The reason for the latter is that high dropout rates were expected, Y-27632 mw Inhibitors,Modulators,Libraries thus we also per formed an analysis excluding research with attrition rates higher than 20%, significantly higher dropout RRs or non modern imputation processing. A funnel plot was used as a test of the main outcome to detect publication or reporting bias through visual in spection. Beggs and Eggers tests were also conducted for statistical checking. When a significant small study effect was noted, we assessed its influence through the trim and fill method. It seems that adequate missing value management is useful in carrying out appropriate CCBT evaluation, because we expect overall attrition rates to be high.

Although it was physically unfeasible for us to collect all the original data without imputation, in the present meta analysis we considered the potential impact on the review result through a sensitivity Inhibitors,Modulators,Libraries analysis in terms of the influence of imputation. Also, the modern imput ation was defined as an imputation needing more com plex processing than classic and comparatively simple imputations such as last observation carried forward or mean imputation. Results Characteristics of included studies Out of 4,888 studies initially screened, following the process shown in Figure 1, fourteen were identified as relevant to the investigation of the clinical effectiveness of CCBT as the sole intervention. All continu ous mean and SD values of post treatment primary out come data were available, and data from all 14 were finally Inhibitors,Modulators,Libraries used for 16 comparisons in the meta analysis, as mentioned below.

In this inclusion process, we excluded two significant studies by Selmi et al. and Wright et al. that were included in all of the five prior meta analyses mentioned above, Inhibitors,Modulators,Libraries because we ultim ately judged one trial by Selmi et al. to have been conducted without an ITT analysis, proper allocation concealment and random sequence generation. The other, by Wright et al, was not regarded as being a study on self help, due to highly intensive assistance of eight standard CBT sessions. There were more women than men subjects, and the mean age ranged from 22. 6 years to 55 years. The majority of CCBT programmes were based on Inhibitors,Modulators,Libraries stand ard CBT, while combined CBT with other therapies was used in two trials. All studies used a self reported measure of depression as their primary outcome, and eight trials mainly used BDI.

All studies stated that allocation con cealment and ITTs were adequately performed. There were follow up data beyond six months after the interven tions for 7 trials, one study finished sellekchem the follow up of only the intervention group, and thus control data were not available. Another study presented the results of the follow up at 18 months by transforming a waiting list group into an intervention group after a first phase trial, and therefore could not be included in the current meta analysis.