Interpersonal Psychotherapy for Depression: A Meta-Analysis
Abstract
Objective:
Method:
Results:
Conclusions:
Method
Search Strategy
Inclusion and Exclusion Criteria
Quality Assessment
Analyses
Power Calculation
Results
Selection and Inclusion of Studies
Characteristics of Included Studies
Study Authors (Reference Number) | IPT Typea | Diagnosis (Basis of Diagnosis)b | Target Group | Study Interventionsc (N) | Formatd | Sessions (N) | ITTe | Outcome Measuresb | Countryf |
---|---|---|---|---|---|---|---|---|---|
Bellino et al. (36) | O | Major depression (clinical judgment) | Adults with borderline personality disorder | IPT+PHA (N=20); PHA (N=19) | IND | 24 | N | HAM-D | IT |
Blom et al. (37) | O | Major depression (SCID) and HAM-D ≥14 | Adult outpatients | IPT (N=50); IPT+PHA (N=49); PHA (N=47); IPT+PLA (N=47) | IND | 12 | Y | HAM-D, MADRS | NL |
Bodenmann et al. (38) | O | Major depression or dysthymia (SCID) | Adults over age 60 (and their partners) | IPT (N=20); COCT (N=20); CBT (N=20) | IND | 20 | Y | HAM-D, BDI | SW |
Bolton et al. (39) | A | Major depression or subsyndromal depression (clinical interview) | Adults | IPT (N=107); UC (N=117) | GRP | 16 | Y | Specially developed measures for local use | UG |
Bolton et al. (40) | A | Major depression or subsyndromal depression (clinical interview) | Adolescent survivors of war and displacement | IPT (N=105); WL (N=104); creative play (N=105) | GRP | 16 | Y | Specially developed measures for local use | UG |
Browne et al. (41) | O | Dysthymia (SCID) with or without major depression | Adults | IPT (N=178); IPT+PHA (N=212); PHA (N=196) | IND | 10 | N | MADRS | CA |
De Mello et al. (42) | A | Dysthymia (clinical interview), major depression permitted | Adults | IPT+PHA (N=16); PHA (N=19) | IND | 16 | N | HAM-D, MADRS | BR |
Elkin et al. (43) | O | Major depression (RDC) and HAM-D ≥14 | Adults | IPT (N=61); CBT (N=59); PHA (N=57); PLA (N=62) | IND | 16 | Y | HAM-D, BDI | US |
Finkenzeller et al. (44) | A | HAM-D ≥14 | Stroke patients | IPT (N=27); IPT+PHA (N=23); PHA (N=24) | GRP | 8 | Y | HAM-D, HADS | GE |
Frank et al. (45) | M | Recovered from major depression (RDC) after acute treatment (PHA+weekly IPT)c | Adults | M-IPT+M-PHA (N=25); M-PHA (N=28); M-IPT (N=26); M-IPT+PLA (N=26); PLA (N=23) | IND | Monthly | Y | Recurrence rate after 3 years | US |
Lespérance et al. (46) | O | Major depression (SCID) and HAM-D-24 ≥20 | Patients with coronary artery disease | IPT+PHA (N=67); PHA (N=75); IPT+PLA (N=75); PLA (N=67) | IND | 12 | Y | HAM-D | CA |
Klerman et al. (47) | M | Clinical improvement after acute treatment (PHAc) for neurotic depression (DSM-II) | Adults | M-IPT+M-PHA (N=25); M-IPT+PLA (N=25); M-IPT (N=25); M-PHA (N=25); PLA (N=25); clinical management only (N=25) | IND | Weekly | Y | Recurrence rate after 8 months | US |
