Gender as predictor and moderator of outcome in cognitive behavior therapy and pharmacotherapy for adult depression: An "individual patient data" meta-analysis

Pim Cuijpers, Erica Weitz, Jos Twisk, Christine Kuehner, Ioana Cristea, Daniel David, Robert J. Derubeis, Sona Dimidjian, Boadie W. Dunlop, Mahbobeh Faramarzi, Ulrich Hegerl, Robin B. Jarrett, Sidney H. Kennedy, Farzan Kheirkhah, Roland Mergl, Jeanne Miranda, David C. Mohr, Zindel V. Segal, Juned Siddique, Anne D. SimonsJeffrey R. Vittengl, Steven D. Hollon

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Background It has yet to be established whether gender moderates or predicts outcome of psychological and pharmacological treatments for adult depression because: (1) individual randomized trials typically lack sufficient statistical power to detect moderators and predictors and (2) meta-analyses cannot examine such associations directly. Methods We conducted an "individual patient data" meta-analysis with the primary data of 1,766 patients from 14 eligible randomized trials comparing cognitive behavior therapy (CBT) with pharmacotherapy. Five studies also compared CBT and pharmacotherapy with pill placebo. We examined the extent to which gender moderates or predicts outcome, using the Hamilton Rating Scale for Depression-17-item (HAM-D-17), with mixed effects models. Results Despite the high statistical power, we did not find any indication (P > 0.05) that gender moderates outcome (i.e., no indication that either men or women respond better or worse to CBT than to pharmacotherapy or vice versa). Gender was neither a nonspecific predictor (indicating whether gender is related to improvement, regardless of comparison or control groups), nor a specific predictor (predicting outcome of CBT and pharmacotherapy compared to pill placebo). The average differences between men and women within three conditions (CBT, pharmacotherapy, and pill placebo) were less than one point on the HAM-D-17. Conclusions The lack of predictive relations in a this good sized sample suggests that gender does not moderate differential response to CBT versus medication treatment and that it neither predicts nonspecific response across the treatments nor the specificity of response for either treatment with respect to pill placebo.

Original languageEnglish (US)
Pages (from-to)941-951
Number of pages11
JournalDepression and Anxiety
Volume31
Issue number11
DOIs
StatePublished - Nov 1 2014

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Cognitive Therapy
Meta-Analysis
Depression
Drug Therapy
Placebos
Therapeutics
Pharmacology
Psychology
Control Groups

Keywords

  • cognitive-behavior therapy
  • gender
  • major depressive disorder
  • meta-analysis
  • pharmacotherapy

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology

Cite this

Gender as predictor and moderator of outcome in cognitive behavior therapy and pharmacotherapy for adult depression : An "individual patient data" meta-analysis. / Cuijpers, Pim; Weitz, Erica; Twisk, Jos; Kuehner, Christine; Cristea, Ioana; David, Daniel; Derubeis, Robert J.; Dimidjian, Sona; Dunlop, Boadie W.; Faramarzi, Mahbobeh; Hegerl, Ulrich; Jarrett, Robin B.; Kennedy, Sidney H.; Kheirkhah, Farzan; Mergl, Roland; Miranda, Jeanne; Mohr, David C.; Segal, Zindel V.; Siddique, Juned; Simons, Anne D.; Vittengl, Jeffrey R.; Hollon, Steven D.

In: Depression and Anxiety, Vol. 31, No. 11, 01.11.2014, p. 941-951.

Research output: Contribution to journalArticle

Cuijpers, P, Weitz, E, Twisk, J, Kuehner, C, Cristea, I, David, D, Derubeis, RJ, Dimidjian, S, Dunlop, BW, Faramarzi, M, Hegerl, U, Jarrett, RB, Kennedy, SH, Kheirkhah, F, Mergl, R, Miranda, J, Mohr, DC, Segal, ZV, Siddique, J, Simons, AD, Vittengl, JR & Hollon, SD 2014, 'Gender as predictor and moderator of outcome in cognitive behavior therapy and pharmacotherapy for adult depression: An "individual patient data" meta-analysis', Depression and Anxiety, vol. 31, no. 11, pp. 941-951. https://doi.org/10.1002/da.22328
Cuijpers, Pim ; Weitz, Erica ; Twisk, Jos ; Kuehner, Christine ; Cristea, Ioana ; David, Daniel ; Derubeis, Robert J. ; Dimidjian, Sona ; Dunlop, Boadie W. ; Faramarzi, Mahbobeh ; Hegerl, Ulrich ; Jarrett, Robin B. ; Kennedy, Sidney H. ; Kheirkhah, Farzan ; Mergl, Roland ; Miranda, Jeanne ; Mohr, David C. ; Segal, Zindel V. ; Siddique, Juned ; Simons, Anne D. ; Vittengl, Jeffrey R. ; Hollon, Steven D. / Gender as predictor and moderator of outcome in cognitive behavior therapy and pharmacotherapy for adult depression : An "individual patient data" meta-analysis. In: Depression and Anxiety. 2014 ; Vol. 31, No. 11. pp. 941-951.
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AU - Twisk, Jos

AU - Kuehner, Christine

AU - Cristea, Ioana

AU - David, Daniel

AU - Derubeis, Robert J.

AU - Dimidjian, Sona

AU - Dunlop, Boadie W.

AU - Faramarzi, Mahbobeh

AU - Hegerl, Ulrich

AU - Jarrett, Robin B.

AU - Kennedy, Sidney H.

AU - Kheirkhah, Farzan

AU - Mergl, Roland

AU - Miranda, Jeanne

AU - Mohr, David C.

AU - Segal, Zindel V.

AU - Siddique, Juned

AU - Simons, Anne D.

AU - Vittengl, Jeffrey R.

AU - Hollon, Steven D.

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N2 - Background It has yet to be established whether gender moderates or predicts outcome of psychological and pharmacological treatments for adult depression because: (1) individual randomized trials typically lack sufficient statistical power to detect moderators and predictors and (2) meta-analyses cannot examine such associations directly. Methods We conducted an "individual patient data" meta-analysis with the primary data of 1,766 patients from 14 eligible randomized trials comparing cognitive behavior therapy (CBT) with pharmacotherapy. Five studies also compared CBT and pharmacotherapy with pill placebo. We examined the extent to which gender moderates or predicts outcome, using the Hamilton Rating Scale for Depression-17-item (HAM-D-17), with mixed effects models. Results Despite the high statistical power, we did not find any indication (P > 0.05) that gender moderates outcome (i.e., no indication that either men or women respond better or worse to CBT than to pharmacotherapy or vice versa). Gender was neither a nonspecific predictor (indicating whether gender is related to improvement, regardless of comparison or control groups), nor a specific predictor (predicting outcome of CBT and pharmacotherapy compared to pill placebo). The average differences between men and women within three conditions (CBT, pharmacotherapy, and pill placebo) were less than one point on the HAM-D-17. Conclusions The lack of predictive relations in a this good sized sample suggests that gender does not moderate differential response to CBT versus medication treatment and that it neither predicts nonspecific response across the treatments nor the specificity of response for either treatment with respect to pill placebo.

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