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WHAT IS THE THRESHOLD FOR A CLINICALLY RELEVANT EFFECT? THE CASE OF MAJOR DEPRESSIVE DISORDERS

2014; Wiley; Volume: 31; Issue: 5 Linguagem: Inglês

10.1002/da.22249

1520-6394

Pim Cuijpers, Erick H. Turner, Sander L. Koole, Annemiek van Dijke, Filip Smit,

Health Systems, Economic Evaluations, Quality of Life

Depression and AnxietyVolume 31, Issue 5 p. 374-378 Theoretical Review WHAT IS THE THRESHOLD FOR A CLINICALLY RELEVANT EFFECT? THE CASE OF MAJOR DEPRESSIVE DISORDERS Pim Cuijpers Ph.D., Corresponding Author Pim Cuijpers Ph.D. Department of Clinical Psychology, VU University Amsterdam, The Netherlands EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, VU University Amsterdam, The Netherlands Leuphana University, Lünebrug, GermanyCorrespondence to: Pim Cuijpers, Professor of Clinical Psychology Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. E-mail: [email protected]Search for more papers by this authorErick H. Turner M.D., Erick H. Turner M.D. Behavioral Health and Neurosciences Division, Portland Veterans Affairs Medical Center, Portland, Oregon Departments of Psychiatry and Pharmacology, Oregon Health and Science University, Portland, OregonSearch for more papers by this authorSander L. Koole Ph.D., Sander L. Koole Ph.D. Department of Clinical Psychology, VU University Amsterdam, The Netherlands EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, VU University Amsterdam, The NetherlandsSearch for more papers by this authorAnnemiek van Dijke Ph.D., Annemiek van Dijke Ph.D. Delta Psychiatrisch Centrum, Poortugaal, The NetherlandsSearch for more papers by this authorFilip Smit Ph.D., Filip Smit Ph.D. Department of Clinical Psychology, VU University Amsterdam, The Netherlands EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, VU University Amsterdam, The Netherlands Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The NetherlandsSearch for more papers by this author Pim Cuijpers Ph.D., Corresponding Author Pim Cuijpers Ph.D. Department of Clinical Psychology, VU University Amsterdam, The Netherlands EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, VU University Amsterdam, The Netherlands Leuphana University, Lünebrug, GermanyCorrespondence to: Pim Cuijpers, Professor of Clinical Psychology Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. E-mail: [email protected]Search for more papers by this authorErick H. Turner M.D., Erick H. Turner M.D. Behavioral Health and Neurosciences Division, Portland Veterans Affairs Medical Center, Portland, Oregon Departments of Psychiatry and Pharmacology, Oregon Health and Science University, Portland, OregonSearch for more papers by this authorSander L. Koole Ph.D., Sander L. Koole Ph.D. Department of Clinical Psychology, VU University Amsterdam, The Netherlands EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, VU University Amsterdam, The NetherlandsSearch for more papers by this authorAnnemiek van Dijke Ph.D., Annemiek van Dijke Ph.D. Delta Psychiatrisch Centrum, Poortugaal, The NetherlandsSearch for more papers by this authorFilip Smit Ph.D., Filip Smit Ph.D. Department of Clinical Psychology, VU University Amsterdam, The Netherlands EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, VU University Amsterdam, The Netherlands Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The NetherlandsSearch for more papers by this author First published: 22 February 2014 https://doi.org/10.1002/da.22249Citations: 94Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Abstract Background Randomized trials can show whether a treatment effect is statistically significant and can describe the size of the effect. There are, however, no validated methods available for establishing the clinical relevance of these outcomes. Recently, it was proposed that a standardized mean difference (SMD) of 0.50 be used as cutoff for clinical relevance in the treatment of depression. Methods We explore what the effect size means and why the size of an effect has little bearing on its clinical relevance. We will also examine how the “minimally important difference,” as seen from the patient perspective, may be helpful in deciding where the cutoff for clinical relevance should be placed for a given condition. Results Effect sizes in itself cannot give an indication of the clinical relevance of an intervention because the outcome itself determines the clinical relevance and not only the size of the effects. The “minimal important difference” (MID) could be used as a starting point for pinpointing the cutoff for clinical relevance. A first, rough attempt to implement this approach for depression resulted in a tentative clinical relevance cutoff of SMD = 0.24. Using this cutoff, psychotherapy, pharmacotherapy, and combined treatment have effect sizes above this cutoff. Discussion Statistical outcomes cannot be equated with clinical relevance. The “MID” may be used for pinpointing the cutoff for clinical relevance, but more work in this area is needed. Citing Literature Volume31, Issue5May 2014Pages 374-378 RelatedInformation