Individual behavioral activation in the treatment of depression: A meta analysis

Figures & data

Figure 1. PRISMA flow diagram.

Table 1. Selected characteristics of randomised trials comparing individual behavioral activation to control groups.

Study	Diagnosis	Nint	Nctr	Nsess	Control	Mean age	Prop women	Recr	Target group	SG	AC	BA	ITT	RoB	country
Choi et al., 2020	Self-report	90	94	5	Other^a	69	0.73	Other	Elderly	+	−	−	+	2	US
Chowdhary et al., 2016	Self-report	24	31	7	Cau	41	0.69	Other	Adults	+	−	sr	+	3	India
Dimidjian et al., 2006	Mood dis	43	53	24	Other^b	40	0.66	Comm	Adults	+	−	sr	+	3	US
Dimidjian et al., 2017	Self-report	86	77	10	Cau	29	1.00	Other	Perinatal	+	+	sr	+	4	US
Ekers et al., 2011	Mood dis	23	24	12	WL	45	0.62	Clin	Adults	+	+	sr	+	4	UK
Funderburk et al., 2021	Self-report	68	72	4	Cau	53	0.09	Clin	Veterans	−	+	sr	+	3	US
Gawrysiak et al., 2009	Self-report	14	16	1	Cau	18	0.80	Comm	Students	−	−	sr	+	2	US
Hemanny et al., 2020	Mood dis	24	26	12	Cau	40	0.86	Comm	Adults	+	−	+	+	3	Brasil
Jordans et al., 2019	Mood dis	60	60	4	Cau	nr	0.85	Other	Adults	+	+	sr	+	4	Nepal
Kanter et al., 2015	Mood dis	21	22	8	Cau	38	0.79	Clin	Minority	+	−	sr	+	3	US
McIndoo et al., 2016	Self-report	16	14	4	WL	19	0.62	Comm	Students	+	−	−	+	2	US
Nasrin et al., 2017	Mood dis	19	17	1	WL	36	0.59	Clin	Adults	+	+	sr	−	3	UK
Pagoto et al., 2013	Mood dis	68	76	18	Other^c	46	1.00	Comm	Overw w	+	+	+	+	4	US
Patel et al., 2017	Self-report	230	236	6	Cau	43	0.77	Clin	Adults	+	+	sr	+	4	India
Raue et al., 2019	Self-report	8	10	12	Cau	76	0.83	Other	Elderly	−	−	−	−	0	US
Richards et al., 2018	Self-report	15	14	8	Cau	65	0.48	Other	Gen. med.	+	+	sr	+	4	UK
Taylor & Marshall, 1977	Self-report	7	7	6	WL	22	0.71	Comm	Students	−	−	sr	−	1	Canada
Thomas et al., 2019	Self-report	15	12	8	Cau	66	0.40	Comm	Gen. med.	+	+	sr	+	4	UK
Turner et al., 1979	Self-report	17	17	5	Cau	25	0.50	Comm	Adults	−	−	sr	−	1	US
Vázquez et al., 2017	Self-report	22	19	4	Cau	58	0.93	Other	Caregivers	+	+	sr	+	4	Europe
Vázquez et al., 2020	Self-report	70	80	4	Cau	55	0.96	Other	Caregivers	+	+	sr	+	4	Europe
Wilson et al., 1983	Self-report	8	9	8	WL	40	0.80	Comm	Adults	−	−	sr	−	1	Australia

Abbreviations: AC: allocation concealment; BA: masking of assessors; Cau: Care-as-usual; Clin: clinical; Comm: community; Gen. med: general medical patients; ITT: intention to treat analyses; Mood dis: diagnosed mood disorder; N_ctr: Number of participants in the control group; N_int: Number of participants in the intervention group; N_sess: Number of sessions; Overw w: overweight women; RoB: risk of bias total score; SG: sequence generation; WL: waitlist.

Notes:

^a brief non-specific support.

^b Placebo.

^c Life style advice.

Figure 2. Forest plot a) Abbreviations: bat: behavioral activation therapy; cau: care-as-usual; ctr: control; g: Hedges’ g; S.E.: standard error; vs: versus; wl: waiting list.

Table 2. The effects of individual Behavioral activation for depression according to different models.

Models	K	G	CI	I^2	CI	PI	NNT
Main outcomes	22	0.83	[0.55; 1.1]	76.05	[63.92; 84.1]	[−0.28; 1.93]	3.57
Three-Level Model (CHE)	30	0.82	[0.54; 1.1]	83.10	–	[−0.34; 1.99]	3.60
One effect size per study (lowest effect size)	22	0.76	[0.46; 1.06]	76.27	[64.29; 84.23]	[−0.44; 1.96]	3.95
One effect size per study (highest effect size)	22	0.87	[0.58; 1.16]	75.50	[63.01; 83.78]	[−0.26; 2.01]	3.35
Outliers removed	25	0.82	[0.62; 1.02]	64.27	[45.29; 76.67]	[0.04; 1.6]	3.59
Influence Analysis	30	0.82	[0.57; 1.07]	74.01	[62.85; 81.82]	[−0.3; 1.94]	3.62
Adjusted for publication bias	28	0.60	[0.29; 0.92]	78.60	[69.6; 84.9]	[−0.85; 2.06]	5.22
Only studies with low risk of bias	11	0.56	[0.09; 1.03]	80.46	[65.94; 88.79]	[−0.85; 1.98]	5.62
Assuming independence of effects	30	0.82	[0.57; 1.07]	74.01	[62.85; 81.82]	[−0.3; 1.94]	3.62

Table 3. Subgroup analyses.

		K	G	CI	I^2	CI	NNT
Control group	Usual care	13	0.69	[0.31; 1.08]	78.7	[64.1; 87.3]	4.43	<0.001
	Waitlist	5	1.47	[1.11; 1.83]	0	[0; 79.2]	1.90
	Other	4	0.70	[0.06; 1.34]	58.2	[0; 86.1]	4.35
Diagnosis	Mood	7	0.81	[0.29; 1.33]	73.6	[43.4; 87.7]	3.67	0.81
	Cut-off	15	0.87	[0.5; 1.25]	77.2	[62.6; 86]	3.37
Recruitment	Community	9	1.11	[0.71; 1.51]	62	[21.5; 81.6]	2.55	0.25
	Clinical	5	0.70	[−0.09; 1.49]	76.5	[42.8; 90.4]	4.35
	Other	8	0.68	[0.1; 1.25]	81.2	[64; 90.2]	4.50
Target group	Adults in general	9	0.95	[0.55; 1.35]	69	[37.9; 84.5]	3.05	0.46
	Other	13	0.76	[0.35; 1.18]	79.3	[65.3; 87.7]	3.95
Risk of bias	Low	9	0.68	[0.17; 1.18]	81.4	[65.7; 89.9]	4.50	0.27
	Other	13	0.98	[0.63; 1.34]	68.9	[44.8; 82.5]	2.94

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