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American Journal of Epidemiology Advance Access originally published online on March 3, 2009
American Journal of Epidemiology 2009 169(9):1158-1165; doi:10.1093/aje/kwp014
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

PRACTICE OF EPIDEMIOLOGY

Mixed Treatment Comparison Meta-Analysis of Complex Interventions: Psychological Interventions in Coronary Heart Disease

Nicky J. Welton, D. M. Caldwell, E. Adamopoulos and K. Vedhara

Correspondence to Dr. Nicky J. Welton, Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, Cotham House, Cotham Hill, Bristol BS6 6JL, United Kingdom (e-mail: nicky.welton{at}bristol.ac.uk).

Received for publication March 14, 2008. Accepted for publication January 12, 2009.

Meta-analyses of psychological interventions typically find a pooled effect of "psychological intervention" compared with usual care. This answers the research question, "Are psychological interventions in general effective?" In fact, psychological interventions are usually complex with several different components. The authors propose that mixed treatment comparison meta-analysis methods may be a valuable tool when exploring the efficacy of interventions with different components and combinations of components, as this allows one to answer the research question, "Are interventions with a particular component (or combination of components) effective?" The authors illustrate the methods using a meta-analysis of psychological interventions for patients with coronary heart disease for a variety of outcomes. The authors carried out systematic literature searches to update an earlier Cochrane review and classified components of interventions into 6 types: usual care, educational, behavioral, cognitive, relaxation, and support. Most interventions were a combination of these components. There was some evidence that psychological interventions were effective in reducing total cholesterol and standardized mean anxiety scores, that interventions with behavioral components were effective in reducing the odds of all-cause mortality and nonfatal myocardial infarction, and that interventions with behavioral and/or cognitive components were associated with reduced standardized mean depression scores.

Bayesian inference; coronary disease; Markov chain Monte Carlo; meta-analysis

Abbreviations: DIC, deviance information criterion; SMD, standardized mean difference


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