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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?

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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 Horst
Objectives 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 Disorders

ISSN

0165-0327

Publisher

Elsevier

Volume

257

Page range

180-186

Department affiliated with

  • Primary Care and Public Health Publications

Full text available

  • Yes

Peer reviewed?

  • Yes

Legacy Posted Date

2019-10-07

First Open Access (FOA) Date

2020-07-05

First Compliant Deposit (FCD) Date

2019-10-07

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