Article

Treatment Matching in the Posthospital Care of Depressed Patients

Clark University, Worcester, Massachusetts, United States
American Journal of Psychiatry (Impact Factor: 13.56). 12/2005; 162(11):2131-8. DOI: 10.1176/appi.ajp.162.11.2131
Source: PubMed

ABSTRACT This study assessed the efficacy of 1) matching patients to treatments and 2) adding additional family therapy or cognitive therapy in a group of recently discharged patients with major depression.
Patients with major depression were recruited during a psychiatric hospitalization. After discharge, they were randomly assigned to one of four treatment conditions that were either "matched" or "mismatched" to their pattern of cognitive distortion and family impairment. The four treatment conditions were 1) pharmacotherapy alone; 2) combined pharmacotherapy and cognitive therapy; 3) combined pharmacotherapy and family therapy; and 4) combined pharmacotherapy, cognitive therapy, and family therapy. Randomly assigned treatment continued for 24 weeks on an outpatient basis.
Among patients with at least moderate depressive symptoms at hospital discharge, low rates of remission (16%) and improvement (29%) were obtained. Matched treatment led to a significantly greater proportion of patients who improved and greater reductions over time in interviewer-rated depressive symptoms than mismatched treatment. However, matched treatment did not produce greater change in self-reported depression or interviewer-rated suicidal ideation. Treatment that included a family therapy component also led to a greater proportion of patients who improved and to significant reductions in interviewer-rated depression and suicidal ideation than treatment without family therapy.
These results suggest that 1) current treatments are not very efficacious in the aftercare of hospitalized depressed patients, 2) treatment matching moderately improves outcome for patients who are symptomatic at hospital discharge, and 3) inclusion of family therapy improves the outcome of posthospital care for depressed patients.

Download full-text

Full-text

Available from: Christopher G Beevers, Aug 19, 2015
0 Followers
 · 
91 Views
  • Source
    • "Identified through chart review of consecutive admissions, patients with BD and MDD were approached during hospitalization or treatment for a current mood episode to determine their willingness to participate in institutional review boardYapproved clinical trials of pharmacological, individual, and family interventions (Miller et al., 2004, 2005 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Despite the extensive literature on family functioning and mood disorders, less is known about concordance between patient- and family-reported family functioning. To address this question, adults with bipolar I disorder (BD; n = 92) or major depressive disorder (MDD; n = 121) and their family members (n = 135 and 201, respectively) were recruited from hospital sources. All patients and their family members completed the Family Assessment Device (Epstein, Baldwin, Bishop. J Marital Fam Ther. 9:171-180, 1983). Intraclass correlation coefficients revealed that, in contrast to the moderate degree of concordance in the MDD sample, degree of concordance between patient- and family-reported family functioning was significantly weaker in BD. Subsequent analysis revealed that this discordance was driven by the reports of the child and young adolescent family members of the patients with BD. Results highlight the importance of collateral reports in the assessment of family functioning, especially among families of patients with BD, in research and treatment.
    The Journal of nervous and mental disease 04/2013; 201(5). DOI:10.1097/NMD.0b013e31828e1041 · 1.81 Impact Factor
  • Source
    • "no family therapy) generally improved therapy results (depressive symptoms, suicidal ideation, cases improved and in remission, treatment failures), whereas 13 sessions of CBT (vs. no CBT) had no significant effect on the variables mentioned except for the percentage of treatment failures (Miller et al., 2005; Table 1). An Italian RCT showed that family therapy combined with (maintenance) medication reduces relapse rates of recurrent MDD to a greater extent than a dose increase of antidepressants without psychosocial intervention (Fabbri, Fava, Rafanelli, & Tomba, 2007). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Systemic therapy is a widely used psychotherapy approach. Yet there exist few systematic reviews on its efficacy. A meta-content analysis was performed to analyze the efficacy of systemic therapy for the treatment of mental disorders in adulthood. All randomized (or matched) controlled trials (RCT) evaluating systemic/systems oriented therapy in various settings (family, couple, individual, group, multifamily group therapy) with adult index patients suffering from mental disorders were identified by database searches and cross-references in other reviews. Inclusion criteria were: index patient diagnosed with a DSM or ICD listed mental disorder, trial published in any language up to the end of 2008. The RCTs were content analyzed according to their research methodology, interventions applied, and results. Thirty-eight trials published in English, German, Spanish, and Chinese were identified, 34 of them showing systemic therapy to be efficacious for the treatment of mood disorders, eating disorders, substance use disorders, mental and social factors related to medical conditions and physical disorders, and schizophrenia. Systemic therapy may also be efficacious for anxiety disorders. Results were stable across follow-up periods of up to 5 years. There is a sound evidence-base for the efficacy of systemic therapy for adult index patients with mental disorders in at least five diagnostic groups.
    Family Process 12/2010; 49(4):457-85. DOI:10.1111/j.1545-5300.2010.01334.x · 1.73 Impact Factor
  • Source
    • "The family intervention (M = 5.1 sessions) was delivered using the problem-centered systems therapy of the family (Ryan, Epstein, Keitner, Miller, & Bishop, 2005). The primary report of this study provides full details about methodology and outcome findings (Miller et al., 2005). "
    [Show abstract] [Hide abstract]
    ABSTRACT: There is a paucity of research on the emergence of suicidal ideation in recently hospitalized patients undergoing treatment for depression. As part of a larger clinical trial, patients (N = 103) with major depression without suicidal ideation at hospital discharge were followed for up to 6 months while receiving study-related outpatient treatments. Fifty-five percent reported the emergence of suicidal ideation during the outpatient period, with the vast majority (79%) exhibiting this problem within the first 2 months post-discharge. Seventy percent of those reporting severe suicidality prior to hospitalization exhibited a reemergence of suicidal ideation post-discharge. However, 29% without significant suicidality at the index hospitalization later developed suicidal ideation during the outpatient treatment period. A faster time to the emergence of suicidal ideation was predicted by both higher prehospitalization levels of suicidal ideation as well as greater depression severity at hospital discharge. Overall, rates of emergent suicidal ideation found in the current sample of recently hospitalized patients were higher than those reported in previous outpatient samples.
    Suicide and Life-Threatening Behavior 11/2008; 38(5):539-51. DOI:10.1521/suli.2008.38.5.539 · 1.40 Impact Factor
Show more