title: Effectiveness of psychological interventions in preventing recurrence of depressive disorder: meta-analysis and meta-regression.
abstract: BACKGROUND
  Major depression is probably best seen as a chronically recurrent disorder, with patients experiencing another depressive episode after remission. Therefore, attention to reduce the risk of relapse or recurrence after remission is warranted. The aim of this review is to meta-analytically examine the effectiveness of psychological interventions to reduce relapse or recurrence rates of depressive disorder.
  
  
  METHODS
  We systematically reviewed the pertinent trial literature until May 2014. The random-effects model was used to compute the pooled relative risk of relapse or recurrence (RR). A distinction was made between two comparator conditions: (1) treatment-as-usual and (2) the use of antidepressants. Other sources of heterogeneity in the data were explored using meta-regression.
  
  
  RESULTS
  Twenty-five randomised trials met inclusion criteria. Preventive psychological interventions were significantly better than treatment-as-usual in reducing the risk of relapse or recurrence (RR=0.64, 95% CI=0.53-0.76, z=4.89, p<0.001, NNT=5) and also more successful than antidepressants (RR=0.83, 95% CI=0.70-0.97, z=2.40, p=0.017, NNT=13). Meta-regression showed homogeneity in effect size across a range of study, population and intervention characteristics, but the preventive effect of psychological intervention was usually better when the prevention was preceded by treatment in the acute phase (b=-1.94, SEb=0.68, z=-2.84, p=0.005).
  
  
  CONCLUSIONS
  Differences between the primary studies in methodological design, composition of the patient groups and type of intervention may have caused heterogeneity in the data, but could not be evaluated in a meta-regression owing to poor reporting.
  
  
  CONCLUSIONS
  We conclude that there is supporting evidence that preventive psychological interventions reduce the risk of relapse or recurrence in major depression.
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands. Electronic address: k.leliefeld@vumc.nl.
authors.forename: Karolien E M
authors.initials: KE
authors.lastname: Biesheuvel-Leliefeld
authors.affiliation: Department of Clinical and Experimental Psychology, Groningen University, Groningen, The Netherlands.
authors.forename: Gemma D
authors.initials: GD
authors.lastname: Kok
authors.affiliation: Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University and VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Claudi L H
authors.initials: CL
authors.lastname: Bockting
authors.affiliation: Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University and VU University Medical Centre, Amsterdam, The Netherlands; Leuphana University, Lüneburg, Germany.
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.affiliation: Department of Psychology, Vanderbilt University, Nashville, TN, USA.
authors.forename: Steven D
authors.initials: SD
authors.lastname: Hollon
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Harm W J
authors.initials: HW
authors.lastname: van Marwijk
authors.affiliation: Department of Clinical Psychology, EMGO Institute for Health and Care Research, VU University and VU University Medical Centre, Amsterdam, The Netherlands; Department of Public Mental Health, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands; Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands.
authors.forename: Filip
authors.initials: F
authors.lastname: Smit
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000517:prevention & control* / Q000628:therapy*; D006801:Humans; D011613:Psychotherapy; D012008:Recurrence; D012044:Regression Analysis
chemical_list: D000928:Antidepressive Agents
keywords: Major depressive disorder; Meta-analysis; Prevention; Psychotherapy; Recurrence; Relapse