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Fried EI, Cristea IA, Naudet F. Treating Bipolar Depression Using Psilocybin-Validity Threats Regarding Efficacy and Safety. JAMA Psychiatry 2024:2817596. [PMID: 38598200 DOI: 10.1001/jamapsychiatry.2024.0420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Eiko I Fried
- Department of Psychology, Clinical Psychology Unit, Leiden University, Leiden, the Netherlands
| | - Ioana A Cristea
- Department of General Psychology, University of Padova, Padova, Italy
| | - Florian Naudet
- University of Rennes, University Hospital of Rennes, Inserm, Institut de recherche en santé, environnement et travail, Rennes, France
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Miguel C, Cecconi J, Harrer M, van Ballegooijen W, Bhattacharya S, Karyotaki E, Cuijpers P, Gentili C, Cristea IA. Assessment of suicidality in trials of psychological interventions for depression: a meta-analysis. Lancet Psychiatry 2024; 11:252-261. [PMID: 38428438 DOI: 10.1016/s2215-0366(24)00027-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Psychological interventions that are efficacious as treatments for depression could indirectly affect suicide-related outcomes. We examined suicidal thoughts and behaviours as eligibility criteria, outcomes, and adverse events across trials of psychotherapy for depression. METHODS We used a publicly available meta-analytic database developed through systematic searches (updated as of May 1, 2023) to identify randomised controlled trials in which a psychological intervention for depression was compared with an inactive or non-specific control condition in adults with depression and in which any suicide-related outcomes were reported. We also identified studies in which suicide risk was an exclusion criterion. We excluded inpatient studies and trials of unguided digital interventions or collaborative care that included a psychological component. Pairs of reviewers worked independently to select studies and extract data. In a random-effects meta-analysis with robust variance estimation, we assessed the effect of the psychological intervention on suicide outcomes in trials in which suicide was explicitly assessed as an outcome with clinical scales with established psychometric properties. Risk of bias was assessed with the Cochrane risk-of-bias tool (version 2). FINDINGS Of the 469 randomised trials we identified in which a psychological intervention was compared with an inactive control in people with depression, 251 excluded people judged at risk of suicide. Any assessment of suicide was included in only 45 trials, 12 of which assessed suicidal ideation or risk as an outcome. These 12 trials included 3930 participants, 2795 (71%) of whom were female and 1135 (29%) of whom were male; data for age and ethnicity were not consistently reported. Psychological interventions for depression were associated with a small reduction in suicidal ideation and risk in 11 trials (one trial reported only follow-up data) after the intervention (standardised mean difference -0·31 [95% CI -0·60 to -0·03]) but not at follow-up (-0·49 [-1·31 to 0·32]). Suicide-related adverse events were reported in 25 trials, and suicide-related serious adverse events (eg, suicide attempts, deaths by suicide) were reported in 13 trials. Heterogeneity was substantial across all analyses, and prediction intervals crossed zero. INTERPRETATION Trials of psychological interventions for depression rarely report assessments of suicide. Psychological interventions might reduce suicidal ideation in patients with depression, but more randomised controlled trials are required to clarify this effect. Monitoring and reporting of suicide-related adverse events should be improved in trials of psychological interventions for depression, and future trials should incorporate outcomes related to suicidal thoughts or behaviours. FUNDING None. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jessica Cecconi
- Department of General Psychology, University of Padua, Padua, Italy
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Technical University of Munich, Munich, Germany
| | - Wouter van Ballegooijen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands; Department of Psychiatry, Amsterdam UMC, Amsterdam, Netherlands
| | - Shalini Bhattacharya
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Claudio Gentili
- Department of General Psychology, University of Padua, Padua, Italy
| | - Ioana A Cristea
- Department of General Psychology, University of Padua, Padua, Italy.
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Naudet F, Patel CJ, DeVito NJ, Le Goff G, Cristea IA, Braillon A, Hoffmann S. Improving the transparency and reliability of observational studies through registration. BMJ 2024; 384:e076123. [PMID: 38195116 DOI: 10.1136/bmj-2023-076123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Affiliation(s)
- Florian Naudet
- CHU Rennes, Inserm, Institut de Recherche en Santé, Environnement et Travail-UMR_S 1085, University of Rennes, Rennes, France
- Institut Universitaire de France, Paris, France
| | - Chirag J Patel
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicholas J DeVito
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Ioana A Cristea
- Department of General Psychology, University of Padova, Padova, Italy
| | | | - Sabine Hoffmann
- Department of Statistics, Ludwig-Maximilians-Universität München, Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
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Dal-Ré R, Banzi R, Cristea IA, Fernández-de-Las-Peñas C, Hemkens LG, Janiaud P, Jansen MS, Naudet F, Rosendaal FR. Using the phases of clinical development of medicines to describe clinical trials assessing other interventions is widespread but not useful. J Clin Epidemiol 2023; 161:157-163. [PMID: 37517503 DOI: 10.1016/j.jclinepi.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Rafael Dal-Ré
- Epidemiology Unit, Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Rita Banzi
- Center for Health Regulatory Policies, Istituto di Ricerche Farmacologiche Mario Negri - IRCCS, Milan, Italy
| | - Ioana A Cristea
- Department of General Psychology, University of Padova, Padova, Italy
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Lars G Hemkens
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland; Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA; Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
| | - Perrine Janiaud
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Marieke S Jansen
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Florian Naudet
- Univ Rennes, CHU Rennes, Inserm, Centre d'investigation clinique de Rennes (CIC1414), Service de pharmacologie clinique, Institut de recherche en santé, environnement et travail (Irset), UMR S 1085, EHESP, Rennes, France
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Braillon A, Fried EI, Cristea IA, Cosgrove L, Naudet F. Treatments for major depression. Lancet 2023; 401:2110. [PMID: 37355287 DOI: 10.1016/s0140-6736(23)00953-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/04/2023] [Indexed: 06/26/2023]
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Setkowski K, Palantza C, van Ballegooijen W, Gilissen R, Oud M, Cristea IA, Noma H, Furukawa TA, Arntz A, van Balkom AJLM, Cuijpers P. Which psychotherapy is most effective and acceptable in the treatment of adults with a (sub)clinical borderline personality disorder? A systematic review and network meta-analysis. Psychol Med 2023; 53:3261-3280. [PMID: 37203447 PMCID: PMC10277776 DOI: 10.1017/s0033291723000685] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 02/11/2023] [Accepted: 02/27/2023] [Indexed: 05/20/2023]
Abstract
A broad range of psychotherapies have been proposed and evaluated in the treatment of borderline personality disorder (BPD), but the question which specific type of psychotherapy is most effective remains unanswered. In this study, two network meta-analyses (NMAs) were conducted investigating the comparative effectiveness of psychotherapies on (1) BPD severity and (2) suicidal behaviour (combined rate). Study drop-out was included as a secondary outcome. Six databases were searched until 21 January 2022, including RCTs on the efficacy of any psychotherapy in adults (⩾18 years) with a diagnosis of (sub)clinical BPD. Data were extracted using a predefined table format. PROSPERO ID:CRD42020175411. In our study, a total of 43 studies (N = 3273) were included. We found significant differences between several active comparisons in the treatment of (sub)clinical BPD, however, these findings were based on very few trials and should therefore be interpreted with caution. Some therapies were more efficacious compared to GT or TAU. Furthermore, some treatments more than halved the risk of attempted suicide and committed suicide (combined rate), reporting RRs around 0.5 or lower, however, these RRs were not statistically significantly better compared to other therapies or to TAU. Study drop-out significantly differed between some treatments. In conclusion, no single treatment seems to be the best choice to treat people with BPD compared to other treatments. Nevertheless, psychotherapies for BPD are perceived as first-line treatments, and should therefore be investigated further on their long-term effectiveness, preferably in head-to-head trials. DBT was the best connected treatment, providing solid evidence of its effectiveness.
