title: Effectiveness of cognitive behavioral therapy for depression in patients receiving disability benefits: a systematic review and individual patient data meta-analysis.
abstract: OBJECTIVE
  To systematically summarize the randomized trial evidence regarding the relative effectiveness of cognitive behavioural therapy (CBT) in patients with depression in receipt of disability benefits in comparison to those not receiving disability benefits.
  
  
  METHODS
  All relevant RCTs from a database of randomized controlled and comparative studies examining the effects of psychotherapy for adult depression (http://www.evidencebasedpsychotherapies.org), electronic databases (MEDLINE, EMBASE, PSYCINFO, AMED, CINAHL and CENTRAL) to June 2011, and bibliographies of all relevant articles. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTION: Adult patients with major depression, randomly assigned to CBT versus minimal/no treatment or care-as-usual.
  
  
  METHODS
  Three teams of reviewers, independently and in duplicate, completed title and abstract screening, full text review and data extraction. We performed an individual patient data meta-analysis to summarize data.
  
  
  RESULTS
  Of 92 eligible trials, 70 provided author contact information; of these 56 (80%) were successfully contacted to establish if they captured receipt of benefits as a baseline characteristic; 8 recorded benefit status, and 3 enrolled some patients in receipt of benefits, of which 2 provided individual patient data. Including both patients receiving and not receiving disability benefits, 2 trials (227 patients) suggested a possible reduction in depression with CBT, as measured by the Beck Depression Inventory, mean difference [MD] (95% confidence interval [CI]) = -2.61 (-5.28, 0.07), p = 0.06; minimally important difference of 5. The effect appeared larger, though not significantly, in those in receipt of benefits (34 patients) versus not receiving benefits (193 patients); MD (95% CI) = -4.46 (-12.21, 3.30), p = 0.26.
  
  
  CONCLUSIONS
  Our data does not support the hypothesis that CBT has smaller effects in depressed patients receiving disability benefits versus other patients. Given that the confidence interval is wide, a decreased effect is still possible, though if the difference exists, it is likely to be small.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada. shanil.ebrahim@utoronto.ca
authors.forename: Shanil
authors.initials: S
authors.lastname: Ebrahim
authors.forename: Luis
authors.initials: L
authors.lastname: Montoya
authors.forename: Wanda
authors.initials: W
authors.lastname: Truong
authors.forename: Sandy
authors.initials: S
authors.lastname: Hsu
authors.forename: Mostafa
authors.initials: M
authors.lastname: Kamal El Din
authors.forename: Alonso
authors.initials: A
authors.lastname: Carrasco-Labra
authors.forename: Jason W
authors.initials: JW
authors.lastname: Busse
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Walter
authors.forename: Diane
authors.initials: D
authors.lastname: Heels-Ansdell
authors.forename: Rachel
authors.initials: R
authors.lastname: Couban
authors.forename: Irene
authors.initials: I
authors.lastname: Patelis-Siotis
authors.forename: Marg
authors.initials: M
authors.lastname: Bellman
authors.forename: L Esther
authors.initials: LE
authors.lastname: de Graaf
authors.forename: David J A
authors.initials: DJ
authors.lastname: Dozois
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Bieling
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Guyatt
mesh_terms: D000328:Adult; D015982:Bias; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000628:therapy*; D006233:Persons with Disabilities; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D012306:Risk; D016896:Treatment Outcome