Levkovitz et al. (48) | M | Recovered from major depression (DSM-IV) after acute treatment (PHAc) | Adults | M-IPT+M-PHA (N=7); M-PHA (N=7) | GRP | 18 | Y | HAM-D score at 6-month follow-up | IS |
Luty et al. (49) | O | Major depression (SCID; DSM-III-R) | Adults | IPT (N=91); CBT (N=86) | IND | 16 | Y | MADRS | NZ |
Markowitz et al. (50) | A | HAM-D-24 ≥15 and clinical judgment of depressive symptoms | HIV patients | IPT (N=24); SUP (N=24); CBT (N=27); SUP+PHA (N=26) | IND | 11 | Y | BDI, HAM-D | US |
Markowitz et al. (51) | A | Dysthymia (SCID) and HAM-D-24 >13 | Adults | IPT (N=23); IPT+PHA (N=21); SUP (N=26); PHA (N=24) | IND | 16 | Y | BDI, CDRS, HAM-D | US |
Markowitz et al. (52) | A | Dysthymia (SCID) and HAM-D-24 >13 | Adults with secondary alcohol use disorder | IPT (N=14); SUP (N=12) | IND | 16 | Y | BDI, CDRS, HAM-D | US |
Marshall et al. (53) | O | Major depression (SCID) and HAM-D ≥10 | Adults | IPT (N=35); CBT (N=37); PHA (N=30) | IND | 16 | N | HAM-D | CA |
Martin et al. (54) | O | Major depression (clinical judgment) and HAM-D ≥18 | Adults | IPT (N=13); PHA (N=15) | IND | 16 | Y | BDI, HAM-D | UK |
Mufson et al. (55) | A | HAM-D-24 ≥15 | Adolescents | IPT (N=24); monitoring (N=24) | IND | 12 | Y | BDI, HAM-D | US |
Mufson et al. (56) | A | Mood disorder (K-SADS) | Adolescents | IPT (N=34); UC (N=29) | IND | 12 | Y | BDI, HAM-D | US |
Mulcahy et al. (57) | A | Major depression (DSM-IV, MCMI-III) | Women with postpartum depression | IPT (N=29); UC (N=28) | GRP | 10 | N | EPDS, BDI, HAM-D | AU |
Neimeyer and Feixas (58) | O | Major depression (RDC) and BDI >15 | Adults | IPT (N=39); CBT+homework (N=32); CBT, no homework (N=31) | GRP | 10 | N | HAM-D | US |
O'Hara et al. (59) | A | Major depression (SCID) and HAM-D ≥12 | Women with postpartum depression | IPT (N=60); WL (N=60) | IND | 12 | Y | BDI, HAM-D | US |
Ransom et al. (60) | A | Major depression or dysthymia (PRIME-MD) | Rural HIV patients | IPT (N=41); UC (N=38) | TEL | 10 | Y | BDI | US |
Reynolds et al. (61) | A | Major depression (SADS, SCID) | Bereaved adults (age 50 or older) | IPT+PHA (N=16); PHA (N=25) | IND | 16 | Y | HAM-D | US |
Reynolds et al. (62) | M | Recovered from major depression after 16-week acute treatment (PHA + weekly IPT)c | Older adults | M-PHA+M-IPT (N=25); M-PHA (N=28); M-IPT+PLA (N=25); PLA (N=29) | IND | Monthly | Y | Recurrence rate after 3 years | US |
Reynolds et al. (63) | M | Recovered from major depression after 22-week acute treatment (PHA + weekly IPT)c | Older adults | M-PHA+M-IPT (N=28); M-PHA (N=35); M-IPT+PLA (N=35); PLA (N=18) | IND | Monthly | Y | Recurrence rate after 2 years | US |
Rosselló and Bernal (64) | A | Major depression and/or dysthymia (DISC) | Adolescents | IPT (N=23); CBT (N=25); WL (N=23) | IND | 12 | Y | CDI | PR |
