The development and internal evaluation of a predictive model to identify for whom Mindfulness-Based Cognitive Therapy (MBCT) offers superior relapse prevention for recurrent depression versus maintenance antidepressant medication
Z. Cohen, R. DeRubeis, Rachel Hayes, E. Watkins, G. Lewis, R. Byng, S. Byford, C. Crane, W. Kuyken, T. Dalgleish, S. Schweizer
Clinical psychological science : a journal of the Association for Psychological Science April 29, 2022 DOI: 10.1177/21677026221076832 (opens in new tab) via Semantic Scholar
Summary
AI-generated from the abstractDepression often returns even after successful treatment. Using data from 424 adults with recurrent depression, researchers built models to predict relapse over 24 months for those continuing antidepressant medication (ADM) versus switching to mindfulness-based cognitive therapy (MBCT). Only the ADM model modestly predicted relapse better than baseline severity. People with the poorest ADM prognosis who switched to MBCT had lower relapse rates (48% vs. 70%) and longer time before relapse than those who stayed on ADM. For those with moderate or good ADM prognosis, both treatments led to similar relapse likelihood. The results suggest predictive models could help tailor relapse prevention choices.
Study at a glance
| Characteristics | Prognostic model development using previously published data Peer reviewed |
|---|---|
| Sample size | 424 |
| Population | Adults with recurrent depression |
| Intervention | Mindfulness-based cognitive therapy |
| Duration | 24-month follow-up |
| Keywords | Medicine Psychology |
| Key finding | Individuals with the poorest ADM prognoses who switched to MBCT had better outcomes (48% relapse) compared with those who maintained ADM (70% relapse). |
Abstract
Depression is highly recurrent, even following successful pharmacological and/or psychological intervention. We aimed to develop clinical prediction models to inform adults with recurrent depression choosing between antidepressant medication (ADM) maintenance or switching to mindfulness-based cognitive therapy (MBCT). Using previously published data (N = 424), we constructed prognostic models using elastic-net regression that combined demographic, clinical, and psychological factors to predict relapse at 24 months under ADM or MBCT. Only the ADM model (discrimination performance: area under the curve [AUC] = .68) predicted relapse better than baseline depression severity (AUC = .54; one-tailed DeLong’s test: z = 2.8, p = .003). Individuals with the poorest ADM prognoses who switched to MBCT had better outcomes compared with individuals who maintained ADM (48% vs. 70% relapse, respectively; superior survival times, z = −2.7, p = .008). For individuals with moderate to good ADM prognoses, both treatments resulted in similar likelihood of relapse. If replicated, the results suggest that predictive modeling can inform clinical decision-making around relapse prevention in recurrent depression.