Efficacy and moderators of mindfulness-based cognitive therapy in prevention of depressive relapse: an individual patient data meta-analysis from randomized trials
Van Heeringen, K
American Medical Association (AMA)
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Importance: Relapse prevention in recurrent depression is a significant public health problem and antidepressants are the current first-line treatment approach. Identifying an equally efficacious non-pharmacological intervention would be an important development. Objective: To conduct an individual patient data meta-analysis examining the efficacy of Mindfulness Based Cognitive Therapy (MBCT) compared with usual care and other active treatments, including antidepressants. Data Sources: Studies reported in the English language, and published or accepted for publication in peer-reviewed journals identified from EMBASE, PubMed/Medline, PsycINFO, Web of Science, Scopus, and the Cochrane Controlled Trials Register from the first available year to 22 November 2014. Study Selection: Randomized trials of manualized MBCT for relapse prevention in recurrent depression in full or partial remission that compared MBCT with at least one non-MBCT treatment, including usual care. Data Extraction and Synthesis: Individual patient data were obtained for nine out of ten randomized trials, comprising 1329 participants, with data available for 1258 (95%). The main outcome measure was time (weeks) to depressive relapse over a 60 week follow-up period. Data were pooled using two-stage and one-stage meta-analysis methods, and fixed and random effect(s) models. Results: Using a two-stage random effects approach, patients receiving MBCT had a reduced risk of depressive relapse within a 60-week follow-up period (hazard ratio: 0.69, 95% confidence interval 0.58 to 0.82), compared with those who did not receive MBCT. Furthermore, comparisons with active treatments suggest a reduced risk of depressive relapse within a 60-week follow-up period (hazard ratio: 0.79, 95% confidence interval 0.64 to 0.97). Using a one-stage approach, socio-demographic (i.e. age, gender, education and relationship status) and psychiatric (i.e. age of onset and number of previous episodes of depression) variables showed no statistically significant interaction with MBCT treatment. However, there was some evidence to suggest that greater severity of depressive symptoms prior to treatment was associated with a larger effect of MBCT compared with other treatments. Conclusions and Relevance: MBCT appears efficacious as a treatment for relapse prevention for those who suffer recurrent depression, particularly those with more pronounced residual symptoms. Recommendations are made concerning how future trials can address remaining uncertainties and improve the rigor of the field.
WK, RT, SB and RB were partially supported by the NIHR HTA program (08/56/01). RT and RB have also been supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust. This work was supported by the Wellcome Trust Grants GR067797 and 104908/Z/14/Z.