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Affiliation(s)
- Kim Setkowski
- Research Department, 113 Suicide Prevention, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC, VU University, Amsterdam Public Health research institute, and GGZinGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Christina Palantza
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Wouter van Ballegooijen
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC, VU University, Amsterdam Public Health research institute, and GGZinGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Renske Gilissen
- Research Department, 113 Suicide Prevention, Amsterdam, the Netherlands
| | - Matthijs Oud
- Department of Treatment, Care and Reintegration, Trimbos Institute, Utrecht, the Netherlands
| | - Ioana A. Cristea
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Toshi A. Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Arnoud Arntz
- Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Anton J. L. M. van Balkom
- Department of Psychiatry, Amsterdam UMC, VU University, Amsterdam Public Health research institute, and GGZinGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
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Miguel C, Karyotaki E, Ciharova M, Cristea IA, Penninx BW, Cuijpers P. Psychotherapy for comorbid depression and somatic disorders: a systematic review and meta-analysis. Psychol Med 2023; 53:2503-2513. [PMID: 34792017 PMCID: PMC10123840 DOI: 10.1017/s0033291721004414] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 09/01/2021] [Accepted: 10/11/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The treatment of depression in patients with somatic disorders is crucial, given its negative impact on quality of life (QoL), functioning, and even on the somatic disease prognosis. We aimed to examine the most updated evidence on the effects of psychotherapy in patients with depression and somatic disorders, including HIV, oncological, cardiometabolic, and neurological disorders. METHODS We conducted a meta-analysis of 75 randomized trials (8209 participants) of psychotherapy for adults with somatic disorders and a diagnosis or elevated symptoms of depression. Outcomes included depression, QoL, somatic health-related outcomes, and mortality. RESULTS Psychotherapy significantly reduced the severity of depression at post-treatment across all categories of somatic disorders (Hedges'g = 0.65; 95% CI 0.52-0.79), with sustained effects at 6-11 months (g = 0.38; 95% CI 0.22-0.53) and at 12 months follow-up or longer (g = 0.13; 95% CI 0.04-0.21). Psychotherapy also showed significant effects on QoL (g = 0.26; 95% CI 0.17-0.35), maintained up to 11 months follow-up (g = 0.25; 95% CI 0.16-0.34). No significant effects were observed on the most frequently reported somatic health-related outcomes (glycemic control, pain), and neither on mortality. Heterogeneity in most analyses was very high, and only 29 (38%) trials were rated at low risk of bias (RoB). CONCLUSIONS Psychotherapy may be an effective treatment option for patients with depression and somatic disorders, with long-term effects on depression severity and QoL. However, these results should be interpreted with caution due to heterogeneity and RoB.
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Affiliation(s)
- Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, The Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Ioana A. Cristea
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Brenda W.J.H. Penninx
- Department of Psychiatry, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, The Netherlands
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Cristea IA, Halvorsen JØ, Cosgrove L, Naudet F. Psychotherapy and psychedelic drugs - Authors' reply. Lancet Psychiatry 2023; 10:168. [PMID: 36804069 DOI: 10.1016/s2215-0366(23)00029-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Ioana A Cristea
- Department of General Psychology, University of Padova, Padova 35131, Italy.
| | - Joar Øveraas Halvorsen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; St Olavs University Hospital, Trondheim, Norway
| | - Lisa Cosgrove
- Applied Ethics Center, University of Massachusetts, Boston, MA, USA
| | - Florian Naudet
- Clinical Investigation Center, University of Rennes, 1, Rennes, France; Clinical Investigation Center (INSERM 1414) and Adult Psychiatry Department, Rennes University Hospital, Rennes, France
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Cristea IA, Halvorsen JØ, Cosgrove L, Naudet F. New treatments for mental disorders should be routinely compared to psychotherapy in trials conducted for regulatory purposes. Lancet Psychiatry 2022; 9:934-936. [PMID: 36403594 DOI: 10.1016/s2215-0366(22)00340-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/15/2022] [Accepted: 09/20/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Ioana A Cristea
- Department of General Psychology, University of Padova, Padova, Italy.
| | - Joar Øveraas Halvorsen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; St Olav's University Hospital, Trondheim, Norway
| | - Lisa Cosgrove
- Applied Ethics Center, University of Massachusetts, Boston, MA, USA
| | - Florian Naudet
- Clinical Investigation Center, University of Rennes 1, Rennes, France; Clinical Investigation Center and Adult Psychiatry Department, Rennes University Hospital, Rennes, France
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Naudet F, Fried EI, Cosgrove L, Turner E, Braillon A, Cristea IA. Psychedelic drugs: more emphasis on safety issues. Nature 2022; 611:449. [DOI: 10.1038/d41586-022-03680-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Driessen E, Cohen ZD, Lorenzo-Luaces L, Hollon SD, Richards DA, Dobson KS, Dimidjian S, Delgadillo J, Vázquez FL, McNamara K, Horan JJ, Gardner P, Oei TP, Mehta AHP, Twisk JWR, Cristea IA, Cuijpers P. Efficacy and moderators of cognitive therapy versus behavioural activation for adults with depression: study protocol of a systematic review and meta-analysis of individual participant data. BJPsych Open 2022; 8:e154. [PMID: 35946068 PMCID: PMC9379999 DOI: 10.1192/bjo.2022.560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cognitive therapy and behavioural activation are both widely applied and effective psychotherapies for depression, but it is unclear which works best for whom. Individual participant data (IPD) meta-analysis allows for examining moderators at the participant level and can provide more precise effect estimates than conventional meta-analysis, which is based on study-level data. AIMS This article describes the protocol for a systematic review and IPD meta-analysis that aims to compare the efficacy of cognitive therapy and behavioural activation for adults with depression, and to explore moderators of treatment effect. (PROSPERO: CRD42022341602). METHOD Systematic literature searches will be conducted in PubMed, PsycINFO, EMBASE and the Cochrane Library, to identify randomised clinical trials comparing cognitive therapy and behavioural activation for adult acute-phase depression. Investigators of these trials will be invited to share their participant-level data. One-stage IPD meta-analyses will be conducted with mixed-effects models to assess treatment effects and to examine various available demographic, clinical and psychological participant characteristics as potential moderators. The primary outcome measure will be depressive symptom level at treatment completion. Secondary outcomes will include post-treatment anxiety, interpersonal functioning and quality of life, as well as follow-up outcomes. CONCLUSIONS To the best of our knowledge, this will be the first IPD meta-analysis concerning cognitive therapy versus behavioural activation for adult depression. This study has the potential to enhance our knowledge of depression treatment by using state-of-the-art statistical techniques to compare the efficacy of two widely used psychotherapies, and by shedding more light on which of these treatments might work best for whom.
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Affiliation(s)
- Ellen Driessen
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, The Netherlands; and Depression Expertise Center, Pro Persona Mental Health Care, The Netherlands
| | - Zachary D Cohen
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | | | | | - David A Richards
- Department of Health and Community Science, Faculty of Health and Life Sciences, University of Exeter, UK; and Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Norway
| | | | - Sona Dimidjian
- Crown Institute and Department of Psychology and Neuroscience, University of Colorado Boulder, USA
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, University of Sheffield, UK
| | - Fernando L Vázquez
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Spain
| | | | - John J Horan
- Counseling Psychology Program, Arizona State University, USA
| | - Pauline Gardner
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Australia
| | - Tian P Oei
- School of Psychology, The University of Queensland, Australia
| | - Anuj H P Mehta
- Department of Psychology, University of Toronto Scarborough, Canada
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, The Netherlands
| | - Ioana A Cristea
- Department of Brain and Behavioral Sciences, University of Pavia; and IRCCS Mondino Foundation, Italy
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
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Collaco JM, Tracy MC, Sheils CA, Rice JL, Rhein LM, Nelin LD, Moore PE, Manimtim WM, Levin JC, Lai K, Hayden LP, Fierro JL, Austin ED, Alexiou S, Agarwal A, Villafranco N, Siddaiah R, Popova AP, Cristea IA, Baker CD, Bansal M, McGrath-Morrow SA. Insurance coverage and respiratory morbidities in bronchopulmonary dysplasia. Pediatr Pulmonol 2022; 57:1735-1743. [PMID: 35437911 PMCID: PMC9232996 DOI: 10.1002/ppul.25933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/07/2022] [Accepted: 04/17/2022] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Preterm infants and young children with bronchopulmonary dysplasia (BPD) are at increased risk for acute care utilization and chronic respiratory symptoms during early life. Identifying risk factors for respiratory morbidities in the outpatient setting could decrease the burden of care. We hypothesized that public insurance coverage was associated with higher acute care usage and respiratory symptoms in preterm infants and children with BPD after initial neonatal intensive care unit (NICU) discharge. METHODS Subjects were recruited from BPD clinics at 10 tertiary care centers in the United States between 2018 and 2021. Demographics and clinical characteristics were obtained through chart review. Surveys for clinical outcomes were administered to caregivers. RESULTS Of the 470 subjects included in this study, 249 (53.0%) received employer-based insurance coverage and 221 (47.0%) received Medicaid as sole coverage at least once between 0 and 3 years of age. The Medicaid group was twice as likely to have sick visits (adjusted odd ratio [OR]: 2.06; p = 0.009) and emergency department visits (aOR: 2.09; p = 0.028), and three times more likely to be admitted for respiratory reasons (aOR: 3.04; p = 0.001) than those in the employer-based group. Additionally, those in the Medicaid group were more likely to have nighttime respiratory symptoms (aOR: 2.62; p = 0.004). CONCLUSIONS Children with BPD who received Medicaid coverage were more likely to utilize acute care and have nighttime respiratory symptoms during the first 3 years of life. More comprehensive studies are needed to determine whether the use of Medicaid represents a barrier to accessing care, lower socioeconomic status, and/or a proxy for detrimental environmental exposures.
