Efficacy and moderators of short-term psychodynamic psychotherapy for depression: A systematic review and meta-analysis of individual participant data

Frederik J Wienicke; Manfred E Beutel; Rüdiger Zwerenz; Elmar Brähler; Peter Fonagy; Patrick Luyten; Matthew Constantinou; Jacques P Barber; Kevin S McCarthy; Nili Solomonov; Peter J Cooper; Leonardo De Pascalis; Robert Johansson; Gerhard Andersson; Alessandra Lemma; Joel M Town; Allan A Abbass; Bita Ajilchi; Mary Beth Connolly Gibbons; Jaime López-Rodríguez; Valerio Villamil-Salcedo; Giuseppe Maina; Gianluca Rosso; Jos W R Twisk; William J Burk; Jan Spijker; Pim Cuijpers; Ellen Driessen

doi:10.1016/j.cpr.2023.102269

Efficacy and moderators of short-term psychodynamic psychotherapy for depression: A systematic review and meta-analysis of individual participant data

Clin Psychol Rev. 2023 Apr:101:102269. doi: 10.1016/j.cpr.2023.102269. Epub 2023 Mar 16.

Authors

Frederik J Wienicke¹, Manfred E Beutel², Rüdiger Zwerenz², Elmar Brähler³, Peter Fonagy⁴, Patrick Luyten⁵, Matthew Constantinou⁴, Jacques P Barber⁶, Kevin S McCarthy⁷, Nili Solomonov⁸, Peter J Cooper⁹, Leonardo De Pascalis¹⁰, Robert Johansson¹¹, Gerhard Andersson¹², Alessandra Lemma¹³, Joel M Town¹⁴, Allan A Abbass¹⁴, Bita Ajilchi¹⁵, Mary Beth Connolly Gibbons¹⁶, Jaime López-Rodríguez¹⁷, Valerio Villamil-Salcedo¹⁷, Giuseppe Maina¹⁸, Gianluca Rosso¹⁸, Jos W R Twisk¹⁹, William J Burk²⁰, Jan Spijker²¹, Pim Cuijpers²², Ellen Driessen²¹

Affiliations

¹ Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands. Electronic address: fritz.wienicke@ru.nl.
² Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany.
³ Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany; Integrated Research and Treatment Center Adiposity Diseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany.
⁴ Department of Clinical, Educational and Health Psychology, University College London, London, UK.
⁵ Department of Clinical, Educational and Health Psychology, University College London, London, UK; Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.
⁶ Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY, USA.
⁷ Department of Psychology, Chestnut Hill College, Philadelphia, PA, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁸ Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, New York, NY, USA.
⁹ School of Psychology and Clinical Language Science, University of Reading, Reading, UK.
¹⁰ Department of Psychological Science, University of Liverpool, Liverpool, UK; Department of Psychology, University of Bologna, Bologna, Italy.
¹¹ Department of Psychology, Stockholm University, Stockholm, Sweden.
¹² Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
¹³ Anna Freud National Center for Children and Families, London, UK.
¹⁴ Center for Emotions & Health, Dalhousie University, Halifax, Nova Scotia, Canada.
¹⁵ Department of Psychology, Faculty of Human Science, Science and Research Branch, Islamic Azad University, Tehran, Iran.
¹⁶ Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
¹⁷ National Institute of Psychiatry, Mexico City, Mexico.
¹⁸ Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.
¹⁹ Department of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam, the Netherlands.
²⁰ Department of Developmental Psychology, Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands.
²¹ Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Nijmegen, Netherlands; Depression Expertise Center, Pro Persona Mental Health Care, Nijmegen, the Netherlands.
²² Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.

PMID: 36958077
DOI: 10.1016/j.cpr.2023.102269

Abstract

Background: Short-term psychodynamic psychotherapy (STPP) is frequently used to treat depression, but it is unclear which patients might benefit specifically. Individual participant data (IPD) meta-analyses can provide more precise effect estimates than conventional meta-analyses and identify patient-level moderators. This IPD meta-analysis examined the efficacy and moderators of STPP for depression compared to control conditions.

Methods: PubMed, PsycInfo, Embase, and Cochrane Library were searched September 1st, 2022, to identify randomized trials comparing STPP to control conditions for adults with depression. IPD were requested and analyzed using mixed-effects models.

Results: IPD were obtained from 11 of the 13 (84.6%) studies identified (n = 771/837, 92.1%; mean age = 40.8, SD = 13.3; 79.3% female). STPP resulted in significantly lower depressive symptom levels than control conditions at post-treatment (d = -0.62, 95%CI [-0.76, -0.47], p < .001). At post-treatment, STPP was more efficacious for participants with longer rather than shorter current depressive episode durations.

Conclusions: These results support the evidence base of STPP for depression and indicate episode duration as an effect modifier. This moderator finding, however, is observational and requires prospective validation in future large-scale trials.

Keywords: Depression; Efficacy; Individual participant data Meta-analysis; Moderators; Outcome; Short-term psychodynamic psychotherapy.

Publication types

Meta-Analysis
Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Depression / therapy
Female
Humans
Male
Psychotherapy
Psychotherapy, Brief* / methods
Psychotherapy, Psychodynamic* / methods
Treatment Outcome