The development and internal evaluation of a predictive model to identify for whom Mindfulness-Based Cognitive Therapy (MBCT) offers superior relapse prevention for recurrent depression versus maintenance antidepressant medication

Zachary D Cohen; Robert J DeRubeis; Rachel Hayes; Edward R Watkins; Glyn Lewis; Richard Byng; Sarah Byford; Catherine Crane; Willem Kuyken; Tim Dalgleish; Susanne Schweizer

doi:10.1177/21677026221076832

The development and internal evaluation of a predictive model to identify for whom Mindfulness-Based Cognitive Therapy (MBCT) offers superior relapse prevention for recurrent depression versus maintenance antidepressant medication

Clin Psychol Sci. 2023 Jan;11(1):59-76. doi: 10.1177/21677026221076832. Epub 2022 Apr 29.

Authors

Zachary D Cohen¹, Robert J DeRubeis², Rachel Hayes³, Edward R Watkins⁴, Glyn Lewis^{5

6}, Richard Byng^{6

7}, Sarah Byford⁸, Catherine Crane⁹, Willem Kuyken⁹, Tim Dalgleish^{10

11}, Susanne Schweizer^{12

13}

Affiliations

¹ Department of Psychiatry, University of California Los Angeles, Los Angeles, USA.
² Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
³ University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter, UK.
⁴ Sir Henry Wellcome Mood Disorder Center, University of Exeter, Exeter, UK.
⁵ Division of Psychiatry, Faulty of Brain Sciences, University College London, London, UK.
⁶ Community Primary Care Research Group, University of Plymouth, Plymouth, UK.
⁷ National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care, South West Peninsula.
⁸ Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
⁹ Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK.
¹⁰ Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, UK.
¹¹ Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
¹² Department of Psychology, University of Cambridge, Cambridge, UK.
¹³ School of Psychology, University of New South Wales, Sydney, Australia.

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 data from the PREVENT trial (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: 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 to those who maintained ADM (48% vs. 70% relapse, respectively; superior survival times [z=-2.7, p=.008]). For individuals with moderate-to-good ADM prognosis, 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.

Abstract

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