Depression is a complex mental health disorder with highly heterogeneous symptoms that vary significantly across individuals, influenced by various factors, including sex and regional contexts. Network analysis is an analytical method that provides a robust framework for evaluating the heterogeneity of depressive symptoms and identifying their potential clinical implications.

To investigate sex-specific differences in the network structures of depressive symptoms in Asian patients diagnosed with depressive disorders, using data from the Research on Asian Psychotropic Prescription Patterns for Antidepressants, Phase 3, which was conducted in 2023.

A network analysis of 10 depressive symptoms defined according to the National Institute for Health and Care Excellence guidelines was performed. The sex-specific differences in the network structures of the depressive symptoms were examined using the Network Comparison Test. Subgroup analysis of the sex-specific differences in the network structures was performed according to geographical region classifications, including East Asia, Southeast Asia, and South or West Asia.

A total of 998 men and 1,915 women with depression were analysed in this study. The analyses showed that all 10 depressive symptoms were grouped into a single cluster. Low self-confidence and loss of interest emerged as the most central nodes for men and women, respectively. In addition, a significant difference in global strength invariance was observed between the networks. In the regional subgroup analysis, only East Asian men showed two distinct clustering patterns. In addition, significant differences in global strength and network structure were observed only between East Asian men and women.

The study highlights the sex-specific differences in depressive symptom networks across Asian countries. The results revealed that low self-confidence and loss of interest are the main symptoms of depression in Asian men and women, respectively. The network connections were more localised in men, whereas women showed a more diverse network. Among the Asian subgroups analysed, only East Asians exhibited significant differences in network structure. The considerable effects of neurovegetative symptoms in men may indicate potential neurobiological underpinnings of depression in the East Asian population.

It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.

To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.

Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.

IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).

Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.