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Research Letter
April 17, 2019

Combining Pharmacological and Nonpharmacological Interventions in Network Meta-analysis in Psychiatry

Author Affiliations
  • 1Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
  • 2Center for Innovation in Mental Health, Academic Unit of Psychology; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southhampton, England
  • 3Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, England
  • 4Oxford Health National Health Service Foundation Trust, Warneford Hospital, Oxford, England
JAMA Psychiatry. 2019;76(8):867-868. doi:10.1001/jamapsychiatry.2019.0574

Network meta-analyses (NMAs) assess the comparative associations of 2 or more interventions even if they have not been compared in a randomized clinical trial.1 The validity of NMAs is founded on the assumption of transitivity (ie, that effect modifiers do not substantially differ across the included trials).1 The popularity of NMAs on pharmacological or nonpharmacological interventions is increasing in psychiatry.2 Recent NMAs have combined pharmacological and nonpharmacologic interventions in the same network. Although this may be informative for developing guidelines, it is methodologically challenging and could compromise the validity of NMAs. We aimed to evaluate NMAs that combined pharmacological and nonpharmacological interventions and provide guidance on how to conduct them.