Supported self-help to prevent relapse or recurrence of depression: who benefits most?

Dijkstra-Kersten, Sandra M A, Biesheuvel-Leliefeld, Karolien E M, van der Wouden, Johannes C, van Schaik, Digna J F, Bosmans, Judith E, van Marwijk, Harm W J and van der Horst, Henriette E (2019) Supported self-help to prevent relapse or recurrence of depression: who benefits most? Journal of Affective Disorders, 257. pp. 180-186. ISSN 0165-0327

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Abstract

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.

Item Type: Article
Schools and Departments: Brighton and Sussex Medical School > Primary Care and Public Health
Depositing User: Rosie Harvey
Date Deposited: 07 Oct 2019 11:01
Last Modified: 05 Jul 2020 01:00
URI: http://sro.sussex.ac.uk/id/eprint/86753

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