Estimating the smallest worthwhile difference of recommended psychotherapies for depression: observational study

作者：Ethan Sahker, Yan Luo, Kenji Omae, Aran Tajika, Manuela L. Ferreira, Astrid Chevance, Stefan Leucht, Sarah Markham, Roger Ede, Andrea Cipriani, Georgia Salanti, Toshi A. Furukawa · 发表于：The British Journal of Psychiatry · 年份：2025 · DOI：10.1192/bjp.2025.10453 · 被引用次数：6 · 研究领域：Treatment of Major Depression、Psychotherapy Techniques and Applications、Digital Mental Health Interventions

Background The smallest worthwhile difference (SWD) represents the smallest beneficial effect of an intervention that patients deem worthwhile given the harms, expenses and inconveniences of the intervention. The SWD facilitates interpretation of the patient-perceived importance of intervention effects. We previously estimated the SWD for antidepressants for depression, but the SWD for psychotherapy remains unknown. Aims To estimate the SWD of recommended psychotherapies for depression compared with no treatment. Method We estimated the SWD through a patient required difference in response rates between psychotherapy and no treatment after 2 months. We recruited using Prolific, an online cross-sectional survey platform, in the UK and USA in January 2025. We also queried a random subset of respondents to replicate our previous SWD estimation for antidepressants. Results In the primary study, we recruited 526 participants (mean age: 36.7 years (s.d. = 12.5); 54% women and 61% White individuals). Of these, 6% reported that they would not initiate psychotherapy with a 100% treatment response. For those willing to initiate psychotherapy, 87 reported moderate-to-severe depressive symptoms but were not in treatment, 184 were in treatment and 131 reported absent-to-mild symptoms with or without previous treatment. The median SWD for people with moderate-to-severe depressive symptoms, not in treatment and willing to consider psychotherapies was a 20% (interquartile range: 10–35%) diff...