Dijkstra-Kersten_Supported self-help for recurrent depression - moderators_accepted (1).pdf (283.23 kB)
Supported self-help to prevent relapse or recurrence of depression: who benefits most?
journal contribution
posted on 2023-06-09, 19:15 authored by Sandra M A Dijkstra-Kersten, Karolien E M Biesheuvel-Leliefeld, Johannes C van der Wouden, Digna J F van Schaik, Judith E Bosmans, Harm van MarwijkHarm van Marwijk, Henriette E van der HorstObjectives To identify subgroups for whom supported self-help preventive cognitive therapy (S-PCT) is more (cost)effective than treatment as usual (TAU) in preventing relapse and recurrence of major depression. Methods We conducted a randomized controlled trial in which 248 remitted, recurrently depressed participants were randomized to S-PCT (n=124) or TAU (n=124). Clinical outcome was relapse or recurrence of major depressive disorder (SCID-I). We tested the potential moderating effects on relapse or recurrence of age, gender, education level, residual depressive symptoms, number of previous episodes, age of onset, antidepressant medication, somatization, and self-efficacy with logistic regression analyses adjusted for baseline values of depressive symptoms. We examined moderating effects on costs using linear regression analyses adjusted for baseline costs. A stratified cost-effectiveness analysis was performed to tease out differences in cost-effectiveness between subgroups. Results We found no moderating effect on relapse or recurrence for any of the potential moderators. For costs, the number of previous depressive episodes was identified as a moderator. At a willingness-to-pay of 16,000€, the probability that S-PCT was cost-effective compared to TAU was 95% for participants with 2-3 previous episodes and 11% for participants with =4 episodes. Conclusions S-PCT was effective in preventing relapse or recurrence of depressive disorders in a broad range of participants, but is more likely to be cost-effective in participants with 2-3 episodes than with =4 episodes. This indicates that S-PCT can best be offered to participants with fewer previous depressive episodes.
History
Publication status
- Published
File Version
- Accepted version
Journal
Journal of Affective DisordersISSN
0165-0327Publisher
ElsevierExternal DOI
Volume
257Page range
180-186Department affiliated with
- Primary Care and Public Health Publications
Full text available
- Yes
Peer reviewed?
- Yes
Legacy Posted Date
2019-10-07First Open Access (FOA) Date
2020-07-05First Compliant Deposit (FCD) Date
2019-10-07Usage metrics
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