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Premature conclusions
- Christine Kuehner (19 November 2003)
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Christine Kuehner, research psychologist Central Institute of Mental Health
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kuehner{at}zi-mannheim.de Christine Kuehner
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To my opinion, the meta-analysis by Jane-Llopis and colleagues (Br J Psychiatry, 183, 384-397) suffers from some methodological flaws that misguided the authors to draw premature conclusions on predictors of prevention in depression prevention programmes. Firstly, many of the selected studies did not target the prevention of depression but examined therapeutic or preventive strategies for other primary disorders and used depression scores as secondary outcome measures. For example, Bisson et al. (1997) studied the efficacy of psychological debriefing (PD) on the development of posttraumatic stress disorder (PTSD) in victims of acute burn traumas and showed that PD may even worsen the long-term course of victims. But while PD may have been mistakenly considered as helpful for preventing PTSD in the past, no reasonable therapist or researcher has ever claimed that massive emotional confrontation would represent a promising strategy for depression or depression prevention. Secondly, the codings of respective methods look rather inconsistent, and I was wondering how the authors were able to reach such a high interrater reliability across codes. For example, the PD method by Bisson et al. (1997) was coded as “behavioural, cognitive and educational” (p. 389), while the code “cognitive” was missing for Seligman’s intervention based on cognitive therapy (!). Similarly, four research groups using similar variants of the “Coping with Depression Course” by Lewinsohn et al. (1984) were coded differently (e.g., “cognitive and competence”, “behavioural, cognitive, educational and social support”, “cognitive”, and “behavioural, cognitive, competence and educational” (pp. 386ff.). Finally, their coding category “behavioural methods” incorporates very heterogeneous strategies. For example, behavioural strategies found to be helpful in CBT for depression focus on increasing pleasant activities and social skills training (Lewinsohn et al., 1984), while, on the other hand, the delivery of peer support telephone dyads by lay persons, as used in the studies by Heller et al. (1991), may be regarded as a very specific behavioural strategy which has so far not been recommended as a helpful intervention by the research community. In the present meta-analysis, respective interventions from the studies by Heller et al. (1991) had negative effect sizes and therefore may have substantially accounted for the missing or even negative effect of the “behavioural” component of preventive measures. References Bisson, J. I., Jenkins, P. L., Alexander, J., et al (1997) Randomised controlled trial of psychological debriefing for victims of acute burn trauma. British Journal of Psychiatry, 171, 78 –81. Heller, K., Thompson, M.G., Trueba, P.E., et al. (1991) Peer support telephone dyads for elderly women: was this the wrong intervention? American Journal of Community Psychology, 19, 53-74. Jane-Llopis, E., Hosman, C., Jenkins, R. & Anderson, P. (2003) Predictors of efficacy in depression prevention programmes. Meta analysis. British Journal of Psychiatry, 183, 384-397. Lewinsohn, P.M., Antonuccio, D.O., Steinmetz J.L. & Teri, L (1984) The coping with depression course. A psychoeducational intervention for unipolar depression. Castalia Publishing Company, Eugene, OR. Christine Kuehner, PhD Central Institute of Mental Health PO Box 122120 68072 Mannheim, Germany Tel: ++49-621-1703-731 Fax: ++49-621-1703-741 |
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