendrick, T, Watkins, E, Wiles, N , Kessler, D, Richards, D, Sharp, D, Brabyn, S, Littlewood, E, Salisbury, C, White, IR, Lewis, G & Pilling, S 2021, 'The contribution of depressive 'disorder characteristics' to determinations of prognosis for adults with depression: an individual patient data meta-analysis', Psychological Medicine, vol. 51, no. 7, pp. 1068-1081. https://doi.org/10.1017/S0033291721001367

The contribution of depressive 'disorder characteristics' to determinations of prognosis for adults with depression: an individual patient data meta-analysis. / Buckman, Joshua E J; Saunders, Rob; Cohen, Zachary D et al.
In: Psychological Medicine, Vol. 51, No. 7, 05.2021, p. 1068-1081.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - The contribution of depressive 'disorder characteristics' to determinations of prognosis for adults with depression

T2 - an individual patient data meta-analysis

AU - Buckman, Joshua E J

AU - Saunders, Rob

AU - Cohen, Zachary D

AU - Barnett, Phoebe

AU - Clarke, Katherine

AU - Ambler, Gareth

AU - DeRubeis, Robert J

AU - Gilbody, Simon

AU - Hollon, Steven D

AU - Kendrick, Tony

AU - Watkins, Edward

AU - Wiles, Nicola

AU - Kessler, David

AU - Richards, David

AU - Sharp, Deborah

AU - Brabyn, Sally

AU - Littlewood, Elizabeth

AU - Salisbury, Chris

AU - White, Ian R

AU - Lewis, Glyn

AU - Pilling, Stephen

N1 - Funding Information: This study was supported by the Wellcome Trust through a Clinical Research Fellowship to JB (201292/Z/16/Z), Medical Research Council (Programme for IW: MC-UU-12023/21), MQ Foundation (for ZC: MQDS16/72), the Higher Education Funding Council for England, the National Institute of Health Research (NIHR), NIHR University College London Hospitals Biomedical Research Centre (RS, KC, PB and SP), NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (NW and DK), University College London (GA and GL), University of Pennsylvania (RDR), Vanderbilt University (SDH), University of Southampton (TK), University of Exeter (EW) and University of York (SG). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The studies that make up the Dep-GP IPD database were funded by: 1. AHEAD: Health Technology Assessment programme of the National Health Service Research and Development Directorate. 2. CADET: UK Medical Research Council (MRC; reference G0701013), managed by the National Institute for Health Research (NIHR) on behalf of the MRC-NIHR partnership. 3. COBALT: The National Institute for Health Research Health Technology Assessment (NIHR HTA) programme (project number 06/404/02). 4. GENPOD: Medical Research Council and supported by the Mental Health Research Network. 5. HEALTHLINES: NIHR under its Programme Grant for Applied Research (Grant Reference Number RP-PG-0108-10011). 6. IPCRESS: BUPA Foundation. 7. ITAS: Primary Secondary Care Interface initiative of the United Kingdom National Health Service Research and Development Programme (PSI 2-58). 8. MIR: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (project 11/129/76) and supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol. 9. PANDA: NIHR Programme Grant for Applied Research (RP-PG-0610-10048). 10. REEACT: UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (project 06/43/05). 11. RESPOND: HTA programme as project number 02/07/04. 12. TREAD: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme. The funders of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. All authors were fully independent of their respective funders and had responsibility for the decision to submit for this manuscript for publication.

PY - 2021/5

Y1 - 2021/5

N2 - BACKGROUND: This study aimed to investigate general factors associated with prognosis regardless of the type of treatment received, for adults with depression in primary care.METHODS: We searched Medline, Embase, PsycINFO and Cochrane Central (inception to 12/01/2020) for RCTs that included the most commonly used comprehensive measure of depressive and anxiety disorder symptoms and diagnoses, in primary care depression RCTs (the Revised Clinical Interview Schedule: CIS-R). Two-stage random-effects meta-analyses were conducted.RESULTS: Twelve (n = 6024) of thirteen eligible studies (n = 6175) provided individual patient data. There was a 31% (95%CI: 25 to 37) difference in depressive symptoms at 3-4 months per standard deviation increase in baseline depressive symptoms. Four additional factors: the duration of anxiety; duration of depression; comorbid panic disorder; and a history of antidepressant treatment were also independently associated with poorer prognosis. There was evidence that the difference in prognosis when these factors were combined could be of clinical importance. Adding these variables improved the amount of variance explained in 3-4 month depressive symptoms from 16% using depressive symptom severity alone to 27%. Risk of bias (assessed with QUIPS) was low in all studies and quality (assessed with GRADE) was high. Sensitivity analyses did not alter our conclusions.CONCLUSIONS: When adults seek treatment for depression clinicians should routinely assess for the duration of anxiety, duration of depression, comorbid panic disorder, and a history of antidepressant treatment alongside depressive symptom severity. This could provide clinicians and patients with useful and desired information to elucidate prognosis and aid the clinical management of depression.

AB - BACKGROUND: This study aimed to investigate general factors associated with prognosis regardless of the type of treatment received, for adults with depression in primary care.METHODS: We searched Medline, Embase, PsycINFO and Cochrane Central (inception to 12/01/2020) for RCTs that included the most commonly used comprehensive measure of depressive and anxiety disorder symptoms and diagnoses, in primary care depression RCTs (the Revised Clinical Interview Schedule: CIS-R). Two-stage random-effects meta-analyses were conducted.RESULTS: Twelve (n = 6024) of thirteen eligible studies (n = 6175) provided individual patient data. There was a 31% (95%CI: 25 to 37) difference in depressive symptoms at 3-4 months per standard deviation increase in baseline depressive symptoms. Four additional factors: the duration of anxiety; duration of depression; comorbid panic disorder; and a history of antidepressant treatment were also independently associated with poorer prognosis. There was evidence that the difference in prognosis when these factors were combined could be of clinical importance. Adding these variables improved the amount of variance explained in 3-4 month depressive symptoms from 16% using depressive symptom severity alone to 27%. Risk of bias (assessed with QUIPS) was low in all studies and quality (assessed with GRADE) was high. Sensitivity analyses did not alter our conclusions.CONCLUSIONS: When adults seek treatment for depression clinicians should routinely assess for the duration of anxiety, duration of depression, comorbid panic disorder, and a history of antidepressant treatment alongside depressive symptom severity. This could provide clinicians and patients with useful and desired information to elucidate prognosis and aid the clinical management of depression.

KW - depression

KW - individual patient data meta-analysis

KW - prognosis

KW - systematic review

KW - treatment outcome

U2 - 10.1017/S0033291721001367

DO - 10.1017/S0033291721001367

M3 - Article (Academic Journal)

C2 - 33849685

SN - 0033-2917

VL - 51

SP - 1068

EP - 1081

JO - Psychological Medicine

JF - Psychological Medicine

IS - 7

ER -

The contribution of depressive 'disorder characteristics' to determinations of prognosis for adults with depression: an individual patient data meta-analysis

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