Efficacy of inpatient psychotherapy for major depressive disorder: a meta-analysis of controlled trials.

Abstract

This meta-analysis investigates the efficacy of inpatient psychotherapy in major depressive disorders compared to control conditions. In total, 14 studies were entered into the meta-analysis with a total of 1.080 patients. Primary outcome was the standardized mean differences in self-rated depression outcomes. A priori planned subgroup analyses included the influence of different control conditions: (a) no psychiatric inpatient treatment (e.g., waitlist control), (b) treatment as usual (TAU; e.g., non-manualized clinical management), (c) TAU determined by study design (manualized/'placebo' control condition), as well as number of sessions and influence of self- vs. clinician ratings. The meta-analysis of 19 available comparisons resulted in a moderate pooled effect size showing a small and statistically significant benefit of the psychotherapeutic intervention over control conditions (g=0.24, P<0.001, I2 =0%). This corresponds to a number needed to treat of 7.4. The effects of the interventions were stable over 12-month follow-up (g=0.21, P<0.01, I2 =30%). Comparisons with waitlist or non-standardized control treatments tended to be associated with larger effect sizes than standardized control treatments. Despite some limitations (small number of studies), this meta-analysis provides evidence for a small but sustained effect of inpatient psychotherapy in patients with major depressive disorders.