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Affiliation(s)
- Joseph M Collaco
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michael C Tracy
- Division of Pediatric Pulmonary, Stanford University, Stanford, California, USA
| | - Catherine A Sheils
- Division of Pulmonary Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica L Rice
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lawrence M Rhein
- Neonatal-Perinatal Medicine/Pediatric Pulmonology, University of Massachusetts, Worcester, Massachusetts, USA
| | - Leif D Nelin
- Division of Neonatology, Nationwide Children's Hospital and Ohio State University, Columbus, Ohio, USA
| | - Paul E Moore
- Pulmonary Medicine, Vanderbilt University and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Winston M Manimtim
- Neonatal/Perinatal Medicine, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Jonathan C Levin
- Division of Pulmonary Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Khanh Lai
- Division of Pediatric Pulmonary and Sleep Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Lystra P Hayden
- Division of Pulmonary Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Julie L Fierro
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eric D Austin
- Pulmonary Medicine, Vanderbilt University and Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stamatia Alexiou
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amit Agarwal
- Division of Pulmonary Medicine, Arkansas Children's Hospital and University of Arkansas for medical Sciences, Little Rock AR, Pennsylvania, USA
| | - Natalie Villafranco
- Pulmonary Medicine, Texas Children's Hospital and Baylor University, Houston, Texas, USA
| | - Roopa Siddaiah
- Pediatric Pulmonology, Penn State Health, Hershey, Pennsylvania, USA
| | - Antonia P Popova
- Pediatric Pulmonology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ioana A Cristea
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Children's Hospital and Indiana University, Indianapolis, Indiana, USA
| | - Christopher D Baker
- Section of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Manvi Bansal
- Pulmonology and Sleep Medicine, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Sharon A McGrath-Morrow
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Scanff A, Naudet F, Cristea IA, Moher D, Bishop DVM, Locher C. Correction: A survey of biomedical journals to detect editorial bias and nepotistic behavior. PLoS Biol 2022; 20:e3001525. [PMID: 35041657 PMCID: PMC8765609 DOI: 10.1371/journal.pbio.3001525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Scanff A, Naudet F, Cristea IA, Moher D, Bishop DVM, Locher C. A survey of biomedical journals to detect editorial bias and nepotistic behavior. PLoS Biol 2021; 19:e3001133. [PMID: 34813595 PMCID: PMC8610247 DOI: 10.1371/journal.pbio.3001133] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 10/20/2021] [Indexed: 11/23/2022] Open
Abstract
Alongside the growing concerns regarding predatory journal growth, other questionable editorial practices have gained visibility recently. Among them, we explored the usefulness of the Percentage of Papers by the Most Prolific author (PPMP) and the Gini index (level of inequality in the distribution of authorship among authors) as tools to identify journals that may show favoritism in accepting articles by specific authors. We examined whether the PPMP, complemented by the Gini index, could be useful for identifying cases of potential editorial bias, using all articles in a sample of 5,468 biomedical journals indexed in the National Library of Medicine. For articles published between 2015 and 2019, the median PPMP was 2.9%, and 5% of journal exhibited a PPMP of 10.6% or more. Among the journals with the highest PPMP or Gini index values, where a few authors were responsible for a disproportionate number of publications, a random sample was manually examined, revealing that the most prolific author was part of the editorial board in 60 cases (61%). The papers by the most prolific authors were more likely to be accepted for publication within 3 weeks of their submission. Results of analysis on a subset of articles, excluding nonresearch articles, were consistent with those of the principal analysis. In most journals, publications are distributed across a large number of authors. Our results reveal a subset of journals where a few authors, often members of the editorial board, were responsible for a disproportionate number of publications. To enhance trust in their practices, journals need to be transparent about their editorial and peer review practices.
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Affiliation(s)
- Alexandre Scanff
- Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d’Investigation Clinique de Rennes), Rennes, France
| | - Florian Naudet
- Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d’Investigation Clinique de Rennes), Rennes, France
| | - Ioana A. Cristea
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Dorothy V. M. Bishop
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Clara Locher
- Univ Rennes, CHU Rennes, Inserm, CIC 1414 (Centre d’Investigation Clinique de Rennes), Rennes, France
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15
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Cristea IA, Nechita DM. Effective psychological interventions for relapse prevention in schizophrenia. Lancet Psychiatry 2021; 8:938-939. [PMID: 34653392 DOI: 10.1016/s2215-0366(21)00351-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Ioana A Cristea
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; IRCCS Mondino Foundation, Pavia, Italy.
| | - Diana M Nechita
- Department of Clinical Psychology and Psychotherapy, and International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania
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16
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Affiliation(s)
- Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ioana A. Cristea
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly,IRCCS Mondino FoundationPaviaItaly
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17
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Abstract
Florian Naudet and co-authors propose a pathway involving registered criteria for evaluation and approval of new drugs.
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Affiliation(s)
- Florian Naudet
- Université de Rennes 1, CHU Rennes, Inserm, CIC 1414 (Centre d’Investigation Clinique de Rennes), Rennes, France
- * E-mail:
| | - Maximilian Siebert
- Université de Rennes 1, CHU Rennes, Inserm, CIC 1414 (Centre d’Investigation Clinique de Rennes), Rennes, France
| | - Rémy Boussageon
- Université Claude Bernard Lyon 1, CNRS, UMR 5558, LBBE, EMET, Lyon, France
| | - Ioana A. Cristea
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Erick H. Turner
- Behavioral Health and Neurosciences Division, VA Portland Health Care System, Portland, Oregon, United States of America
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, United States of America
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18
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Cuijpers P, Quero S, Noma H, Ciharova M, Miguel C, Karyotaki E, Cipriani A, Cristea IA, Furukawa TA. Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types. World Psychiatry 2021; 20:283-293. [PMID: 34002502 PMCID: PMC8129869 DOI: 10.1002/wps.20860] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The effects of psychotherapies for depression have been examined in several hundreds of randomized trials, but no recent network meta-analysis (NMA) has integrated the results of these studies. We conducted an NMA of trials comparing cognitive behavioural, interpersonal, psychodynamic, problem-solving, behavioural activation, life-review and "third wave" therapies and non-directive supportive counseling with each other and with care-as-usual, waiting list and pill placebo control conditions. Response (50% reduction in symptoms) was the primary outcome, but we also assessed remission, standardized mean difference, and acceptability (all-cause dropout rate). Random-effects pairwise and network meta-analyses were conducted on 331 randomized trials with 34,285 patients. All therapies were more efficacious than care-as-usual and waiting list control conditions, and all therapies - except non-directive supportive counseling and psychodynamic therapy - were more efficacious than pill placebo. Standardized mean differences compared with care-as-usual ranged from -0.81 for life-review therapy to -0.32 for non-directive supportive counseling. Individual psychotherapies did not differ significantly from each other, with the only exception of non-directive supportive counseling, which was less efficacious than all other therapies. The results were similar when only studies with low risk of bias were included. Most therapies still had significant effects at 12-month follow-up compared to care-as-usual, and problem-solving therapy was found to have a somewhat higher long-term efficacy than some other therapies. No consistent differences in acceptability were found. Our conclusion is that the most important types of psychotherapy are efficacious and acceptable in the acute treatment of adult depression, with few significant differences between them. Patient preference and availability of each treatment type may play a larger role in the choice between types of psychotherapy, although it is possible that a more detailed characterization of patients with a diagnosis of depression may lead to a more precise matching between individual patients and individual psychotherapies.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Soledad Quero
