Presentation T P31

T P31 (Poster Presentation):
Is Cognitive Behavioural Therapy effective in patients receiving disability benefits? A systematic review and individual patient data meta-analysis

Presented by: Shanil Ebrahim


Ebrahim S1,2,3,4, Montoya L5, Truong W6, Hsu S7, Kamal El Din M8, Carrasco-Labra A1,9, Busse JW1,2, Walter SD1, Heels-Ansdell D1, Couban R2, Patelis-Siotis I10,11, Bellman M12, de Graaf LE13, Dozois DJ14, Bieling PJ10, Guyatt GH1,15

  1. Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
  2. Department of Anesthesia, McMaster University, Hamilton, Canada
  3. Department of Medicine, Stanford University, Stanford, USA
  4. Department of Anaesthesia & Pain Medicine, The Hospital for Sick Children, Toronto, Canada
  5. Department of Dentistry, Santo Tomas University, Bogota D.C., Colombia
  6. McMaster Integrative Neuroscience Discovery & Study program, McMaster University, Hamilton, Canada
  7. Department of Oncology, McMaster University, Hamilton, Canada
  8. Ain Shams University, Faculty of Medicine, Cairo, Egypt
  9. Evidence-Based Dentistry Unit, Faculty of Dentistry, University of Chile, Santiago, Chile
  10. Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Canada
  11. Mood Disorders program, St. Joseph’s Healthcare, Hamilton, Canada
  12. National Disability Services, Policy & Procedure department, Sun Life Financial, Toronto, Canada
  13. Department of Medical Psychology and Psychotherapy, Erasmus MC University Medical Center, Rotterdam, the Netherlands
  14. Department of Psychology, University of Western Ontario, London, Canada
  15. Department of Medicine, McMaster University, Hamilton, Canada



Cognitive Behavioural Therapy (CBT) may be less effective in patients whose circumstances or psychological status interferes with the implementation of CBT. Our objective was to summarize the randomized trial evidence regarding the relative effectiveness of CBT in patients with depression in receipt of disability benefits in comparison to those not receiving disability benefits.


Eligible studies included adult patients with major depression, randomly assigned to CBT versus minimal/no treatment or care-as-usual. We searched all relevant RCTs from a database of randomized controlled and comparative studies examining the effects of psychotherapy for adult depression, electronic databases (MEDLINE, EMBASE, PsycInfo, AMED, CINAHL and CENTRAL) to June 2011, and bibliographies of all relevant articles. Teams of reviewers, independently and in duplicate, completed title and abstract screening, full text review of potentially eligible articles, and data extraction of all eligible studies. We performed an individual patient data meta-analysis to summarize data.


Of 92 eligible trials, 70 provided author contact information; of these 56 (80%) were successfully contacted to establish if they captured receipt of benefits as a baseline characteristic; 8 recorded benefit status, and 3 enrolled some patients in receipt of benefits, of which 2 provided individual patient data. Including both patients receiving and not receiving disability benefits, 2 trials (227 patients) suggested a possible reduction in depression with CBT, as measured by the Beck Depression Inventory, mean difference [MD] (95% confidence interval [CI]) = -2.61 (-5.28, 0.07), p = 0.06; minimally important difference of 5. The effect appeared larger, though not significantly, in those in receipt of benefits (34 patients) versus not receiving benefits (193 patients); MD (95% CI) = -4.46 (-12.21, 3.30), p = 0.26.


Our data does not support the hypothesis that CBT has smaller effects in depressed patients receiving disability benefits versus other patients. Given that the confidence interval is wide, a decreased effect is still possible, though if the difference exists, it is likely to be small.

Schedule Details

Tuesday September 30
12:45 - 13:45 Poster Viewing
Session: Mental disorders