Is investigator background related to outcome in head to head trials of psychotherapy and pharmacotherapy for adult depression? A systematic review and meta-analysis.
BACKGROUND
The influence of factors related to the background of investigators conducting trials comparing psychotherapy and pharmacotherapy has remained largely unstudied. Specializations emphasizing biological determinants of mental disorders, like psychiatry, might favor pharmacotherapy, while others stressing psychosocial factors, like psychology, could promote psychotherapy. Yet financial conflict of interest (COI) could be a confounding factor as authors with a medical specialization might receive more sponsoring from the pharmaceutical industry.


METHODS
We conducted a meta-analysis with subgroup and meta-regression analysis examining whether the specialization and affiliation of trial authors were associated to outcomes in the direct comparison of psychotherapy and pharmacotherapy for the acute treatment of depression. Meta-regression analysis also included trial risk of bias and author conflict of interest in relationship to the pharmaceutical industry.


RESULTS
We included 45 trials. In half, the first author was psychologist. The last author was psychiatrist/MD in half of the trials, and a psychologist or statistician/other technical in the rest. Most lead authors had medical affiliations. Subgroup analysis indicated that studies with last authors statisticians favored pharmacotherapy. Univariate analysis showed a negative relationship between the presence of statisticians and outcomes favoring psychotherapy. Multivariate analysis showed that trials including authors with financial COI reported findings more favorable to pharmacotherapy.


CONCLUSIONS
We report the first detailed overview of the background of authors conducting head to head trials for depression. Trials co-authored by statisticians appear to subtly favor pharmacotherapy. Receiving funding from the industry is more closely related to finding better outcomes for the industry's elective treatment than are factors related to authors' background.


CONCLUSIONS
For a minority of authors we could not retrieve background information. The number of trials was insufficient to evidence subtler effects.
Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania.|Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, United States of America.
Ioana A
http://orcid.org/0000-0002-9854-7076
IA
Cristea
Department of General Psychology, University of Padua, Padua, Italy.
Claudio
C
Gentili
IMT Institute for Advanced Studies, Lucca, Italy.
Pietro
P
Pietrini
Department of Clinical Psychology, VU University, Amsterdam, The Netherlands.|EMGO Institute for Health and Care Research, Amsterdam, The Netherlands.
Pim
P
Cuijpers
D002986:Clinical Trials as Topic; D003863:Depression / Q000628:therapy*; D006801:Humans; D011613:Psychotherapy / Q000379:methods*