- Department of Basic and Clinical Psychology and PsychobiologyUniversitat Jaume ICastellónSpain,CIBER of Physiopathology of Obesity and Nutrition (CIBEROBN)MadridSpain
| | - Hisashi Noma
- Department of Data ScienceInstitute of Statistical MathematicsTokyoJapan
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Andrea Cipriani
- Department of PsychiatryUniversity of OxfordOxfordUK,Oxford Health NHS Foundation TrustWarneford HospitalOxfordUK
| | - Ioana A. Cristea
- Department of Brain and Behavioral SciencesUniversity of PaviaPaviaItaly,IRCCS Mondino FoundationPaviaItaly
| | - Toshi A. Furukawa
- Department of Health Promotion and Human BehaviorKyoto University Graduate School of Medicine, School of Public HealthKyotoJapan
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19
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Affiliation(s)
- Ioana A Cristea
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Tomaso Vecchi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,IRCCS Mondino Foundation, Pavia, Italy
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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20
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Cuijpers P, Quero S, Papola D, Cristea IA, Karyotaki E. Care-as-usual control groups across different settings in randomized trials on psychotherapy for adult depression: a meta-analysis. Psychol Med 2021; 51:634-644. [PMID: 31843031 DOI: 10.1017/s0033291719003581] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Care-as-usual (CAU) is often used as a control condition in psychotherapy research, but it may vary considerably what that entails, ranging from no treatment, to routine treatment in primary care, general medical care, perinatal care, and specialized mental health care. METHODS We conducted a meta-analysis of trials comparing psychotherapy for depression to CAU, with a focus on the different categories of CAU and countries where the studies were conducted. We used an existing database of randomized trials on psychotherapy for depression that is updated every year. RESULTS A total of 140 studies with 15 419 patients were included. We found no significant differences in effects between categories of CAU (effect sizes ranging from g = 0.43 for CAU in primary care to g = 0.73 for no treatment), but heterogeneity was high in all CAU categories. After stratifying effects across specific countries (within CAU categories) we found that heterogeneity was considerably lower and there were several significant differences between countries. Overall, effects were larger in non-Western countries (g = 0.84 to 1.28) compared to those in Western countries (g = 0.52; p for difference = 0.002). Effects were smaller in studies with risk of bias (p = 0.01). CONCLUSIONS There are no significant differences between major categories of CAU when compared to psychotherapy conditions in randomized trials. However, effects of psychotherapy differ considerably across CAU conditions in specific countries. CAU therefore is a heterogeneous control condition in psychotherapy research.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Soledad Quero
- Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Davide Papola
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Neuroscience, Biomedicine and Movement Science, Section of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Ioana A Cristea
- Department of Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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21
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Gál É, Ștefan S, Cristea IA. The efficacy of mindfulness meditation apps in enhancing users' well-being and mental health related outcomes: a meta-analysis of randomized controlled trials. J Affect Disord 2021; 279:131-142. [PMID: 33049431 DOI: 10.1016/j.jad.2020.09.134] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/30/2020] [Accepted: 09/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mindfulness applications are popular tools for improving well-being, but their effectiveness is unclear. We conducted a meta-analysis of randomized controlled trials (RCTs) that employed a mindfulness meditation app as the main intervention to improve users' well-being and mental-health related outcomes. METHODS A systematic search was conducted in PsycINFO, PubMed, Web of Science, ProQuest Dissertations and Theses Global, the Cochrane Library, Open Grey and ResearchGate through June, 2020. Effects were calculated as standardized mean difference (Hedges' g) between app-delivered mindfulness interventions and control conditions at post-test and pooled with a random-effects model. RESULTS From 2637 records, we selected 34 trials (N = 7566). Significant effect sizes were found at post-test for perceived stress (n = 15; g = 0.46, 95% CI [0.24, .68], I2= 68%), anxiety (n = 15; g = 0.28, 95% CI [0.16, .40], I2= 35%), depression (n = 15; g = 0.33, 95% CI [0.24, .43], I2= 0%), and psychological well-being (n = 5; g = 0.29, 95% CI [0.14, .45], I2= 0%). No significant effects were found for distress at post-test (n = 6; g = 0.10, 95% CI [-0.02, .22], I2= 11%) and general well-being (n = 5; g = 0.14, 95% CI [-0.02, 0.29], I2 = 14%). CONCLUSION AND LIMITATIONS Mindfulness apps seem promising in improving well-being and mental-health, though results should be interpreted carefully due to the small number of included studies, overall uncertain risk of bias and heterogeneity.
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Affiliation(s)
- Éva Gál
- Evidence Based Psychological Assessment and Interventions Doctoral School, Babeș- Bolyai University, Cluj-Napoca, Romania.
| | - Simona Ștefan
- Department of Clinical Psychology and Psychotherapy, Babeș- Bolyai University, Cluj-Napoca, Romania; The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș- Bolyai University, Cluj- Napoca, Romania
| | - Ioana A Cristea
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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22
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Cosgrove L, Naudet F, Högberg G, Shaughnessy AF, Cristea IA. Reconceptualising treatment-resistant depression as difficult-to-treat depression. Lancet Psychiatry 2021; 8:11-13. [PMID: 33065028 DOI: 10.1016/s2215-0366(20)30416-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/01/2020] [Accepted: 09/04/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Lisa Cosgrove
- Department of Counseling Psychology, University of Massachusetts-Boston, Boston, MA, USA
| | - Florian Naudet
- University of Rennes 1, Rennes, France; Clinical Investigation Centre (INSERM 1414), Rennes University Hospital, Rennes, France
| | | | - Allen F Shaughnessy
- Tufts University School of Medicine, Malden, MA, USA; Cambridge Health Alliance, Malden, MA, USA
| | - Ioana A Cristea
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy.
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23
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Braillon A, Naudet F, Cristea IA, Lexchin J. Baclofen and Alcohol Use Disorders: Breakthrough or Great White Elephant? Alcohol Alcohol 2020; 55:49-50. [PMID: 31761929 DOI: 10.1093/alcalc/agz083] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/19/2019] [Accepted: 09/10/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alain Braillon
- Alcohol Treatment Unit, University Hospital, 80000 Amiens, France
| | - Florian Naudet
- Centre d'Investigation Clinique, University Hospital and Inserm, 35000 Rennes, France
| | - Ioana A Cristea
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Joel Lexchin
- School of Health Policy and Management, York University, Toronto, Canada
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24
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Affiliation(s)
- Florian Naudet
- University of Rennes, CHU Rennes, Inserm, CIC 1414 [(Centre d'Investigation Clinique de Rennes)], F- 35000, Rennes, France
| | - Alain Braillon
- Alcohol treatment unit, University Hospital, Amiens, France
| | - Ioana A Cristea
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Joel Lexchin
- School of Health Policy and Management, York University, Toronto, Canada
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25
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Gentili C, Cecchetti L, Handjaras G, Lettieri G, Cristea IA. The case for preregistering all region of interest (ROI) analyses in neuroimaging research. Eur J Neurosci 2020; 53:357-361. [PMID: 32852863 DOI: 10.1111/ejn.14954] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/16/2020] [Accepted: 08/12/2020] [Indexed: 01/31/2023]
Abstract
In neuroimaging studies, small sample sizes and the resultant reduced statistical power to detect effects that are not large, combined with inadequate analytic choices, concur to produce inflated or false-positive findings. To mitigate these issues, researchers often restrict analyses to specific brain areas, using the region of interest (ROI) approach. Crucially, ROI analysis assumes the a priori justified definition of the target region. Nonetheless, reports often lack details about where in the timeline, ranging from study conception to the data analysis and interpretation of findings, were ROIs selected. Frequently, the rationale for ROI selection is vague or inadequately founded on the existing literature. These shortcomings have important implications for ROI-based studies, augmenting the risk that observed effects are inflated or even false positives. Tools like preregistration and registered reports could address this problem, ensuring the validity of ROI-based studies. The benefits could be enhanced by additional practices such as selection of ROIs using quantitative methods (i.e., meta-analysis) and the sharing of whole-brain unthresholded maps of effect size, as well as of binary ROIs, in publicly accessible repositories.
