title: Behavioural activation for depression; an update of meta-analysis of effectiveness and sub group analysis.
abstract: BACKGROUND
  Depression is a common, disabling condition for which psychological treatments are recommended. Behavioural activation has attracted increased interest in recent years. It has been over 5 years since our meta-analyses summarised the evidence supporting and this systematic review updates those findings and examines moderators of treatment effect.
  
  
  METHODS
  Randomised trials of behavioural activation for depression versus controls or anti-depressant medication were identified using electronic database searches, previous reviews and reference lists. Data on symptom level and study level moderators were extracted and analysed using meta-analysis, sub-group analysis and meta-regression respectively.
  
  
  RESULTS
  Twenty six randomised controlled trials including 1524 subjects were included in this meta-analysis. A random effects meta-analysis of symptom level post treatment showed behavioural activation to be superior to controls (SMD -0.74 CI -0.91 to -0.56, k = 25, N = 1088) and medication (SMD -0.42 CI -0.83 to-0.00, k = 4, N = 283). Study quality was low in the majority of studies and follow- up time periods short. There was no indication of publication bias and subgroup analysis showed limited association between moderators and effect size.
  
  
  CONCLUSIONS
  The results in this meta-analysis support and strengthen the evidence base indicating Behavioural Activation is an effective treatment for depression. Further high quality research with longer term follow-up is needed to strengthen the evidence base.
authors.affiliation: Durham University/Tees Esk and Wear Valleys NHS Foundation Trust, Department of Medicine, Pharmacy & Health, Durham University, Stockton on Tees, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Ekers
authors.affiliation: Department of Medicine, Pharmacy & Health, Durham University, Stockton on Tees, United Kingdom.
authors.forename: Lisa
authors.initials: L
authors.lastname: Webster
authors.affiliation: Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands.
authors.forename: Annemieke
authors.initials: A
authors.lastname: Van Straten
authors.affiliation: Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands.
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.affiliation: School of Medicine, University of Exeter, Exeter, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Richards
authors.affiliation: Hull York Medical School and Department of Health Sciences, University of York, York, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Gilbody
mesh_terms: D003863:Depression / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011613:Psychotherapy; D016896:Treatment Outcome