Life events and treatment prognosis for depression: A systematic review and individual patient data meta-analysis.
Depression
Individual patient data meta-analysis
Stressful life events
Systematic review
Treatment outcome
Journal
Journal of affective disorders
ISSN: 1573-2517
Titre abrégé: J Affect Disord
Pays: Netherlands
ID NLM: 7906073
Informations de publication
Date de publication:
15 02 2022
15 02 2022
Historique:
received:
04
05
2021
revised:
10
11
2021
accepted:
12
12
2021
pubmed:
18
12
2021
medline:
27
1
2022
entrez:
17
12
2021
Statut:
ppublish
Résumé
To investigate associations between major life events and prognosis independent of treatment type: (1) after adjusting for clinical prognostic factors and socio-demographics; (2) amongst patients with depressive episodes at least six-months long; and (3) patients with a first life-time depressive episode. Six RCTs of adults seeking treatment for depression in primary care met eligibility criteria, individual patient data (IPD) were collated from all six (n = 2858). Participants were randomized to any treatment and completed the same baseline assessment of life events, demographics and clinical prognostic factors. Two-stage random effects meta-analyses were conducted. Reporting any major life events was associated with poorer prognosis regardless of treatment type. Controlling for baseline clinical factors, socio-demographics and social support resulted in minimal residual evidence of associations between life events and treatment prognosis. However, removing factors that might mediate the relationships between life events and outcomes reporting: arguments/disputes, problem debt, violent crime, losing one's job, and three or more life events were associated with considerably worse prognoses (percentage difference in 3-4 months depressive symptoms compared to no reported life events =30.3%(95%CI: 18.4-43.3)). Assessing for clinical prognostic factors, social support, and socio-demographics is likely to be more informative for prognosis than assessing self-reported recent major life events. However, clinicians might find it useful to ask about such events, and if they are still affecting the patient, consider interventions to tackle problems related to those events (e.g. employment support, mediation, or debt advice). Further investigations of the efficacy of such interventions will be important.
Identifiants
pubmed: 34920035
pii: S0165-0327(21)01345-8
doi: 10.1016/j.jad.2021.12.030
pmc: PMC9113943
pii:
doi:
Types de publication
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
298-308Subventions
Organisme : Wellcome Trust
ID : 201292/Z/16/Z
Pays : United Kingdom
Organisme : Medical Research Council
ID : G0200243
Pays : United Kingdom
Organisme : Department of Health
ID : 06/404/02
Pays : United Kingdom
Organisme : Department of Health
ID : 11/129/76
Pays : United Kingdom
Informations de copyright
Copyright © 2021. Published by Elsevier B.V.
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