title: Relapse rates after psychotherapy for depression - stable long-term effects? A meta-analysis.
abstract: BACKGROUND
  Depression is the most common mental disorder. Effective psychotherapeutic treatments for depression exist; however, data on their long-term effectiveness beyond a time span of two years is still scarce. Our aim was to perform a meta-analysis, investigating (a) overall rates of relapse more than two years after psychotherapy (meta-analysis 1), and (b) if psychotherapy has more enduring effects than non-psychotherapeutic comparison conditions (e.g. pharmacotherapy, treatment as usual), again beyond a time span of two years post-therapy (meta-analysis 2).
  
  
  METHODS
  We searched electronic databases Medline, PsycINFO and the COCHRANE Library. Main selection criteria were (i) RCT of psychotherapy with follow-up interval of more than 2 years, (ii) primary diagnosis of depression, assessed by observer ratings, (iii) report of relapse at follow-up.
  
  
  RESULTS
  We identified 11 studies, 6 of which included a non-psychotherapeutic comparison condition. Together they comprised long-term data of 966 patients. Mean follow-up duration was 4.4 years. The overall relapse rate at long-term follow-up was 0.39 (95% CI 0.29, 0.50). Psychotherapy resulted in significantly less relapses (53.1% vs. 71.1%, OR 0.51; 95% CI 0.32, 0.82, p=0.005) than comparison treatments. This finding corresponded to a number needed to treat (NNT) of 5.55.
  
  
  CONCLUSIONS
  Results can only be preliminary as data was sparse and studies differed methodologically. Heterogeneity in the first meta-analysis was high (I(2)=82%). Results indicated publication bias.
  
  
  CONCLUSIONS
  The relapse rate more than two years after psychotherapy is relatively high, but significantly lower compared to non-psychotherapeutic treatments. Multiannual follow-ups should routinely be included in future psychotherapy RCTs.
authors.affiliation: Clinic for Psychosomatic Medicine and Psychotherapy, University of Giessen, Ludwigstrasse 76, 35392 Giessen, Germany. Electronic address: christiane.steinert@psycho.med.uni-giessen.de.
authors.forename: Christiane
authors.initials: C
authors.lastname: Steinert
authors.affiliation: Clinic for Psychosomatic Medicine and Psychotherapy, University of Giessen, Ludwigstrasse 76, 35392 Giessen, Germany.
authors.forename: Mareike
authors.initials: M
authors.lastname: Hofmann
authors.affiliation: Clinic for Psychosomatic Medicine and Psychotherapy, University of Giessen, Ludwigstrasse 76, 35392 Giessen, Germany; Clinic for Psychosomatic Medicine and Psychotherapy, University of Marburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Kruse
authors.affiliation: Clinic for Psychosomatic Medicine and Psychotherapy, University of Giessen, Ludwigstrasse 76, 35392 Giessen, Germany.
authors.forename: Falk
authors.initials: F
authors.lastname: Leichsenring
mesh_terms: D002908:Chronic Disease; D003866:Depressive Disorder / Q000628:therapy*; D006801:Humans; D011613:Psychotherapy / Q000379:methods*; D012008:Recurrence; D013995:Time; D016896:Treatment Outcome
keywords: Depression; Long-term follow-up; Meta-analysis; Psychotherapy; Relapse