the generalizability of psychotherapy efficacy trials in major depressive disorder an analysis of the influence of patient selection in efficacy trials on symptom outcome in daily practice普遍性的心理治疗重度抑郁症疗效试验分析的影响患者选择在症状疗效试验结果在日常实践.pdfVIP

van der Lem et al. BMC Psychiatry 2012, 12:192 /1471-244X/12/192 RESEARCH ARTICLE Open Access The generalizability of psychotherapy efficacy trials in major depressive disorder: an analysis of the influence of patient selection in efficacy trials on symptom outcome in daily practice 1,4*† 1 1,2 1 3 Rosalind van der Lem , Wouter WH de Wever , Nic JA van der Wee , Tineke van Veen , Pim Cuijpers and Frans G Zitman1 Abstract Background: Treatment guidelines for major depressive disorder (MDD) are based on results from randomized clinical trials, among others in psychotherapy efficacy trials. However, patients in these trials differ from routine practice patients since trials use stringent criteria for patient selection. It is unknown whether the exclusion criteria used in psychotherapy efficacy trials (PETs) influence symptom outcome in clinical practice. We first explored which exclusion criteria are used in PETs. Second, we investigated the influence of commonly used exclusion criteria on symptom outcome in routine clinical practice. Methods: We performed an extensive literature search in PubMed, PsycInfo and additional databases for PETs for MDD. From these, we identified commonly used exclusion criteria. We investigated the influence of exclusion criteria on symptom outcome by multivariate regression models in a sample of patients suffering from MDD according to the MINIplus from a routine clinical practice setting (n=598). Data on routine clinical practice patients were gathered through Routine Outcome Monitoring. Results: We selected 20 PETs and identified the following commonly used exclusion criteria: ‘a baseline severity threshold of HAM-D≤14’, ‘current or past ab