title: Gender as predictor and moderator of outcome in cognitive behavior therapy and pharmacotherapy for adult depression: an "individual patient data" meta-analysis.
abstract: BACKGROUND
  It has yet to be established whether gender moderates or predicts outcome of psychological and pharmacological treatments for adult depression because: (1) individual randomized trials typically lack sufficient statistical power to detect moderators and predictors and (2) meta-analyses cannot examine such associations directly.
  
  
  METHODS
  We conducted an "individual patient data" meta-analysis with the primary data of 1,766 patients from 14 eligible randomized trials comparing cognitive behavior therapy (CBT) with pharmacotherapy. Five studies also compared CBT and pharmacotherapy with pill placebo. We examined the extent to which gender moderates or predicts outcome, using the Hamilton Rating Scale for Depression-17-item (HAM-D-17), with mixed effects models.
  
  
  RESULTS
  Despite the high statistical power, we did not find any indication (P > 0.05) that gender moderates outcome (i.e., no indication that either men or women respond better or worse to CBT than to pharmacotherapy or vice versa). Gender was neither a nonspecific predictor (indicating whether gender is related to improvement, regardless of comparison or control groups), nor a specific predictor (predicting outcome of CBT and pharmacotherapy compared to pill placebo). The average differences between men and women within three conditions (CBT, pharmacotherapy, and pill placebo) were less than one point on the HAM-D-17.
  
  
  CONCLUSIONS
  The lack of predictive relations in a this good sized sample suggests that gender does not moderate differential response to CBT versus medication treatment and that it neither predicts nonspecific response across the treatments nor the specificity of response for either treatment with respect to pill placebo.
authors.affiliation: Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, The Netherlands.
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.forename: Erica
authors.initials: E
authors.lastname: Weitz
authors.forename: Jos
authors.initials: J
authors.lastname: Twisk
authors.forename: Christine
authors.initials: C
authors.lastname: Kuehner
authors.forename: Ioana
authors.initials: I
authors.lastname: Cristea
authors.forename: Daniel
authors.initials: D
authors.lastname: David
authors.forename: Robert J
authors.initials: RJ
authors.lastname: DeRubeis
authors.forename: Sona
authors.initials: S
authors.lastname: Dimidjian
authors.forename: Boadie W
authors.initials: BW
authors.lastname: Dunlop
authors.forename: Mahbobeh
authors.initials: M
authors.lastname: Faramarzi
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hegerl
authors.forename: Robin B
authors.initials: RB
authors.lastname: Jarrett
authors.forename: Sidney H
authors.initials: SH
authors.lastname: Kennedy
authors.forename: Farzan
authors.initials: F
authors.lastname: Kheirkhah
authors.forename: Roland
authors.initials: R
authors.lastname: Mergl
authors.forename: Jeanne
authors.initials: J
authors.lastname: Miranda
authors.forename: David C
authors.initials: DC
authors.lastname: Mohr
authors.forename: Zindel V
authors.initials: ZV
authors.lastname: Segal
authors.forename: Juned
authors.initials: J
authors.lastname: Siddique
authors.forename: Anne D
authors.initials: AD
authors.lastname: Simons
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Vittengl
authors.forename: Steven D
authors.initials: SD
authors.lastname: Hollon
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000706:statistics & numerical data*; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D012737:Sex Factors
chemical_list: D000928:Antidepressive Agents
keywords: cognitive-behavior therapy; gender; major depressive disorder; meta-analysis; pharmacotherapy