Delgadillo, J. orcid.org/0000-0001-5349-230X and Gonzalez Salas Duhne, P. (2020) Targeted prescription of cognitive-behavioral therapy versus person-centered counseling for depression using a machine learning approach. Journal of Consulting and Clinical Psychology, 88 (1). pp. 14-24. ISSN 0022-006X
Abstract
Objective: Depression is a highly common mental disorder and a major cause of disability worldwide. Several psychological interventions are available, but there is a lack of evidence to decide which treatment works best for whom. This study aimed to identify subgroups of patients who respond differentially to cognitive behavioural therapy (CBT) or person-centred counselling for depression (CfD).
Methods: This was a retrospective analysis of archival routine practice data for 1435 patients who received either CBT (N=1104) or CfD (N=331) in primary care. The main outcome was post-treatment reliable and clinically significant improvement (RCSI) in the PHQ-9 depression measure. A targeted prescription algorithm was developed in a training sample (N=1085) using a supervised machine learning approach (elastic net with optimal scaling). The clinical utility of the algorithm was examined in a statistically independent test sample (N=350) using chi-square analysis and odds ratios.
Results: Cases in the test sample that received their model-indicated “optimal” treatment had a significantly higher RCSI rate (62.5%) compared to those who received the “suboptimal” treatment (41.7%); x2 (DF = 1) = 4.79, p = .03, OR = 2.33 (95% CI = 1.09, 5.02).
Conclusions: Targeted prescription has the potential to make best use of currently available evidence-based treatments, improving outcomes for patients at no additional cost to psychological services.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2019 American Psychological Association. This is an author-produced version of a paper accepted for publication in Journal of Consulting and Clinical Psychology. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | depression; cognitive behavioural therapy; counselling; precision medicine; personalized treatment selection |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Science (Sheffield) > Department of Psychology (Sheffield) |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 13 Nov 2019 15:37 |
Last Modified: | 07 Jan 2020 15:46 |
Status: | Published |
Publisher: | American Psychological Association |
Refereed: | Yes |
Identification Number: | 10.1037/ccp0000476 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:153112 |