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Centre for Evidence-
Based Medicine

Example NNTs - Mental Health

Condition or Disorder Intervention vs. Control Outcome Follow-up Duration Event Rates % NNT (95% CI)
CER EER
Major depression1 Repetitive transcranial magnetic stimulation (rTMS) vs. sham rTMS ≥50% reduction in scores on the Hamilton Depression Rating Scale or Montgomery-Asberg Depression Rating Scale 2 weeks 25 49 5 (3 to 466)/td>
Children and adolescents with non-psychotic major depressive disorder2 Fluoxetine vs. placebo Improvement 8 weeks 33 56 5 (3 to 33)
Bipolar disorder; manic relapse3 Training plus routine care vs. routine care alone Manic relapse 18 months 57 27 3 (2 to 16)
Major depression4 Slow, repetitive transcranial magnetic stimulation (rTMS) vs. Sham rTMS Severity of depression 2 weeks 25 49 5 (3 to 466)
Social phobia5 Paroxetine vs. placebo Treatment response (mean change in scores on the Liebowitz Social Anxiety Scale and the proportion of responders on the Clinical Global Impression scale) 12 weeks 32 66 4 (3 to 5)
Engaging unmotivated problem drinkers into treatment6 Concerned significant others (CSO) were allocated to Community reinforcement and family training (CRAFT- teaching behavior changing skills to use at home) or Johnson Institute (JI) intervention (to prepare for confrontational family meetings) or Al-Anon (a 12 step program) Number of problem drinkers engaged in treatment at follow up, change in concerned significant other functioning and relationship quality 1 year CRAFT: 67 vs. Al-A: 20 3 (2 to 4)
CRAFT: 67 vs. JI: 35 4 (2 to 10)
Al-A: 35 vs. JI: 20 Not significant
Relapse in residual depression7 Clinical management + cognitive therapy (CT) vs. clinical management alone Relapse 1 year 47 29 6 (4 to 42)
Non-chronic treatment resistant depression8 Venlafaxine vs. paroxetine (control) Therapeutic response 4 weeks 33 52 6 (3 to 254)
Remission 20 42 5 (3 to 21)
Alcohol related illness in ongoing drinkers9 Integrated outpatient treatment (IOT-inpatient evaluation, treatment plan, monthly primary care visits to measure biological indicators of heavy drinking and offer help and efforts to involve family members) vs. standard care Drinking in previous 30 days 2 years 70 81 4 (3 to 35)
Social Phobia10 Paroxetine vs. placebo Mean change in scores on the Liebowitz Social Anxiety Scale and the proportion of responders on the Clinical Global Impression Scale 12 weeks 32 66 4 (3 to 5)
Relapse in residual depression11 Antidepressants plus cognitive therapy vs. clinical management alone Relapse and symptom ratings 1 year 47 29 6 (4 to 42)
Depression12 Fluozetine vs. desipramine (control) Continuing initial medication 12 months 20 42 5 (4 to 10)
Fluozetine vs. imipramine (control) 27 42 7 (4 to 25)
Moderate depression13 Hypericum extract vs. placebo ≥50% improvement in the Hamilton Depression Rating Scale 8 weeks 48 67 6 (3 to 50)
Hypericum extract vs. imipramine 67 76 Not significant
Opioid dependance14 Methadone maintenance for 14 months vs. 120 days of methadone-assisted maintenance and 60 days of methadone-assited detoxification with intensivepsychosocial serivces and 8 months of aftercare (control) Treatment retention 12 months 55 74 6 (4 to 20)
Depression15 Fluoxetine plue folic acid vs. fluoxetine plus placebo Clinical response (>50% improvement on the Hamilton Depression Rating Scale) 10 weeks 62 82 5 (3 to 30)
Depression16 Nurse telehealth care (12-14 calls to each patient during treatment in which the clinic nurse answered questions, offered support and discussed the patient's mental and overall health vs. usual physician care (counselling and treatment with a selective serotonin reuptake inhibitor) ≥50% improvement on the Hamilton Depression Rating Scale 6 weeks 37 50 8 (4 to 90)
6 months 38 57 6 (4 to 18)
≥50% improvement on Beck Depression Inventory 6 weeks 33 38 Not significant
6 months 37 48 Not significant
Alzheimer's disease17 Family intervention, which comprised 3 sessions of caregiver education, 6 sessions of stress management and 5 sessions of coping skills management vs. interview control group, which comprised of a1 session cathartic interview Caregiver psychiatric morbidity and depression 3 months 85 23 2 (2 to 5)
Family intervention vs. no interview 77 23 2 (2 to 7)
Postpartum depression18 Support group (7 psychoeducation a1 visits in which partners participated in 4 out of the 7 visits) vs. control group (7 sessions without partner) Depression status established by the Mini International Neuropsychiatric Instrument 10 weeks 62 19 3 (2 to 15)
Fear of flying19 Virtual reality exposure (8 sessions, 4 of which involved information gathering, treatment planning, brief breathing training and cognitive restructuring) vs. waiting list control Proportion of patients who went on a round trip flight at 6 weeks and changes in symptoms (determined from questionnaire) 12 months 7 53 3 (2 to 7)
Standard exposure (8 sessions done at the airport with exposure to pre-flight stimuli and sitting on a stationary airplane with imaginal exposure to takeoffs, cruising and landing) vs. waiting list control 7 67 2 (2 to 4)
Aggression and conduct disorder20 Lithium vs. placebo Responders on the Global Clinical Judgments (Consensus Scale) 4 weeks 30 80 2 (2 to 6)
Responders on the Clinical Global Impressions 70 20 2 (2 to 6)
Bulimia nervosa21 Cognitive behavioural therapy vs. interpersonal therapy (control) Recovery at 20 weeks 1 year 6 29 4 (3 to 8)
Remission at 20 weeks 28 48 5 (3 to 14)
Normal eating attitudes and behaviours at 20 weeks 27 41 7 (4 to 92)
Post-traumatic stress disorder (PTSD)22 Sertraline vs. placebo Response rate (≥ 30% reduction from baseline in Clinician Administered PTSD Scale, Part 2 total severity score and Clinical Global Improvement - Improvement (CGI - I) score of 1 or 2) 12 weeks 32 53 5 (3 to 17)
Schizophrenia or schizoaffective disorder23 Programme for relapse prevention (education about relapse and how to recognise prodromal symptoms and behaviour, active monitoring, clinical intervention when prodromal episodes were detected and 90 minuets of multifamily psychoeducation groups) vs. usual care Relapse free survival 18 months 66 83 1 (1 to 5)
No hospital admission 61 78 1 (1 to 3)
Chronic depression24 Nefazodone and psychotherapy vs. nefazodone or psychotherapy (control) Remission (a score of 8 or less on the Hamilton Rating Scale for Depression) or satisfactory response (a reduction in the HRDS by at least 50% from baseline and a score of 15 or less) 12 weeks 48 73 4 (3 to 7)
Acute mania25 Valproate vs. placebo ≥ 50% improvement on the Young Mania Rating Scale 21 days 46 70 5 (3 to 15)
Moderate to marked improvement on the Clinical Global Impression Scale 50 68 6 (4 to 74)
Major depressive disorder (MDD)26 Titrated right unilateral electroconvulsive therapy (RUL ECT) vs. fixed dose RUL ECT (control) Cognitive disturbance (decreased ≥ 5 points on the Mini-Mental State Examination) 1-2 days 30 6.7 5 (3 to 22)
Secondary insomnia27 Treatment group (4 weekly 1 hour sessions with a therapist involving sleep hygiene instructions, stimulus control and relaxation) vs. control group Clinical improvement (measured by sleep efficiency percentage) 3 months 19 57 3 (2 to 12)
Secondary insomnia28 Naltrexone plus cognitive behavioural therapy (CBT) vs. placebo plus CBT Drinking relapse (≥ 5 drinks/day for men and ≥ 4 drinks/day for women) 12 weeks 60 38 5 (3 to 21)
Secondary insomnia29 Risperidone vs. haloperidol (control) Need for antiparkinsonian drugs 6 weeks 75 50 5 (3 to 10)
Moderate depression30 Hypericum extract vs. placebo ≥ 50% improvement in Hamilton Depression Rating Scale score 8 weeks 48 67 6 (3 to 50)
Hypericum extract vs. imipramine (control) 67 76 Not significant
Drug refractory schizophrenia31 Cognitive behavioural therapy (attaining a collaborative understanding of the development of symptoms and working towards reducing distress and disability) vs. befriending (control - sessions focused on neutral topics) ≥ 50% improvement in Comprehensive Psychiatric Rating Scale (CPRS) total score 9 months 39 63 5 (3 to 28)
≥ 0% improvement in CPRS schizophrenia change scores 50 70 Not significant

