The limited efficacy of psychological interventions for depression in people with Type 1 or Type 2 diabetes: An Individual Participant Data Meta-Analysis (IPD-MA)

TY - JOUR

T1 - The limited efficacy of psychological interventions for depression in people with Type 1 or Type 2 diabetes

T2 - An Individual Participant Data Meta-Analysis (IPD-MA)

AU - Mather, Sarah

AU - Fisher, Peter

AU - Nevitt, Sarah

AU - Cherry, Mary Gemma

AU - Maturana, Camila

AU - Warren, Jasmine G

AU - Noble, Adam

N1 - Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.

PY - 2022/8/1

Y1 - 2022/8/1

N2 - BACKGROUND: People with either Type 1/Type 2 diabetes experiencing anxiety or depression experience worse clinical and social outcomes. Efficacy of available psychological and pharmacological treatments for anxiety and depression is unclear. Aggregate data meta-analyses (AD-MAs) have failed to consider the clinical relevance of any change these treatments elicit. Thus, we sought to complete an individual participant data meta-analysis (IPD-MA) to evaluate this.METHODS: Eligible RCTs of psychological treatments (PTs) and pharmacological treatments (PhTs) were systematically identified and assessed using the Cochrane Risk of Bias Tool-2. IPD was requested and Jacobson's methodology was used to determine the clinical relevance of symptom-change. Traditional effect sizes were calculated to permit comparison of trials providing and not providing IPD and to compare with AD-MAs.RESULTS: Sufficient data was obtained to conduct an IPD-MA for PTs (12/25) but not PhTs (1/5). Across PT trials, rates of 'recovery' for depression post-intervention were low. Whilst significantly more treated patients did recover (17% [95% CI 0.10, 0.25]) than controls (9% [95% CI 0.03, 0.17]), the difference was small (6% [95% CI 0.02, 0.10]).LIMITATIONS: Only 50% of eligible trials provided IPD; we were also only able to examine outcomes immediately following the end of an intervention.CONCLUSION: Current psychological interventions offer limited benefit in treating anxiety and depression in people with Type 1 or Type 2 diabetes (83% remain depressed). More efficacious interventions are urgently needed.

AB - BACKGROUND: People with either Type 1/Type 2 diabetes experiencing anxiety or depression experience worse clinical and social outcomes. Efficacy of available psychological and pharmacological treatments for anxiety and depression is unclear. Aggregate data meta-analyses (AD-MAs) have failed to consider the clinical relevance of any change these treatments elicit. Thus, we sought to complete an individual participant data meta-analysis (IPD-MA) to evaluate this.METHODS: Eligible RCTs of psychological treatments (PTs) and pharmacological treatments (PhTs) were systematically identified and assessed using the Cochrane Risk of Bias Tool-2. IPD was requested and Jacobson's methodology was used to determine the clinical relevance of symptom-change. Traditional effect sizes were calculated to permit comparison of trials providing and not providing IPD and to compare with AD-MAs.RESULTS: Sufficient data was obtained to conduct an IPD-MA for PTs (12/25) but not PhTs (1/5). Across PT trials, rates of 'recovery' for depression post-intervention were low. Whilst significantly more treated patients did recover (17% [95% CI 0.10, 0.25]) than controls (9% [95% CI 0.03, 0.17]), the difference was small (6% [95% CI 0.02, 0.10]).LIMITATIONS: Only 50% of eligible trials provided IPD; we were also only able to examine outcomes immediately following the end of an intervention.CONCLUSION: Current psychological interventions offer limited benefit in treating anxiety and depression in people with Type 1 or Type 2 diabetes (83% remain depressed). More efficacious interventions are urgently needed.

KW - Anxiety/therapy

KW - Depression/therapy

KW - Diabetes Mellitus, Type 1/complications

KW - Diabetes Mellitus, Type 2/complications

KW - Humans

KW - Psychosocial Intervention

U2 - 10.1016/j.jad.2022.04.132

DO - 10.1016/j.jad.2022.04.132

M3 - Review article

C2 - 35490884

SN - 0165-0327

VL - 310

SP - 25

EP - 31

JO - Journal of affective disorders

JF - Journal of affective disorders

ER -