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Affiliation(s)
- Claudio Gentili
- Department of General Psychology, University of Padova, Padova, Italy
| | - Luca Cecchetti
- Social and Affective Neuroscience Group, MoMiLab, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Giacomo Handjaras
- Social and Affective Neuroscience Group, MoMiLab, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Giada Lettieri
- Social and Affective Neuroscience Group, MoMiLab, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Ioana A Cristea
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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26
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Georgescu R, Fodor LA, Dobrean A, Cristea IA. Psychological interventions using virtual reality for pain associated with medical procedures: a systematic review and meta-analysis. Psychol Med 2020; 50:1795-1807. [PMID: 31456530 DOI: 10.1017/s0033291719001855] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Virtual reality (VR) may enhance the effectiveness of psychological interventions for acute pain. We conducted a meta-analysis to assess the efficacy and safety of VR-based interventions for pain associated with medical procedures. METHODS We searched PubMed, EMBASE, the Cochrane Library, and PsycINFO until June 17th 2018. We identified randomized controlled trials (RCTs), comparing VR-based psychological interventions to usual care, for pain intensity (primary outcome) or affective and cognitive components of pain (secondary outcomes), assessed real-time or retrospectively. Two independent reviewers performed study selection and data extraction. Risk of bias was independently evaluated by three raters using the revised Cochrane Collaboration tool. A random-effects model using the Paule and Mandel estimator was used for pooling effect sizes. RESULTS 27 RCTs (1452 patients) provided enough data for meta-analysis. Compared to usual care, VR-based interventions reduced pain intensity both real-time (9 RCTs, Hedges' g = 0.95, 95% CI 0.32-1.57) and retrospectively (22 RCTs, g = 0.87, 95% CI 0.54-1.21). Results were similar for cognitive (8 RCTs, g = 0.82, 95% CI 0.39-1.26) and affective pain components (14 RCTs, g = 0.55, 95% CI 0.34-0.77). There was marked heterogeneity, which remained similarly high in sensitivity analyses. Across domains, few trials were rated as low risk of bias and there was evidence of publication bias. Adverse events were rare. CONCLUSIONS Though VR-based interventions reduced pain for patients undergoing medical procedures, inferring clinical effectiveness is precluded by the predominance of small trials, with substantial risk of bias, and by incomplete reporting.
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Affiliation(s)
- Raluca Georgescu
- International Institute for The Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania
- Evidence Based Psychological Assessment and Interventions Doctoral School, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Liviu A Fodor
- International Institute for The Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania
- Evidence Based Psychological Assessment and Interventions Doctoral School, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Anca Dobrean
- International Institute for The Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Republicii Street 37, 400015, Cluj-Napoca, Romania
| | - Ioana A Cristea
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Republicii Street 37, 400015, Cluj-Napoca, Romania
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
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Gentili C, Cristea IA. Challenges and Opportunities for Human Behavior Research in the Coronavirus Disease (COVID-19) Pandemic. Front Psychol 2020; 11:1786. [PMID: 32754106 PMCID: PMC7365873 DOI: 10.3389/fpsyg.2020.01786] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/29/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Claudio Gentili
- Department of General Psychology, University of Padova, Padua, Italy
| | - Ioana A. Cristea
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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28
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Fodor LA, Georgescu R, Cuijpers P, Szamoskozi Ş, David D, Furukawa TA, Cristea IA. Efficacy of cognitive bias modification interventions in anxiety and depressive disorders: a systematic review and network meta-analysis. Lancet Psychiatry 2020; 7:506-514. [PMID: 32445689 DOI: 10.1016/s2215-0366(20)30130-9] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/26/2020] [Accepted: 03/16/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cognitive bias modification (CBM) therapies, including attention bias modification, interpretation bias modification, or approach and avoidance training, are prototypical examples of mechanistically derived treatments, but their effectiveness is contentious. We aimed to assess the relative effectiveness of various CBM interventions for anxious and depressive symptomatology. METHODS For this systematic review and network meta-analysis, we searched PubMed, PsycINFO, Embase, and Cochrane Central Register from database inception up until Feb 7, 2020. We included randomised controlled trials of CBM versus control conditions or other forms of CBM for adults aged 18 years and older with clinical or subclinical anxiety or depression measured with a diagnostic interview or a validated clinical scale. We excluded studies comparing CBM with a non-CBM active intervention. Two researchers independently selected studies and evaluated risk of bias with the Cochrane Collaboration tool. Primary outcomes encompassed anxiety and depressive symptoms measured with validated clinical scales. We computed standardised mean differences (SMDs) with a restricted maximum likelihood random effects model. This study is registered with PROSPERO, CRD42018086113. FINDINGS From 2125 records we selected 85 trials, 65 (n=3897) on anxiety and 20 (n=1116) on depression. In a well connected network of anxiety trials, interpretation bias modification outperformed waitlist (SMD -0·55, 95% CI -0·91 to -0·19) and sham training (SMD -0·30, -0·50 to -0·10) for the primary outcome. Attention bias modification showed benefits only in post-hoc sensitivity analyses excluding post-traumatic stress disorder trials. Prediction intervals for all findings were large, including an SMD of 0. Networks of depression trials displayed evidence of inconsistency. Only four randomised controlled trials had low risk of bias on all six domains assessed. INTERPRETATION CBM interventions showed consistent but small benefits; however heterogeneity and risk of bias undermine the reliability of these findings. Larger, definitive trials for interpretation bias modification for anxiety might be warranted, but insufficient evidence precludes conclusions for depression. FUNDING Romanian Ministry of Research and Innovation, The National Council for Scientific Research-The Executive Agency for Higher Education, Research, Development and Innovation Funding.
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Affiliation(s)
- Liviu A Fodor
- International Institute for The Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania; Evidence Based Psychological Assessment and Interventions Doctoral School, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Raluca Georgescu
- International Institute for The Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania; Evidence Based Psychological Assessment and Interventions Doctoral School, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ştefan Szamoskozi
- Department of Applied Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Daniel David
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania; Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ioana A Cristea
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
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Cuijpers P, Veen SCV, Sijbrandij M, Yoder W, Cristea IA. Eye movement desensitization and reprocessing for mental health problems: a systematic review and meta-analysis. Cogn Behav Ther 2020; 49:165-180. [PMID: 32043428 DOI: 10.1080/16506073.2019.1703801] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There is no comprehensive meta-analysis of randomised trials examining the effects of Eye Movement Desensitization and Reprocessing (EMDR) on post-traumatic stress disorder (PTSD) and no systematic review at all of the effects of EMDR on other mental health problems. We conducted a systematic review and meta-analysis of 76 trials. Most trials examined the effects on PTSD (62%). The effect size of EMDR compared to control conditions was g = 0.93 (95% CI: 0.67-.18), with high heterogeneity (I2= 72%). Only four of 27 studies had low risk of bias, and there were indications for publication bias. EMDR was more effective than other therapies (g = 0.36; 95% CI: 0.14-0.57), but not in studies with low risk of bias. Significant results were also found for EMDR in phobias and test anxiety, but the number of studies was small and risk of bias was high. EMDR was examined in several other mental health problems, but for none of these problems, sufficient studies were available to pool outcomes. EMDR may be effective in the treatment of PTSD in the short term, but the quality of studies is too low to draw definite conclusions. There is not enough evidence to advise it for the use in other mental health problems.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Suzanne C van Veen
- Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Whitney Yoder
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Ioana A Cristea
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
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Nutu D, Gentili C, Naudet F, Cristea IA. Open science practices in clinical psychology journals: An audit study. J Abnorm Psychol 2019; 128:510-516. [PMID: 31368730 DOI: 10.1037/abn0000414] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We conducted an audit of 60 clinical psychology journals, covering the first 2 quartiles by impact factor on Web of Science. We evaluated editorial policies in 5 domains crucial to reproducibility and transparency (prospective registration, data sharing, preprints, endorsement of reporting guidelines and conflict of interest [COI] disclosure). We examined implementation in a randomly selected cross-sectional sample of 201 articles published in 2017 in the "best practice" journals, defined as having explicit supportive policies in 4 out of 5 domains. Our findings showed that 15 journals cited prospective registration, 40 data sharing, 15 explicitly permitted preprints, 28 endorsed reporting guidelines, and 52 had mandatory policies for COI disclosure. Except for COI disclosure, few policies were mandatory: registration in 15 journals, data sharing in 1, and reporting guidelines for randomized trials in 18 and for meta-analyses in 15. Seventeen journals were identified as "best practice." An analysis of recent articles showed extremely low compliance for prospective registration (3% articles) and data sharing (2%). One preprint could be identified. Reporting guidelines were endorsed in 19% of the articles, though for most articles this domain was rated as nonapplicable. Only half of the articles included a COI disclosure. Desired open science policies should become clear and mandatory, and their enforcement streamlined by reducing the multiplicity of guidelines and templates. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Daria Nutu
- Faculty of Psychology and Educational Sciences, Babes- Bolyai University
| | | | | | - Ioana A Cristea
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University
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Cristea IA, Naudet F. US Food and Drug Administration approval of esketamine and brexanolone. Lancet Psychiatry 2019; 6:975-977. [PMID: 31680013 DOI: 10.1016/s2215-0366(19)30292-5] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/21/2019] [Accepted: 06/26/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Ioana A Cristea
- Department of Brain and Behavioral Sciences University of Pavia, 27100 Pavia, Italy; Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, 400015 Cluj-Napoca, Romania; Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA.
| | - Florian Naudet
- University Rennes, CHU Rennes, Inserm, CIC 1414, Rennes, France
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Affiliation(s)
- Ioana A Cristea
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Claudio Gentili
- Department of General Psychology, University of Padova, Padova, Italy
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Cristea IA, Karyotaki E, Hollon SD, Cuijpers P, Gentili C. Corrigendum to "Biological markers evaluated in randomized trials of psychological treatments for depression: A systematic review and meta-analysis" [Neurosci. Biobehav. Rev. 101 (2019) 32-44]. Neurosci Biobehav Rev 2019; 104:222. [PMID: 31344590 DOI: 10.1016/j.neubiorev.2019.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ioana A Cristea
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Romania, and Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville TN, USA
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Claudio Gentili
- Department of General Psychology, University of Padova, Italy.
