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Original Investigation
Meta-analysis
June 2016

Efficacy of Mindfulness-Based Cognitive Therapy in Prevention of Depressive RelapseAn Individual Patient Data Meta-analysis From Randomized Trials

Author Affiliations
  • 1Department of Psychiatry, University of Oxford, Prince of Wales International Centre, Warneford Hospital, Oxford, England
  • 2Institute of Health Research, Primary Care Research Group, Exeter Medical School, Exeter, England
  • 3School of Psychology, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, England
  • 4Department of Psychiatry, University Medical Centre, University of Geneva, Geneva, Switzerland
  • 5Institute of Health Research, Child Health Group, Exeter Medical School, Exeter, England
  • 6Department of Psychiatry, Radboud University Nijmegen Medical Centre, Radboud University Nijmegen, Nijmegen, The Netherlands
  • 7Hong Kong Centre for Mindfulness, Hong Kong
  • 8Medical Research Council Cognition and Brain Sciences Unit, Cambridge, England
  • 9Department of Psychology, University of Toronto Scarborough, Toronto, Ontario, Canada
  • 10University Department of Psychiatry, University Hospital, Gent, Belgium
  • 11King’s Health Economics, King’s College London, London, England
  • 12Peninsula School of Medicine, Plymouth University, Plymouth, England
  • 13Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, England
JAMA Psychiatry. 2016;73(6):565-574. doi:10.1001/jamapsychiatry.2016.0076
Abstract

Importance  Relapse prevention in recurrent depression is a significant public health problem, and antidepressants are the current first-line treatment approach. Identifying an equally efficacious nonpharmacological intervention would be an important development.

Objective  To conduct a meta-analysis on individual patient data to examine the efficacy of mindfulness-based cognitive therapy (MBCT) compared with usual care and other active treatments, including antidepressants, in treating those with recurrent depression.

Data Sources  English-language studies published or accepted for publication in peer-reviewed journals identified from EMBASE, PubMed/Medline, PsycINFO, Web of Science, Scopus, and the Cochrane Controlled Trials Register from the first available year to November 22, 2014. Searches were conducted from November 2010 to November 2014.

Study Selection  Randomized trials of manualized MBCT for relapse prevention in recurrent depression in full or partial remission that compared MBCT with at least 1 non-MBCT treatment, including usual care.

Data Extraction and Synthesis  This was an update to a previous meta-analysis. We screened 2555 new records after removing duplicates. Abstracts were screened for full-text extraction (S.S.) and checked by another researcher (T.D.). There were no disagreements. Of the original 2555 studies, 766 were evaluated against full study inclusion criteria, and we acquired full text for 8. Of these, 4 studies were excluded, and the remaining 4 were combined with the 6 studies identified from the previous meta-analysis, yielding 10 studies for qualitative synthesis. Full patient data were not available for 1 of these studies, resulting in 9 studies with individual patient data, which were included in the quantitative synthesis.

Results  Of the 1258 patients included, the mean (SD) age was 47.1 (11.9) years, and 944 (75.0%) were female. A 2-stage random effects approach showed that patients receiving MBCT had a reduced risk of depressive relapse within a 60-week follow-up period compared with those who did not receive MBCT (hazard ratio, 0.69; 95% CI, 0.58-0.82). Furthermore, comparisons with active treatments suggest a reduced risk of depressive relapse within a 60-week follow-up period (hazard ratio, 0.79; 95% CI, 0.64-0.97). Using a 1-stage approach, sociodemographic (ie, age, sex, education, and relationship status) and psychiatric (ie, age at onset and number of previous episodes of depression) variables showed no statistically significant interaction with MBCT treatment. However, there was some evidence to suggest that a greater severity of depressive symptoms prior to treatment was associated with a larger effect of MBCT compared with other treatments.

Conclusions and Relevance  Mindfulness-based cognitive therapy appears efficacious as a treatment for relapse prevention for those with recurrent depression, particularly those with more pronounced residual symptoms. Recommendations are made concerning how future trials can address remaining uncertainties and improve the rigor of the field.

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