Examining what works for whom and how in mindfulness-based cognitive therapy (MBCT) for recurrent depression: moderated-mediation analysis in the PREVENT trial.

Mindfulness skills mediate the effect of mindfulness-based cognitive therapy (MBCT) on depressive symptoms over 24 months, and this mediation is stronger for people with more severe depression. Among 424 adults with recurrent depression, those with higher severity showed an expected 10-point reduction on the Beck Depression Inventory-II, compared to a 3.5-point reduction for those with lower severity. The findings suggest MBCT with antidepressant tapering support works through a unique mechanism—mindfulness skills—that differs from maintenance medication alone, supporting personalized treatment for recurrent depression.

Study at a glance

Abstract

Personalised management of recurrent depression, considering individual patient characteristics, is crucial. This study evaluates the potentially different mediating role of mindfulness skills in managing recurrent depression using mindfulness-based cognitive therapy (MBCT) among people with varying depression severity. Data from the Prevention of Depressive Relapse or Recurrence (PREVENT) trial, comparing MBCT (with antidepressant medication (ADM) tapering support, MBCT-tapering support) versus maintenance-ADM, were used. The study included pre, post, 9-, 12-, 18- and 24-month follow-ups. Adults with ≥3 previous major depressive episodes, in full/partial remission (below threshold for a current episode), on ADM, were assessed for eligibility in primary care practices in the UK. People were randomised (1:1) to MBCT-tapering support or maintenance-ADM. We used the Beck Depression Inventory-II to evaluate depressive symptom changes over the six time points. Pre-post treatment, we employed the Five Facets of Mindfulness Questionnaire to gauge mindfulness skills. Baseline symptom and history variables were used to identify individuals with varying severity profiles. We conducted Latent Profile Moderated-Mediation Growth Mixture Models. A total of 424 people (mean (s.d.) age = 49.44 (12.31) years; with 325 (76.7%) self-identified as female) were included. A mediating effect of mindfulness skills, between trial arm allocation and the linear rate of depressive symptoms change over 24 months, moderated by depression severity, was observed (moderated-mediation index = -0.27, 95% CI = -0.66, -0.03). Conditional indirect effects were -0.42 (95% CI = -0.78, -0.18) for higher severity (expected mean BDI-II reduction = 10 points), and -0.15 (95% CI = -0.35, -0.02) for lower severity (expected mean BDI-II reduction = 3.5 points). Mindfulness skills constitute a unique mechanism driving change in MBCT (versus maintenance-ADM). Individuals with higher depression severity may benefit most from MBCT-tapering support for residual symptoms. It is unclear if these effects apply to those with a current depressive episode. Future research should investigate individuals who are not on medication. This study provides preliminary evidence for personalised management of recurrent depression. ISRCTN26666654.