The Development and Internal Evaluation of a Predictive Model to Identify for Whom Mindfulness-Based Cognitive Therapy Offers Superior Relapse Prevention for Recurrent Depression Versus Maintenance Antidepressant Medication. (January 2023)

• Record Type: Journal Article
• Authors: Cohen, Zachary D.; DeRubeis, Robert J.; Hayes, Rachel; Watkins, Edward R.; Lewis, Glyn; Byng, Richard; Byford, Sarah; Crane, Catherine; Kuyken, Willem; Dalgleish, Tim; Schweizer, Susanne
• Is Part Of: Clinical psychological science. Volume 11:Number 1(2023)
• Page Start: 59
• Page End: 76
• Publication Date: 2023-01
• Subjects: antidepressant medication -- depression -- mindfulness-based cognitive therapy -- precision medicine -- relapse prevention; Clinical psychology -- Periodicals; 616.89
• DOI: 10.1177/21677026221076832
• Languages: English
• ISSNs: 2167-7026

Abstract

Depression is highly recurrent, even following successful pharmacological and/or psychological intervention. We aimed to develop clinical prediction models to inform adults with recurrent depression choosing between antidepressant medication (ADM) maintenance or switching to mindfulness-based cognitive therapy (MBCT). Using previously published data ( N = 424), we constructed prognostic models using elastic-net regression that combined demographic, clinical, and psychological factors to predict relapse at 24 months under ADM or MBCT. Only the ADM model (discrimination performance: area under the curve [AUC] = .68) predicted relapse better than baseline depression severity (AUC = .54; one-tailed DeLong's test: z = 2.8, p = .003). Individuals with the poorest ADM prognoses who switched to MBCT had better outcomes compared with individuals who maintained ADM (48% vs. 70% relapse, respectively; superior survival times, z = −2.7, p = .008). For individuals with moderate to good ADM prognoses, both treatments resulted in similar likelihood of relapse. If replicated, the results suggest that predictive modeling can inform clinical decision-making around relapse prevention in recurrent depression.