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Cristea IA, Karyotaki E, Hollon SD, Cuijpers P, Gentili C. Biological markers evaluated in randomized trials of psychological treatments for depression: a systematic review and meta-analysis. Neurosci Biobehav Rev 2019; 101:32-44. [DOI: 10.1016/j.neubiorev.2019.03.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/05/2019] [Accepted: 03/24/2019] [Indexed: 12/15/2022]
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Stefan S, Cristea IA, Szentagotai Tatar A, David D. Cognitive‐behavioral therapy (CBT) for generalized anxiety disorder: Contrasting various CBT approaches in a randomized clinical trial. J Clin Psychol 2019; 75:1188-1202. [DOI: 10.1002/jclp.22779] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/11/2019] [Accepted: 03/19/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Simona Stefan
- Department of Clinical Psychology and PsychotherapyBabeş‐Bolyai University Cluj‐Napoca Romania
| | - Ioana A. Cristea
- Department of Clinical Psychology and PsychotherapyBabeş‐Bolyai University Cluj‐Napoca Romania
| | | | - Daniel David
- Department of Clinical Psychology and Psychotherapy/International Institute for the Advanced Study of Psychotherapy and Applied Mental HealthBabeş‐Bolyai University, No 37 Republicii Street Cluj‐Napoca Romania
- Department of Oncological SciencesIcahn School of Medicine at Mount SinaiNew York New York
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Cristea IA, Cahan EM, Ioannidis JPA. Stealth research: Lack of peer-reviewed evidence from healthcare unicorns. Eur J Clin Invest 2019; 49:e13072. [PMID: 30690709 DOI: 10.1111/eci.13072] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Ioana A Cristea
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California.,Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Eli M Cahan
- New York University School of Medicine, New York, New York.,Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California.,Department of Medicine, Stanford University, Stanford, California.,Department of Health Research and Policy, Stanford University, Stanford, California.,Department of Biomedical Data Science, Stanford University, Stanford, California.,Department of Statistics, Stanford University, Stanford, California
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Robe A, Dobrean A, Cristea IA, Păsărelu CR, Predescu E. Attention-deficit/hyperactivity disorder and task-related heart rate variability: A systematic review and meta-analysis. Neurosci Biobehav Rev 2019; 99:11-22. [DOI: 10.1016/j.neubiorev.2019.01.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/09/2019] [Accepted: 01/21/2019] [Indexed: 01/04/2023]
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Cristea IA, Kok RN, Cuijpers P. Persistent Double Standards in Evaluating the Effectiveness of Cognitive Bias Modification: A Commentary on Wiers et al. (2018). J Stud Alcohol Drugs 2018. [DOI: 10.15288/jsad.2018.79.344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ioana A. Cristea
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Republicii Street 37, 400015, Cluj-Napoca, Romania
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Robin N. Kok
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
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Cristea IA, Kok RN, Cuijpers P. Persistent Double Standards in Evaluating the Effectiveness of Cognitive Bias Modification: A Commentary on Wiers et al. (2018). J Stud Alcohol Drugs 2018; 79:344-345. [PMID: 29885139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Affiliation(s)
- Ioana A Cristea
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Republicii Street 37, 400015, Cluj-Napoca, Romania
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Robin N Kok
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
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Abstract
Assessment of researchers is necessary for decisions of hiring, promotion, and tenure. A burgeoning number of scientific leaders believe the current system of faculty incentives and rewards is misaligned with the needs of society and disconnected from the evidence about the causes of the reproducibility crisis and suboptimal quality of the scientific publication record. To address this issue, particularly for the clinical and life sciences, we convened a 22-member expert panel workshop in Washington, DC, in January 2017. Twenty-two academic leaders, funders, and scientists participated in the meeting. As background for the meeting, we completed a selective literature review of 22 key documents critiquing the current incentive system. From each document, we extracted how the authors perceived the problems of assessing science and scientists, the unintended consequences of maintaining the status quo for assessing scientists, and details of their proposed solutions. The resulting table was used as a seed for participant discussion. This resulted in six principles for assessing scientists and associated research and policy implications. We hope the content of this paper will serve as a basis for establishing best practices and redesigning the current approaches to assessing scientists by the many players involved in that process.
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Affiliation(s)
- David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, United States of America
| | - Florian Naudet
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, United States of America
- INSERM CIC-P 1414, Clinical Investigation Center, CHU Rennes, Rennes 1 University, Rennes, France
| | - Ioana A. Cristea
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, United States of America
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Frank Miedema
- Executive Board, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - John P. A. Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, United States of America
- Department of Medicine, Stanford University, Stanford, California, United States of America
- Department of Health Research and Policy, Stanford University, Stanford, California, United States of America
- Department of Biomedical Data Science, Stanford University, Stanford, California, United States of America
- Department of Statistics, Stanford University, Stanford, California, United States of America
| | - Steven N. Goodman
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, United States of America
- Department of Medicine, Stanford University, Stanford, California, United States of America
- Department of Health Research and Policy, Stanford University, Stanford, California, United States of America
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Cuijpers P, Cristea IA, Karyotaki E, Reijnders M, Hollon SD. Component studies of psychological treatments of adult depression: A systematic review and meta-analysis. Psychother Res 2017; 29:15-29. [PMID: 29115185 DOI: 10.1080/10503307.2017.1395922] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES A recent report from the US Institute of Medicine indicated that identifying core elements of psychosocial interventions is a key step in successfully bringing evidence-based psychosocial interventions into clinical practice. Component studies have the best design to examine these core elements. Earlier reviews resulted in heterogeneous sets of studies and probably missed many studies. METHODS We conducted a comprehensive search of component studies on psychotherapies for adult depression and included 16 studies with 22 comparisons. RESULTS Fifteen components were examined of which four were examined in more than one comparison. The pooled difference between the full treatments and treatments with one component removed was g = 0.21 (95% CI: 0.03∼0.39). One study had sufficient statistical power to detect a small effect size and found that adding emotion regulation skills increased the effects of CBT. None of the other studies had enough power to detect an effect size smaller than g = 0.55. Only one study had low risk of bias. CONCLUSIONS The currently available component studies do not have the statistical power nor the quality to draw any meaningful conclusion about key ingredients of psychotherapies for adult depression.
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Affiliation(s)
- Pim Cuijpers
- a Department of Clinical, Neuro and Developmental Psychology , VU University Amsterdam , Amsterdam , Netherlands.,b Amsterdam Public Health Research Institute , Amsterdam , Netherlands
| | - Ioana A Cristea
- c Department of Clinical Psychology and Psychotherapy , Babes-Bolyai University , Cluj-Napoca , Romania
| | - Eirini Karyotaki
- a Department of Clinical, Neuro and Developmental Psychology , VU University Amsterdam , Amsterdam , Netherlands.,b Amsterdam Public Health Research Institute , Amsterdam , Netherlands
| | - Mirjam Reijnders
- a Department of Clinical, Neuro and Developmental Psychology , VU University Amsterdam , Amsterdam , Netherlands.,b Amsterdam Public Health Research Institute , Amsterdam , Netherlands
| | - Steven D Hollon
- d Department of Psychology , Vanderbilt University , Nashville , TN , USA
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Cristea IA, Cuijpers P, Naudet F. Equivalence of Psychodynamic Therapy to Other Established Treatments: Limited Supporting Evidence and Clinical Relevance. Am J Psychiatry 2017; 174:1122-1123. [PMID: 29088931 DOI: 10.1176/appi.ajp.2017.17050592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ioana A Cristea
- From the Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Palo Alto, Calif.; the Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania; and the Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Pim Cuijpers
- From the Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Palo Alto, Calif.; the Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania; and the Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
| | - Florian Naudet
- From the Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Palo Alto, Calif.; the Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania; and the Department of Clinical, Neuro, and Developmental Psychology, Vrije Universiteit Amsterdam, the Netherlands
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Cristea IA, Kok RN, Cuijpers P. Invited commentary on … Confusing procedures with process in cognitive bias modification research †. Br J Psychiatry 2017; 211:272-273. [PMID: 29092836 DOI: 10.1192/bjp.bp.117.200972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 03/22/2017] [Indexed: 11/23/2022]
Abstract
The notion that cognitive bias modification should be appraised exclusively on the basis of trials where its postulated mechanisms were successfully changed starkly contradicts the standards of evidence-based psychotherapy. In the laboratory or as a treatment, cognitive bias modification cannot continue to eschew the rigorous scrutiny applied to other interventions.
