Frederik J. Wienicke

Purpose: Depression is highly prevalent in middle-aged women (MAW), but head-to-head comparisons of first-line interventions in this population are scarce. This systematic review and individual participant data (IPD) meta-analysis examined the comparative efficacy of antidepressant medication (ADM) and interpersonal psychotherapy (IPT) for MAW (aged 40–64) versus other adults (men and non-MAW) on depression, quality of life, and interpersonal problem measures. Methods: PubMed, PsycINFO, Embase, and the Cochrane Library were searched January 1, 2025 to identify randomized trials comparing ADM and IPT for adults with depression. IPD were requested and analyzed using mixed-effects models. Results: IPD were obtained from 9 of the 15 (60%) identified studies, comprising 1,490 participants (527 MAW, 963 other adults). MAW status did not significantly moderate ADM versus IPT comparative efficacy on depression ( p = .10) and interpersonal problems ( p = .29) outcomes. The two treatments did not significantly differ in treatment effect in the MAW group (depression: b = -0.03, p = .76; interpersonal problems: b = -0.20, p = .31). MAW status significantly moderated comparative efficacy on quality of life measures ( b  = 0.37, p = .02). Whereas IPT was non-significantly more efficacious than ADM for MAW ( b = -0.18, p = .15), ADM were non-significantly more efficacious than IPT for other adults ( b = 0.19, p = .051). Conclusion: This is the first IPD meta-analysis directly comparing depression treatments in MAW. The absence of treatment effect differences indicates that other factors (e.g., patient preference) may guide choice between IPT and ADM in this population.

Adding nuance to the between-therapist effect on patient outcomes, research has increasingly demonstrated that a given therapist can differ in their effectiveness depending on who they treat (e.g., patients with different racial/ethnic identities) and/or what they treat (e.g., patients with different presenting problems). This preregistered study examined whether individual therapists are also more or less effective depending on how they treat their patients; that is, delivering one type of therapy versus another. We did so in the context of an individual participant data meta-analysis of clinical trials that compared classes of cognitive-behavioral therapy and psychodynamic therapy for depression. The meta-analytic sample included 30 therapists who were crossed with treatment condition and 492 patients (M = 25.08 patients per therapist; SD = 15.77). Patients completed measures of depression at baseline and posttreatment. Multilevel structural equation models revealed significant variability in the within-therapist treatment condition-outcome association (p < .001), indicating that some therapists were more effective when delivering one treatment over the other. Descriptively, 53% of therapists had similar outcomes across both groups (d < .20), whereas 47% had at least a small-sized treatment-type strength (d ≥ .20; range = 0.21-0.65). Results inform the personalization of treatment usage to the individual provider's effectiveness data. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The 40-item Defense Style Questionnaire (DSQ-40) is frequently used to measure defense mechanisms in adults with depression because of its brevity and efficient assessment. However, previous research has yielded inconsistent results concerning its factor structure, with one- (overall defensive functioning), three- (mature, neurotic, immature), and four- (mature, neurotic, immature, image-distorting) factor solutions being reported. Therefore, we examined the DSQ-40’s latent structure across different samples. Using multigroup confirmatory factor analysis (CFA), we tested the one-, three-, and four-factor solutions using baseline data from three research projects of psychodynamic psychotherapy for depressed adults (N=667; mean age 33.9; standard deviation [SD]=9.3; 79.0% female). Configural invariance across samples was evaluated, and model fit was compared using multiple fit indices. Across samples, the three- and four-factor models outperformed the one-factor model, with the four-factor model providing the best relative fit; however, it fell short of conventional model fit thresholds. Separate CFAs found the four-factor model showing the best relative fit in two samples, and the three-factor model in one, but all models failed to meet acceptable fit criteria. Several defense mechanisms showed weak standardized loadings, high inter-factor correlations, and cross-loadings. These findings indicate that the DSQ-40 lacks a stable factor structure in adults with depression and raise important questions about the instrument’s construct validity, suggesting that its subscale scores cannot be assumed to validly represent the theorized defense categorizations in this population. Further psychometric refinement and evaluation are needed to determine the DSQ-40’s suitability for both clinical and research applications.

Background: Various treatments are recommended as first-line options in practice guidelines for depression, but it is unclear which is most efficacious for a given person. Accurate individualized predictions of relative treatment effects are needed to optimize treatment recommendations for depression and reduce this disorder’s vast personal and societal costs. Aims: We describe the protocol for a systematic review and individual participant data (IPD) network meta-analysis (NMA) to inform personalized treatment selection among five major empirically-supported depression treatments. Method: We will conduct systematic literature searches in PubMed, PsycINFO, EMBASE, and the Cochrane Library to identify randomized clinical trials comparing two or more of five treatments for adult depression: antidepressant medication, cognitive therapy, behavioural activation, interpersonal psychotherapy, and psychodynamic therapy. We will request IPD from identified studies. We will conduct an IPD-NMA and develop a multivariable prediction model that estimates individualized relative treatment effects from demographic, clinical, and psychological participant characteristics. Depressive symptom level at treatment completion will be the primary outcome. We will evaluate this model using a range of measures for discrimination and calibration, and examine its potential generalizability using internal-external cross-validation. Conclusions: We describe a state-of-the-art method to predict personalized treatment effects based on IPD from multiple trials. The resulting prediction model will need prospective evaluation in mental health care for its potential to inform shared decision-making. This study will result in a unique database of IPD from randomized clinical trials around the world covering five widely used depression treatments, available for future research.

Background: Adding short-term psychodynamic psychotherapy (STPP) to antidepressants increases treatment efficacy, but it is unclear which patients benefit specifically. This study examined efficacy moderators of combined treatment (STPP + antidepressants) v. antidepressants for adults with depression.Methods: For this systematic review and meta-analysis (PROSPERO registration number: CRD42017056029), we searched PubMed, PsycINFO, Embase.com, and the Cochrane Library from inception to 1 January 2022. We included randomized clinical trials comparing combined treatment (antidepressants + individual outpatient STPP) v. antidepressants in the acute-phase treatment of depression in adults. Individual participant data were requested and analyzed combinedly using mixed-effects models (adding Cochrane risk of bias items as covariates) and an exploratory machine learning technique. The primary outcome was post-treatment depression symptom level.Results: Data were obtained for all seven trials identified (100%, n = 482, combined: n = 238, antidepressants: n = 244). Adding STPP to antidepressants was more efficacious for patients with high rather than low baseline depression levels [B = −0.49, 95% confidence interval (CI) −0.61 to −0.37, p < 0.0001] and for patients with a depressive episode duration of >2 years rather than B = −0.68, 95% CI −1.31 to −0.05, p = 0.03) and than 1–2 years (B = −0.86, 95% CI −1.66 to −0.06, p = 0.04). Heterogeneity was low. Effects were replicated in analyses controlling for risk of bias.Conclusions: To our knowledge, this is the first study that examines moderators across trials assessing the addition of STPP to antidepressants. These findings need validation but suggest that depression severity and episode duration are factors to consider when adding STPP to antidepressants and might contribute to personalizing treatment selection for depression.