• Peter Bower, Evangelos Kontopantelis, Alex Sutton, Tony Kendrick, David A Richards, Simon Gilbody, Sarah Knowles, Pim Cuijpers, Gerhard Andersson, Helen Christensen, Björn Meyer, Marcus Huibers, Filip Smit, Annemieke van Straten, Lisanne Warmerdam, Michael Barkham, Linda Bilich, Karina Lovell, and Emily Tung-Hsueh Liu.
• NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK. peter.bower@manchester.ac.uk
• BMJ. 2013 Feb 26; 346: f540.

ObjectiveTo assess how initial severity of depression affects the benefit derived from low intensity interventions for depression.DesignMeta-analysis of individual patient data from 16 datasets comparing low intensity interventions with usual care.SettingPrimary care and community settings.Participants2470 patients with depression.InterventionsLow intensity interventions for depression (such as guided self help by means of written materials and limited professional support, and internet delivered interventions).Main Outcome MeasuresDepression outcomes (measured with the Beck Depression Inventory or Center for Epidemiologic Studies Depression Scale), and the effect of initial depression severity on the effects of low intensity interventions.ResultsAlthough patients were referred for low intensity interventions, many had moderate to severe depression at baseline. We found a significant interaction between baseline severity and treatment effect (coefficient -0.1 (95% CI -0.19 to -0.002)), suggesting that patients who are more severely depressed at baseline demonstrate larger treatment effects than those who are less severely depressed. However, the magnitude of the interaction (equivalent to an additional drop of around one point on the Beck Depression Inventory for a one standard deviation increase in initial severity) was small and may not be clinically significant.ConclusionsThe data suggest that patients with more severe depression at baseline show at least as much clinical benefit from low intensity interventions as less severely depressed patients and could usefully be offered these interventions as part of a stepped care model.

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