The mediating role of depression, anxiety, and sleep in the relationship between type D personality and asthma control: a cross-sectional study.

Depression is a leading cause of disability worldwide []. This prevalent and recurrent disorder severely impacts quality of life and functioning, causing impairments in work, relationships, school, and leisure []. Psychotherapy and antidepressants are the two first-line treatment options for depression. Both therapeutic approaches have shown superiority over control conditions such as placebo or treatment as usual in reducing depressive symptoms [, ]. Most previous examinations of the absolute and relative effectiveness of depression treatments have primarily focused on the reduction of depressive symptom severity. However, patients with depression consider improvements in social functioning (e.g., performance at work, home, or school) as important as the absence of symptoms [, ]. Social functioning is thus a central outcome from patients’ perspective [], and it can be conceptualized as the functioning of individuals in several social environments and domains, such as work or study, interpersonal relationships, and leisure activities [, ]. Some prior pairwise meta-analyses have reported small effects of antidepressants on social functioning [, ], small-to-moderate effects of psychotherapy [], and larger effects of combined treatment []. However, direct comparisons between psychotherapy and antidepressants remain inconclusive [], largely due to the lack of head-to-head trials. Existing syntheses, which rely primarily on pairwise meta-analyses, cannot establish the relative effects of first-line treatments on social functioning. Consequently, available evidence provides a limited basis for comparative treatment guidance, despite the recognition of functioning as a critical outcome in clinical guidelines [] and its inclusion in common measurement initiatives [, ]. To address this gap, we systematically reviewed randomized clinical trials of first-line depression treatments to characterize the availability and measurement of social functioning outcomes, and conducted a network meta-analysis to examine the comparative effects of psychotherapy, antidepressants, and their combination on social functioning. The methods of this systematic review and network meta-analysis are detailed in our preregistered OSF protocol () and further described in online supplementary material 1 (for all online suppl. material, see ). The reporting follows the PRISMA guidelines (see PRISMA checklist in online supplementary material 1). Studies were identified from two existing databases of RCTs on depression treatment [, ]. One database focuses on psychotherapy (Metapsy) [], the other on antidepressant medication (GRISELDA) []. Both were built through systematic searches in major bibliographic databases (e.g., PubMed, Embase, PsycINFO) and additional sources (e.g., trial registries), with at least two independent researchers screening titles and abstracts, and subsequently full texts. We used the latest available update of the Metapsy database (May 1, 2025) and updated GRISELDA with a new search up to the same date. No language restrictions were applied. Given that social functioning is not usually a primary outcome, we conducted supplementary screenings of secondary reports or registrations from the trials deemed eligible, as well as previous relevant meta-analyses. When multiple reports referred to the same trial, data were extracted once. Further details about the searches, search strings, and study selection are described in online supplementary material 1.