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Affiliation(s)
- Ioana A Cristea
- Ioana A. Cristea, PhD, Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania, and Meta-Research Innovation Center at Stanford, Stanford University, Stanford, California, USA; Robin N. Kok, MSc, Department of Psychology, University of Southern Denmark, Odense, Denmark, and Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark, and Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands; Pim Cuijpers, PhD, Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Robin N Kok
- Ioana A. Cristea, PhD, Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania, and Meta-Research Innovation Center at Stanford, Stanford University, Stanford, California, USA; Robin N. Kok, MSc, Department of Psychology, University of Southern Denmark, Odense, Denmark, and Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark, and Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands; Pim Cuijpers, PhD, Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
| | - Pim Cuijpers
- Ioana A. Cristea, PhD, Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania, and Meta-Research Innovation Center at Stanford, Stanford University, Stanford, California, USA; Robin N. Kok, MSc, Department of Psychology, University of Southern Denmark, Odense, Denmark, and Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark, and Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands; Pim Cuijpers, PhD, Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, The Netherlands
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Cristea IA, Stefan S, Karyotaki E, David D, Hollon SD, Cuijpers P. The effects of cognitive behavioral therapy are not systematically falling: A revision of Johnsen and Friborg (2015). Psychol Bull 2017; 143:326-340. [PMID: 28230413 DOI: 10.1037/bul0000062] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In a meta-analysis, Johnsen and Friborg (2015) reported a significant negative relationship between publication year and the effect sizes (ESs) of cognitive-behavioral therapy (CBT) for depressive disorders, suggesting its effectiveness was falling. We identified a series of methodological and conceptual caveats and consequently redid the meta-analysis. We used the same inclusion criteria, but only included randomized controlled trials and searched for additional eligible trials. We computed both within-group and between-group ESs for the CBT arm for the Beck Depression Inventory (BDI) and the Hamilton Rating Scale for Depression (HRSD). We assessed risk of bias, sample size, type of control group, and the study's country of origin and conducted subgroup, single, and multiple meta-regression analyses including publication year and other moderators. We identified 30 additional eligible trials. Within-group ESs presented huge heterogeneity estimates (I2 around 90%). Year of publication was significant in some single meta-regression analyses on the BDI, but not significant in others, in most analyses on the HRSD, and in any of the analyses on between-group ESs. Multiple regression models indicated that either year was not significantly related or that both year and country were significantly related to outcomes, with a temporal trend present solely in US studies. Year of publication does not appear to be a reliable and independent moderator of the effectiveness of CBT for depression. The linear "fall" reported by Johnsen and Friborg (2015) is most likely a spurious finding. (PsycINFO Database Record
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Affiliation(s)
- Ioana A Cristea
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University
| | - Simona Stefan
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University
| | | | - Daniel David
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University
| | | | - Pim Cuijpers
- Department of Clinical Psychology, Vrije University Amsterdam
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Cristea IA, Gentili C, Cotet CD, Palomba D, Barbui C, Cuijpers P. Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis. JAMA Psychiatry 2017; 74:319-328. [PMID: 28249086 DOI: 10.1001/jamapsychiatry.2016.4287] [Citation(s) in RCA: 326] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
IMPORTANCE Borderline personality disorder (BPD) is a debilitating condition, but several psychotherapies are considered effective. OBJECTIVE To conduct an updated systematic review and meta-analysis of randomized clinical trials to assess the efficacy of psychotherapies for BPD populations. DATA SOURCES Search terms were combined for borderline personality and randomized trials in PubMed, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials (from database inception to November 2015), as well as the reference lists of earlier meta-analyses. STUDY SELECTION Included were randomized clinical trials of adults with diagnosed BPD randomized to psychotherapy exclusively or to a control intervention. Study selection differentiated stand-alone designs (in which an independent psychotherapy was compared with control interventions) from add-on designs (in which an experimental intervention added to usual treatment was compared with usual treatment alone). DATA EXTRACTION AND SYNTHESIS Data extraction coded characteristics of trials, participants, and interventions and assessed risk of bias using 4 domains of the Cochrane Collaboration Risk of Bias tool (independent extraction by 2 assessors). Outcomes were pooled using a random-effects model. Subgroup and meta-regression analyses were conducted. MAIN OUTCOMES AND MEASURES Standardized mean differences (Hedges g) were calculated using all outcomes reported in the trials for borderline symptoms, self-harm, suicide, health service use, and general psychopathology at posttest and follow-up. Differential treatment retention at posttest was analyzed, reporting odds ratios. RESULTS Thirty-three trials (2256 participants) were included. For borderline-relevant outcomes combined (symptoms, self-harm, and suicide) at posttest, the investigated psychotherapies were moderately more effective than control interventions in stand-alone designs (g = 0.32; 95% CI, 0.14-0.51) and add-on designs (g = 0.40; 95% CI, 0.15-0.65). Results were similar for other outcomes, including stand-alone designs: self-harm (g = 0.32; 95% CI, 0.09-0.54), suicide (g = 0.44; 95% CI, 0.15-0.74), health service use (g = 0.40; 95% CI, 0.22-0.58), and general psychopathology (g = 0.32; 95% CI, 0.09-0.55), with no differences between design types. There were no significant differences in the odds ratios for treatment retention (1.32; 95% CI, 0.87-2.00 for stand-alone designs and 1.01; 95% CI, 0.55-1.87 for add-on designs). Thirteen trials reported borderline-relevant outcomes at follow-up (g = 0.45; 95% CI, 0.15-0.75). Dialectical behavior therapy (g = 0.34; 95% CI, 0.15-0.53) and psychodynamic approaches (g = 0.41; 95% CI, 0.12-0.69) were the only types of psychotherapies more effective than control interventions. Risk of bias was a significant moderator in subgroup and meta-regression analyses (slope β = -0.16; 95% CI, -0.29 to -0.03; P = .02). Publication bias was persistent, particularly for follow-up. CONCLUSIONS AND RELEVANCE Psychotherapies, most notably dialectical behavior therapy and psychodynamic approaches, are effective for borderline symptoms and related problems. Nonetheless, effects are small, inflated by risk of bias and publication bias, and particularly unstable at follow-up.
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Affiliation(s)
- Ioana A Cristea
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania2Department of General Psychology, University of Padova, Padova, Italy3Meta-Research Innovation Center at Stanford, Stanford University, Stanford, California
| | - Claudio Gentili
- Department of General Psychology, University of Padova, Padova, Italy
| | - Carmen D Cotet
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Daniela Palomba
- Department of General Psychology, University of Padova, Padova, Italy
| | - Corrado Barbui
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Pim Cuijpers
- Department of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, the Netherlands
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Cristea IA, Gentili C, Pietrini P, Cuijpers P. Sponsorship bias in the comparative efficacy of psychotherapy and pharmacotherapy for adult depression: meta-analysis. Br J Psychiatry 2017; 210:16-23. [PMID: 27810891 DOI: 10.1192/bjp.bp.115.179275] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/06/2016] [Accepted: 06/25/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sponsorship bias has never been investigated for non-pharmacological treatments like psychotherapy. AIMS We examined industry funding and author financial conflict of interest (COI) in randomised controlled trials directly comparing psychotherapy and pharmacotherapy in depression. METHOD We conducted a meta-analysis with subgroup comparisons for industry v. non-industry-funded trials, and respectively for trial reports with author financial COI v. those without. RESULTS In total, 45 studies were included. In most analyses, pharmacotherapy consistently showed significant effectiveness over psychotherapy, g = -0.11 (95% CI -0.21 to -0.02) in industry-funded trials. Differences between industry and non-industry-funded trials were significant, a result only partly confirmed in sensitivity analyses. We identified five instances where authors of the original article had not reported financial COI. CONCLUSIONS Industry-funded trials for depression appear to subtly favour pharmacotherapy over psychotherapy. Disclosure of all financial ties with the pharmaceutical industry should be encouraged.
