Psychological treatment of depression in inpatients: A systematic review and meta-analysis

Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, Amsterdam, The Netherlands.
Clinical psychology review (Impact Factor: 7.18). 04/2011; 31(3):353-60. DOI: 10.1016/j.cpr.2011.01.002
Source: PubMed


Research on psychological treatment of depression in inpatients is not conclusive, with some studies finding clear positive effects and other studies finding no significant benefit compared to usual care or structured pharmacotherapy. The results of a meta-analysis investigating how effective psychological treatment is for depressed inpatients are presented. A systematic search in bibliographical databases resulted in 12 studies with a total of 570 respondents. This set of studies had sufficient statistical power to detect small effect sizes. Psychological treatments had a small (g=0.29), but statistically significant additional effect on depression compared to usual care and structured pharmacological treatments only. This corresponded with a numbers-needed-to-be-treated of 6.17. Heterogeneity was zero in most analyses, and not significant in all analyses. There was no indication for significant publication bias. Effects were not associated with characteristics of the population, the interventions and the design of the studies. Although the number of studies was small, and the quality of many studies was not optimal, it seems safe to conclude that psychological treatments have a small but robust effect on depression in depressed inpatients. More high-quality research is needed to verify these results.

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Available from: Gerhard Andersson, May 24, 2014
    • "Current inpatient services are frequently criticized for being socially disengaging (Sharac et al., 2010), not being guided by empirical research (Goldman, 2011), and staff report high levels of job dissatisfaction and burn out (Gilbody et al., 2006). Meta-analytic studies indicate inpatients benefit from psychological treatment (Cuijpers et al., 2011; K€ osters, Burlingame, Nachtigall, & Strauss, 2006; Stuart & Bowers, 1995; Xia, Merinder, & Belgamwar, 2011) but access to such therapy is restricted. Behavioral Activation (BA) is a well-established treatment for major depression (Mazzucchelli, Kane, & Rees, 2009), with effects comparable to gold standard Cognitive Behavior Therapy (CBT) and antidepressant medication (Dimidjian et al., 2006; Moradveisi, Huibers, Renner, Arasteh, & Arntz, 2013). "
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    ABSTRACT: The present study employed a multiple baseline study design with repeated measures to explore clinical outcomes, therapy mechanisms, and feasibility of Behavioral Activation for persons admitted to inpatient psychiatry.Methods Six adult inpatients with depressive symptoms and different psychiatric disorders were randomized to different lengths of baseline standard inpatient treatment. Subsequently a 5-day, 10-session Behavioral Activation protocol was added. Daily self-report outcome and process measures were administered and supplemented with hourly self-reports and clinician assessments before and after each study phase.ResultsAfter a relatively stable baseline, at least four participants showed marked gradual improvements both in terms of outcome as well as activation and avoidance as Behavioral Activation was initiated. The temporal relation between process and outcome differed somewhat across metrics. In most instances however, change in activation and avoidance either coincided or preceded decreased depression.LimitationsWe did not include some relatively common disorders, did not control for the effects of increased attention, did not investigate treatment integrity, and did not conduct follow-up after discharge. Raters were not blind and measures were mainly focused on depressive symptoms. All received concurrent medical treatment.Conclusions This preliminary study further supports the promise of Behavioral Activation as an inpatient treatment for persons with a variety of psychiatric disorders. Results also lends preliminary support for the purported mechanisms of Behavioral Activation.
    No preview · Article · Oct 2014 · Journal of Behavior Therapy and Experimental Psychiatry
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    • "exercise and psychotherapy) in mildly depressed patients and pharmacotherapy only for the most severe cases. Among other things, these authors and authorities did not take into consideration that, peculiarly, similar findings were reported concerning psychotherapy [13-16]. "
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    ABSTRACT: During the last decade, a number of meta-analyses questioned the clinically relevant efficacy of antidepressants. Part of the debate concerned the method used in each of these meta-analyses as well as the quality of the data set. The Kirsch data set was analysed with a number of different methods, and eight key questions were tackled. We fit random effects models in both Bayesian and frequentist statistical frameworks using raw mean difference and standardised mean difference scales. We also compare between-study heterogeneity estimates and produce treatment rank probabilities for all antidepressants. The role of the initial severity is further examined using meta-regression methods. The results suggest that antidepressants have a standardised effect size equal to 0.34 which is lower but comparable to the effect of antipsychotics in schizophrenia and acute mania. The raw HDRS difference from placebo is 2.82 with the value of 3 included in the confidence interval (2.21--3.44). No role of initial severity was found after partially controlling for the effect of structural (mathematical) coupling. Although data are not definite, even after controlling for baseline severity, there is a strong possibility that venlafaxine is superior to fluoxetine, with the other two agents positioned in the middle. The decrease in the difference between the agent and placebo in more recent studies in comparison to older ones is attributed to baseline severity alone. The results reported here conclude the debate on the efficacy of antidepressants and suggest that antidepressants are clearly superior to placebo. They also suggest that baseline severity cannot be utilized to dictate whether the treatment should include medication or not. Suggestions like this, proposed by guidelines or institutions (e.g. the NICE), should be considered mistaken.
    Full-text · Article · Aug 2013 · Annals of General Psychiatry
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    • "The number of studies on psychological treatment for inpatients is limited. Recently, we summarized those studies in a meta-analysis and demonstrated small but robust effects [17]. However, there was a considerable variation in treatment setting, content of treatment, number of sessions, and inclusion and exclusion criteria applied. "
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    ABSTRACT: Background Depression in later life is a common mental disorder with a prevalence rate of between 3% and 35% for minor depression and approximately 2% for Major Depressive Disorder (MDD). The most common treatment modalities for MDD are antidepressant medication and psychological interventions. Recently, Behavioral Activation (BA) has gained renewed attention as an effective treatment modality in MDD. Although BA is considered an easy accessible intervention for both patients and health care workers (such as nurses), there is no research on the effectiveness of the intervention in inpatient depressed elderly. The aim of study, described in the present proposal, is to examine the effects of BA when executed by nurses in an inpatient population of elderly persons with MDD. Methods/design The study is designed as a multi-center cluster randomized controlled trial. BA, described as The Systematic Activation Method (SAM) will be compared with Treatment as Usual (TAU). We aim to include ten mental health care units in the Netherlands that will each participate as a control unit or an experimental unit. The patients will meet the following criteria: (1) a primary diagnosis of Major Depressive Disorder (MDD) according to the DSM-IV criteria; (2) 60 years or older; (3) able to read and write in Dutch; (4) have consented to participate via the informed consent procedure. Based on an effect size d = 0.7, we intend to include 51 participants per condition (n = 102). The SAM will be implemented within the experimental units as an adjunctive therapy to Treatment As Usual (TAU). All patients will be assessed at baseline, after eight weeks, and after six months. The primary outcome will be the level of depression measured by means of the Beck Depression Inventory (Dutch version). Other assessments will be activity level, mastery, costs, anxiety and quality of life. Discussion To our knowledge this is the first study to test the effect of Behavioral Activation as a nursing intervention in an inpatient elderly population. This research has been approved by the medical research ethics committee for health-care settings in the Netherlands (No. NL26878.029.09) and is listed in the Dutch Trial Register (NTR No.1809).
    Full-text · Article · Sep 2012 · BMC Psychiatry
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