Article type
Year
Abstract
Background: Cognitive Behavioural Therapy (CBT) for depression may be less effective in patients receiving disability benefits compared to those not receiving benefits.
Objectives: To systematically review and perform an individual patient data meta-analysis (IPDMA) of all RCTs that compared the effectiveness of CBT to minimal or usual care in patients with depression receiving or not receiving disability benefits.
Methods: We searched MEDLINE, EMBASE, PSYCINFO, AMED, CINAHL and CENTRAL to June 2011. Eligible studies enrolled adult patients with major depression and randomly assigned them to CBT or minimal or usual care.
Results: Of 92 potentially eligible trials, none provided outcomes based on receipt of benefit status. Seventy of 92 (76%) authors were contacted to establish if they captured receipt of benefits as a baseline characteristic; 8 recorded benefit status, and 3 enrolled some patients in receipt of disability benefits, of which 2 provided data. Our analysis thus included two trials that enrolled patients on disability benefits and six trials without any patients on disability benefits. Two trials including 227 patients showed an improvement in the overall effect of CBT on depression, as measured by the Beck Depression Inventory (BDI-II) with higher scores representing worse outcome, −2.61 (−5.28, 0.07); p = 0.06. Receipt of benefits (34 patients) versus not receiving benefits (193 patients) was associated with a small reduction in the possible effect of CBT on depression, 4.46 (−3.30, 12.21), p = 0.26, which does not meet the minimally important difference threshold for the BDI-II of 5. Given the wide confidence interval and high risk of bias of studies, the data warrants only low confidence in the estimate.
Conclusions: No significant difference was found in the effect of CBT between patients with depression receiving and not receiving disability benefits. Given that the associated measure of precision includes a large and important difference, a difference may nevertheless be present.
Objectives: To systematically review and perform an individual patient data meta-analysis (IPDMA) of all RCTs that compared the effectiveness of CBT to minimal or usual care in patients with depression receiving or not receiving disability benefits.
Methods: We searched MEDLINE, EMBASE, PSYCINFO, AMED, CINAHL and CENTRAL to June 2011. Eligible studies enrolled adult patients with major depression and randomly assigned them to CBT or minimal or usual care.
Results: Of 92 potentially eligible trials, none provided outcomes based on receipt of benefit status. Seventy of 92 (76%) authors were contacted to establish if they captured receipt of benefits as a baseline characteristic; 8 recorded benefit status, and 3 enrolled some patients in receipt of disability benefits, of which 2 provided data. Our analysis thus included two trials that enrolled patients on disability benefits and six trials without any patients on disability benefits. Two trials including 227 patients showed an improvement in the overall effect of CBT on depression, as measured by the Beck Depression Inventory (BDI-II) with higher scores representing worse outcome, −2.61 (−5.28, 0.07); p = 0.06. Receipt of benefits (34 patients) versus not receiving benefits (193 patients) was associated with a small reduction in the possible effect of CBT on depression, 4.46 (−3.30, 12.21), p = 0.26, which does not meet the minimally important difference threshold for the BDI-II of 5. Given the wide confidence interval and high risk of bias of studies, the data warrants only low confidence in the estimate.
Conclusions: No significant difference was found in the effect of CBT between patients with depression receiving and not receiving disability benefits. Given that the associated measure of precision includes a large and important difference, a difference may nevertheless be present.