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Affiliation(s)
- Ioana A Cristea
- Ioana A. Cristea, Department of Clinical Psychology and Psychotherapy, Babes Bolyai University, Cluj-Napoca, Romania, and Department of General Psychology, University of Padova, Padova, Italy; Claudio Gentili, Department of General Psychology, University of Padova, Padova, Italy, Pietro Pietrini, IMT Institute for Advanced Studies, Lucca, Italy; Pim Cuijpers, Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Claudio Gentili
- Ioana A. Cristea, Department of Clinical Psychology and Psychotherapy, Babes Bolyai University, Cluj-Napoca, Romania, and Department of General Psychology, University of Padova, Padova, Italy; Claudio Gentili, Department of General Psychology, University of Padova, Padova, Italy, Pietro Pietrini, IMT Institute for Advanced Studies, Lucca, Italy; Pim Cuijpers, Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Pietro Pietrini
- Ioana A. Cristea, Department of Clinical Psychology and Psychotherapy, Babes Bolyai University, Cluj-Napoca, Romania, and Department of General Psychology, University of Padova, Padova, Italy; Claudio Gentili, Department of General Psychology, University of Padova, Padova, Italy, Pietro Pietrini, IMT Institute for Advanced Studies, Lucca, Italy; Pim Cuijpers, Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Ioana A. Cristea, Department of Clinical Psychology and Psychotherapy, Babes Bolyai University, Cluj-Napoca, Romania, and Department of General Psychology, University of Padova, Padova, Italy; Claudio Gentili, Department of General Psychology, University of Padova, Padova, Italy, Pietro Pietrini, IMT Institute for Advanced Studies, Lucca, Italy; Pim Cuijpers, Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
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Abstract
BACKGROUND The effects of cognitive behavioural therapy of anxiety disorders on depression has been examined in previous meta-analyses, suggesting that these treatments have considerable effects on depression. In the current meta-analysis we examined whether the effects of treatments of anxiety disorders on depression differ across generalized anxiety disorder (GAD), social anxiety disorder (SAD) and panic disorder (PD). We also compared the effects of these treatments with the effects of cognitive and behavioural therapies of major depression (MDD). METHOD We searched PubMed, PsycINFO, EMBASE and the Cochrane database, and included 47 trials on anxiety disorders and 34 trials on MDD. RESULTS Baseline depression severity was somewhat lower in anxiety disorders than in MDD, but still mild to moderate in most studies. Baseline severity differed across the three anxiety disorders. The effect sizes found for treatment of the anxiety disorders ranged from g = 0.47 for PD, g = 0.68 for GAD and g = 0.69 for SAD. Differences between these effect sizes and those found in the treatment of MDD (g = 0.81) were not significant in most analyses and we found few indications that the effects differed across anxiety disorders. We did find that within-group effect sizes resulted in significantly (p < 0.001) larger effect sizes for depression (g = 1.50) than anxiety disorders (g = 0.73-0.91). Risk of bias was considerable in the majority of studies. CONCLUSIONS Patients participating in trials of cognitive behavioural therapy for anxiety disorders have high levels of depression. These treatments have considerable effects on depression, and these effects are comparable to those of treatment of primary MDD.
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Affiliation(s)
- P Cuijpers
- Department of Clinical, Neuro and Developmental Psychology,Vrije Universiteit Amsterdam,The Netherlands
| | - I A Cristea
- Department of Clinical Psychology and Psychotherapy,Babes-Bolyai University,Cluj-Napoca,Romania
| | - E Weitz
- Department of Clinical, Neuro and Developmental Psychology,Vrije Universiteit Amsterdam,The Netherlands
| | - C Gentili
- Department of General Psychology,University of Padova,Padova,Italy
| | - M Berking
- Department of Clinical Psychology and Psychotherapy,Friedrich-Alexander-University Erlangen-Nürnberg,Germany
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Affiliation(s)
- Ioana A Cristea
- a Department of Clinical Psychology and Psychotherapy , Babes-Bolyai University , Cluj-Napoca , Romania.,b Department of General Psychology , University of Padova , Padova , Italy
| | - Pim Cuijpers
- c Department of Clinical Psychology , Vrije Universiteit Amsterdam , Amsterdam , The Netherlands.,d EMGO Institute for Health and Care Research , Amsterdam , The Netherlands
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Cuijpers P, Ebert DD, Acarturk C, Andersson G, Cristea IA. Personalized Psychotherapy for Adult Depression: A Meta-Analytic Review. Behav Ther 2016; 47:966-980. [PMID: 27993344 DOI: 10.1016/j.beth.2016.04.007] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 03/07/2016] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
Abstract
Personalized medicine is aimed at identifying which characteristics of an individual predict the outcome of a specific treatment, in order to get a better match between the individual and the treatment received. We conducted a systematic review and meta-analysis of randomized trials comparing two psychotherapies directly in a group of depressed patients with a specific characteristic. We focused on the six most examined types of psychotherapy for adult depression. Our searches resulted in 41 studies with 2,741 patients who met inclusion criteria. These 41 studies examined 27 specific characteristics of patients. Power calculations indicated that we would need 4 studies for each characteristic to find a clinically relevant effect size set at g = 0.50 and 16 studies for an effect size of 0.24. Only 3 patient characteristics were found to have sufficient power and to significantly moderate treatment outcomes. Cognitive-behavioral therapy was found to be more effective than other therapies in older adults (g = 0.29), in patients with comorbid addictive disorders (g = 0.31), and in university students (g = 0.46). Risk of bias was considerable in most of the included studies. It was estimated that it will take another 326 years to have sufficient statistical power for showing an effect size of g = 0.50 of the 27 characteristics, and 1,372 years to show an effect size of 0.24. Although several dozens of studies have compared the effects of psychotherapies in specific target groups, we will need to develop more powerful alternatives to comparative outcome studies in order to identify personalized treatments for depression.
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Affiliation(s)
- Pim Cuijpers
- VU University Amsterdam, EMGO Institute for Health and Care Research, and Innovation Incubator.
| | - David D Ebert
- Innovation Incubator and Friedrich-Alexander University Erlangen-Nüremberg
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Cuijpers P, Gentili C, Banos RM, Garcia-Campayo J, Botella C, Cristea IA. Relative effects of cognitive and behavioral therapies on generalized anxiety disorder, social anxiety disorder and panic disorder: A meta-analysis. J Anxiety Disord 2016; 43:79-89. [PMID: 27637075 DOI: 10.1016/j.janxdis.2016.09.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 09/07/2016] [Indexed: 10/21/2022]
Abstract
Although cognitive and behavioral therapies are effective in the treatment of anxiety disorders, it is not clear what the relative effects of these treatments are. We conducted a meta-analysis of trials comparing cognitive and behavioral therapies with a control condition, in patients with social anxiety disorder (SAD), generalized anxiety disorder (GAD) and panic disorder. We included 42 studies in which generic measures of anxiety were used (BAI, HAMA, STAI-State and Trait). Only the effects of treatment for panic disorder as measured on the BAI (13.33 points; 95% CI: 10.58-16.07) were significantly (p=0.001) larger than the effect sizes on GAD (6.06 points; 95% CI: 3.96-8.16) and SAD (5.92 points; 95% CI: 4.64-7.20). The effects remained significant after adjusting for baseline severity and other major characteristics of the trials. The results should be considered with caution because of the small number of studies in many subgroups and the high risk of bias in most studies.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, The Netherlands.
| | - Claudio Gentili
- Department of General Psychology, University of Padova, Padova, Italy
| | - Rosa M Banos
- Department of Personality, Assessment and Psychological Treatments, Valencia, Spain; Ciber Fisiopatología Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain
| | - Javier Garcia-Campayo
- Department of Psychatry, Miguel Servet Hospital & University of Zaragoza, Red Investigación en Atención Primaria (REDIAPP), Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain
| | - Cristina Botella
- Ciber Fisiopatología Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain; Department of Psicología Básica, Clínica y Psicobiología, Castellón, Spain
| | - Ioana A Cristea
- Department of General Psychology, University of Padova, Padova, Italy; Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
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