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Care-as-usual control groups across different settings in randomized trials on psychotherapy for adult depression: a meta-analysis

Published online by Cambridge University Press:  17 December 2019

Pim Cuijpers Open the ORCID record for Pim Cuijpers [Opens in a new window] ,
Soledad Quero ,
Davide Papola ,
Ioana A. Cristea  and
Eirini Karyotaki
Pim Cuijpers*
Affiliation:
Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
Soledad Quero
Affiliation:
Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain
Davide Papola
Affiliation:
Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
Ioana A. Cristea
Affiliation:
Department of Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
Eirini Karyotaki
Affiliation:
Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
*
Author for correspondence: Pim Cuijpers, E-mail: p.cuijpers@vu.nl
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Abstract

Background

Care-as-usual (CAU) is often used as a control condition in psychotherapy research, but it may vary considerably what that entails, ranging from no treatment, to routine treatment in primary care, general medical care, perinatal care, and specialized mental health care.

Methods

We conducted a meta-analysis of trials comparing psychotherapy for depression to CAU, with a focus on the different categories of CAU and countries where the studies were conducted. We used an existing database of randomized trials on psychotherapy for depression that is updated every year.

Results

A total of 140 studies with 15 419 patients were included. We found no significant differences in effects between categories of CAU (effect sizes ranging from g = 0.43 for CAU in primary care to g = 0.73 for no treatment), but heterogeneity was high in all CAU categories. After stratifying effects across specific countries (within CAU categories) we found that heterogeneity was considerably lower and there were several significant differences between countries. Overall, effects were larger in non-Western countries (g = 0.84 to 1.28) compared to those in Western countries (g = 0.52; p for difference = 0.002). Effects were smaller in studies with risk of bias (p = 0.01).

Conclusions

There are no significant differences between major categories of CAU when compared to psychotherapy conditions in randomized trials. However, effects of psychotherapy differ considerably across CAU conditions in specific countries. CAU therefore is a heterogeneous control condition in psychotherapy research.

Keywords

Care-as-usualcontrol conditionsdepressionmajor depressionmeta-analysispsychotherapy
Type
Original Article
Information
Psychological Medicine , Volume 51 , Issue 4 , March 2021 , pp. 634 - 644
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Copyright
Copyright © Cambridge University Press 2019

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