References

  1. Arch Gen Psychiatry 1999; 56:315-20
  2. Arch Gen Psychiatry 1997 Nov;54(11):1031-7
  3. BMJ 1999 Jan 16;318(7177):149-53
  4. Arch Gen Psychiatry. Apr 1999; 56: 15-20
  5. Br J Psychiatry. Aug 1999; 175: 120-6
  6. J Consult Clin Psychol. Oct 1999; 67: 688-97
  7. Arch Gen Psychiatry. Sept 1999; 56: 829-35
  8. Br J Psychiatry. Jul 1999; 175: 12-6
  9. Arch Intern Med. 13 Sept 1999; 159: 1946-52
  10. Br J Psychiatry. Aug 1999; 175: 120-6
  11. Arch Gen Psychiatry. Sept 1999; 56: 829-94
  12. Arch Fam Med. Jul/Aug 1999; 8: 319-25
  13. BMJ. Dec 11, 1999; 319: 1534-9
  14. JAMA. Mar 8, 2000; 283: 1303-10
  15. Affect Disord. Nov 2000; 60: 121-30
  16. Arch Fam Med. Aug 2000; 9:700-8
  17. Br J Psychiatry. Jun 2000; 176: 557-62
  18. Can J Psychiatry. Aug 2000; 45: 554-8
  19. J Consult Clin Psychol. Dec 2000; 68: 1020-6
  20. Arch Gen Psychiatry. Jul 2000; 57: 649-54
  21. Arch Gen Psychiatry. May 2000; 57: 459-66
  22. JAMA. Apr 12, 2000; 283: 1837-44
  23. Arch Gen Psychiatry. Mar 2000; 57:277-83
  24. N Engl J Med. May 18, 2000. 342; 1462-70
  25. J Clin Psychopharmacol. Apr 2000; 20: 195-203
  26. Arch Gen Psychiatry. May 2000; 57: 438-44
  27. Psychol Aging. Jun 2000; 15: 232-40/a>
  28. Am J Psychiatry. Nov 1999; 156: 1758-64
  29. Schizophr Bull. 1999; 25: 721-9
  30. BMJ. Dec 1999; 319: 1534-9
  31. Arch Gen Psychiatry. Feb 2000; 57: 165-72