Rosselló et al. (65) | A | Major depression (DISC) or CDI ≥13 | Adolescents | IPT (N=60); CBT (N=52) | IND+ GRP | 12 | Y | CDI | PR |
Schramm et al. (66) | A | Major depression (SCID) and HAM-D ≥16 | Adult inpatients | IPT+PHA (N=63); PHA (N=61) | IND+ GRP | 23 | Y | BDI, HAM-D | GE |
Schulberg et al. (67) | O | Major depression (DIS) and HAM-D ≥13 | Adults | IPT (N=93); PHA (N=91); UC (N=92) | IND | 16 | Y | HAM-D | US |
Sloane et al. (68) | O | Major depression (RDC) and HAM-D ≥17 | Older adults | IPT (N=19); PHA (N=10); PLA (N=14) | IND | 6 | N | BDI, HAM-D | US |
Spinelli and Endicott (69) | A | Major depression (SCID) and HAM-D-24 ≥12 | Pregnant women | IPT (N=21); parenting education (N=17) | IND | 10 | Y | BDI, EPDS, HAM-D | US |
Swartz et al. (70) | A | Major depression (SCID) and HAM-D ≥15 | Mothers whose children receive psychiatric treatment | IPT (N=26); UC (N=21) | IND | 9 | N | BDI, HAM-D | US |
Tang et al. (71) | A | BDI >19 | Adolescents | IPT (N=35); UC (N=38) | IND | 12 | Y | BDI | TW |
Van Schaik et al. (72) | O | Major depression (PRIME-MD) | Older adults (age 55 or older) | IPT (N=69); UC (N=74) | IND | 8 | Y | GDS, MADRS, PRIME-MD | NL |
Weissman et al. (73) | O | Major depression (SADS) and RTADS ≥7 | Adults | IPT (N=17); IPT+PHA (N=23); on-demand telephone support (N=21); PHA (N=20) | IND | 16 | N | RTADS | US |
Quality Assessment
IPT Compared With Standard or No Treatment
Comparison | Number of Comparisons | d | 95% CI | Heterogeneityb | pc | Number Needed to Treat |
---|---|---|---|---|---|---|
IPT versus control condition | ||||||
All studies | 16 | 0.63*** | 0.36 to 0.90 | 82.96*** | 2.91 | |
Outlier removedd | 15 | 0.52*** | 0.36 to 0.68 | 42.84* | 3.50 | |
HAM-D only | 9 | 0.60*** | 0.39 to 0.81 | 40.47 | 3.05 | |
BDI only | 7 | 0.60*** | 0.32 to 0.89 | 59.62* | 3.05 | |
Subgroup analysese | ||||||
Adapted manual | ||||||
No | 5 | 0.29 | 0.12 to 0.47 | 0.00 | 0.004 | 6.17 |
Yes | 10 | 0.67 | 0.48 to 0.85 | 27.52 | 2.75 | |
Target group | ||||||
Adults in general | 3 | 0.37** | 0.15 to 0.58 | 0.00 | 0.214 | 4.85 |
Adolescents | 5 | 0.63*** | 0.43 to 0.82 | 0.00 | 2.91 | |
Specific target group | 7 | 0.53** | 0.19 to 0.87 | 68.11** | 3.42 | |
Basis of diagnosis | ||||||
Diagnostic interview | 12 | 0.57*** | 0.40 to 0.73 | 29.74 | 0.424 | 3.18 |
Self-report | 3 | 0.38 | –0.04 to 0.80 | 67.73* | 4.72 | |
Control group | ||||||
Usual care | 6 | 0.50*** | 0.28 to 0.72 | 32.20 | 0.182 | 3.62 |
Waiting list | 3 | 0.81*** | 0.42 to 1.20 | 59.63 | 2.30 | |
Other | 5 | 0.38** | 0.14 to 0.62 | 0.00 | 4.72 | |
Intent-to-treat analysis | ||||||
Yes | 10 | 0.57*** | 0.38 to 0.76 | 51.56* | 0.718 | 3.18 |
No | 4 | 0.50** | 0.16 to 0.84 | 12.97 | 3.62 | |
IPT versus other psychotherapyf | ||||||
All studies | 13 | 0.04 | –0.14 to 0.21 | 39.81 | 45.45 | |
