title: Comparative efficacy of seven psychotherapeutic interventions for patients with depression: a network meta-analysis.
abstract: BACKGROUND
  Previous meta-analyses comparing the efficacy of psychotherapeutic interventions for depression were clouded by a limited number of within-study treatment comparisons. This study used network meta-analysis, a novel methodological approach that integrates direct and indirect evidence from randomised controlled studies, to re-examine the comparative efficacy of seven psychotherapeutic interventions for adult depression.
  
  
  RESULTS
  We conducted systematic literature searches in PubMed, PsycINFO, and Embase up to November 2012, and identified additional studies through earlier meta-analyses and the references of included studies. We identified 198 studies, including 15,118 adult patients with depression, and coded moderator variables. Each of the seven psychotherapeutic interventions was superior to a waitlist control condition with moderate to large effects (range d = -0.62 to d = -0.92). Relative effects of different psychotherapeutic interventions on depressive symptoms were absent to small (range d = 0.01 to d = -0.30). Interpersonal therapy was significantly more effective than supportive therapy (d = -0.30, 95% credibility interval [CrI] [-0.54 to -0.05]). Moderator analysis showed that patient characteristics had no influence on treatment effects, but identified aspects of study quality and sample size as effect modifiers. Smaller effects were found in studies of at least moderate (Δd = 0.29 [-0.01 to 0.58]; p = 0.063) and large size (Δd = 0.33 [0.08 to 0.61]; p = 0.012) and those that had adequate outcome assessment (Δd = 0.38 [-0.06 to 0.87]; p = 0.100). Stepwise restriction of analyses by sample size showed robust effects for cognitive-behavioural therapy, interpersonal therapy, and problem-solving therapy (all d>0.46) compared to waitlist. Empirical evidence from large studies was unavailable or limited for other psychotherapeutic interventions.
  
  
  CONCLUSIONS
  Overall our results are consistent with the notion that different psychotherapeutic interventions for depression have comparable benefits. However, the robustness of the evidence varies considerably between different psychotherapeutic treatments.
authors.affiliation: Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland. mail@juergen-barth.de
authors.forename: Jürgen
authors.initials: J
authors.lastname: Barth
authors.forename: Thomas
authors.initials: T
authors.lastname: Munder
authors.forename: Heike
authors.initials: H
authors.lastname: Gerger
authors.forename: Eveline
authors.initials: E
authors.lastname: Nüesch
authors.forename: Sven
authors.initials: S
authors.lastname: Trelle
authors.forename: Hansjörg
authors.initials: H
authors.lastname: Znoj
authors.forename: Peter
authors.initials: P
authors.lastname: Jüni
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
mesh_terms: D000328:Adult; D001499:Bayes Theorem; D003863:Depression / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008390:Markov Chains; D011613:Psychotherapy / Q000379:methods; D016896:Treatment Outcome