Who benefits from psychotherapies for adult depression? A meta-analytic update of the evidence

It is not clear whether specific target groups for psychotherapies in adult depression benefit as much from these treatments as other patients. We examined target groups that have been examined in randomized trials, including women, older adults, students, minorities, patients with general medical disorders, and specific types of depression, and we examined where patients were recruited. We conducted subgroup and multivariate metaregression analyses in a sample of 256 trials (with 332 comparisons) comparing psychotherapy with an inactive control condition. Only 22% of the studies had low risk of bias (RoB), heterogeneity was high and there was a considerable risk of publication bias. A meta-regression analysis among low RoB studies showed that effect sizes found for studies among women, older adults, patients with general medical disorders, patients recruited from primary care, and patients scoring above a cut-off on a self-rating depression scale, did not differ significantly from effect sizes from other studies. For other target groups, the number of low RoB studies was too small to draw any conclusion. We found few indications that psychotherapies for adult depression are more or less effective in women, older adults, patients with comorbid general medical disorders, and primary care patients.