One effect size per study (highest) | 10 | 0.01 | –0.20 to 0.21 | 44.59 | 166.67 | |
One effect size per study (lowest) | 10 | 0.00 | –0.20 to 0.19 | 41.11 | — | |
HAM-D only | 10 | 0.12 | –0.07 to 0.31 | 19.04 | 14.71 | |
BDI only | 7 | 0.28 | –0.02 to 0.57 | 45.46 | 6.41 | |
Studies on dysthymia excluded | 11 | 0.01 | –0.18 to 0.20 | 42.09 | 166.67 | |
Subgroup analysese | ||||||
Adapted manual | ||||||
Yes | 7 | –0.09 | –0.25 to 0.07 | 0.00 | 0.098 | 20.00 |
No | 6 | 0.25 | –0.12 to 0.63 | 62.27* | 7.14 | |
Comparison group | ||||||
CBT | 9 | –0.04 | –0.23 to 0.16 | 39.72 | 0.113 | 45.45 |
Other psychotherapy | 4 | 0.27 | –0.06 to 0.59 | 4.68 | 6.58 | |
Target group | ||||||
Adults | 8 | –0.08 | –0.24 to 0.08 | 0.00 | 0.116 | 21.74 |
More specific group | 5 | 0.31 | –0.15 to 0.77 | 69.51* | 5.75 | |
Intent-to-treat analysis | ||||||
Yes | 9 | 0.16 | –0.06 to 0.38 | 35.74 | 0.106 | 11.11 |
No | 3 | –0.13 | –0.40 to 0.15 | 0.00 | 13.51 | |
IPT versus pharmacotherapyf | ||||||
All studies | 10 | –0.12 | –0.36 to 0.12 | 61.98** | 14.71 | |
Outlier removedg | 9 | –0.19* | –0.38 to –0.01 | 30.95 | 9.43 | |
HAM-D only | 8 | –0.16 | –0.43 to 0.11 | 57.39* | 11.11 | |
BDI only | 3 | –0.31 | –0.72 to 0.09 | 40.39 | 5.75 | |
Studies on dysthymia excluded | 7 | –0.12 | –0.33 to 0.09 | 23.78 | 14.71 | |
Subgroup analysese | ||||||
Medicationh | ||||||
SSRI or SNRI | 3 | –0.39** | –0.68 to –0.11 | 14.18 | 0.037 | 4.59 |
Tricyclic antidepressant | 4 | –0.02 | –0.22 to 0.19 | 0.00 | 83.33 | |
Intent-to-treat analysis | ||||||
Yes | 5 | –0.15 | –0.42 to 0.13 | 45.10 | 0.450 | 11.90 |
No | 4 | –0.28* | –0.50 to –0.06 | 0.00 | 6.41 | |
Pharmacotherapy versus combination treatmenti | ||||||
All studies | 10 | 0.16 | –0.03 to 0.36 | 39.26 | 11.11 | |
HAM-D only | 8 | 0.21 | –0.11 to 0.52 | 64.64** | 8.47 | |
BDI only | 2 | 0.10 | –0.20 to 0.41 | 0.00 | 17.86 | |
Studies on dysthymia excluded | 7 | 0.22 | –0.03 to 0.47 | 44.17 | 8.06 | |
Subgroup analyses | ||||||
Adapted manual | ||||||
Yes | 5 | 0.23 | –0.04 to 0.51 | 50.15 | 0.494 | 7.69 |
No | 5 | 0.08 | –0.25 to 0.41 | 40.50 | 21.74 | |
Medication | ||||||
SSRI | 5 | 0.07 | –0.27 to 0.41 | 64.96* | 0.562 | 25.00 |
Tricyclic antidepressant | 2 | 0.33 | –0.11 to 0.76 | 0.00 | 5.43 | |
Other/protocol | 3 | 0.27 | –0.00 to 0.54 | 0.00 | 6.58 | |
Target group | ||||||
Adults | 5 | 0.07 | –0.12 to 0.27 | 0.00 | 0.569 | 25.00 |
More specific group | 5 | 0.19 | –0.16 to 0.54 | 61.35* | 9.43 | |
Intent-to-treat analysis | ||||||
Yes | 6 | 0.12 | –0.10 to 0.34 | 23.03 | 0.391 | 14.71 |
No | 4 | 0.35 | –0.12 to 0.82 | 63.84* | 5.10 |
IPT Compared With Other Psychotherapies
IPT Compared With Pharmacotherapy
IPT Compared With Combination Treatment
IPT as Maintenance Treatment
Discussion
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