2026/01/03 by Pim Cuijpers, Mathias Harrer, Clara Miguel +2 · 2 voices · 9 citations
Medicine · Psychology · #Baseline (sea) #Cognitive therapy #Depression (economics) #MEDLINE #Multiple baseline design #Personality Disorders and Psychopathology #Psychotherapy Techniques and Applications #Treatment of Major Depression
paper · doi:10.1016/j.jad.2025.121106
published in Journal of Affective Disorders 399, 121106 (Elsevier BV)
openalex created_date 2026/01/03 · openalex publication_date 2026/01/03 · openalex updated_date 2026/08/04
It is not yet clear whether baseline severity is associated with the effects of psychotherapies. We examined baseline severity at the study level in a large sample of randomized controlled trials comparing psychotherapies against a control condition for the treatment of depression. We used an existing large database of randomized trials comparing psychotherapies for depression with control groups ( www.metapsy.org ). We converted baseline severity scores across different depression measures into a common metric. We ran bivariable and multivariable meta-regression analyses to examine the association of effect sizes with baseline severity. We also examined response rates in treatment and control conditions. We included 387 randomized trials (463 comparisons; 47,315 patients). The pooled effect size of the psychotherapies was g = 0.77 (95 % CI, 0.70; 0.84). In the main analyses, we found a highly significant association between the effect size and baseline severity (bivariable coefficient: 0.024 (SE = 0.006; p < 0.0001), multivariable coefficient: 0.022 (SE = 0.007; p = 0.002)). This was confirmed in some but not all sensitivity analyses. Absolute response rates in the control conditions remained stable across different levels of baseline severity (bivariable metaregression analyses: p = 0.545), or showed a negative association (multivariable analyses: p = 0.002). In the therapy conditions the response rates were significantly larger with increasing levels of baseline severity (bivariable: p ≤0.0001; multivariable: p = 0.006). The effects of psychotherapies are probably associated with baseline severity. Response rates in control conditions remained relatively stable across different levels of baseline severity, while in the treatment conditions the response rates increased with increasing levels of baseline severity. • It is not yet clear whether baseline severity is associated with the effects of psychotherapies. • We found that baseline severity at the study level is significantly associated with the effect sizes of therapies for adult depression. • Absolute response rates in control groups do not increase with higher levels of baseline severity. • Absolute response rates in therapy increase significantly with higher levels of baseline severity.