The concept of recovery in major depression
Department of Psychology PSI, University of Bologna, Bolonia, Emilia-Romagna, Italy Psychological Medicine
(Impact Factor: 5.94).
04/2007; 37(3):307-17. DOI: 10.1017/S0033291706008981
There is increasing literature on the unsatisfactory degree of remission that current therapeutic strategies yield in unipolar depression. The aims of this review were to survey the available literature on residual symptoms of depression, to introduce new targets for therapy and to outline a more stringent definition of recovery.
Studies were identified by using MEDLINE (English language articles published from 1967 to June 2006; keywords: recovery, remission, residual symptoms, sequential treatment, drugs and psychotherapy, related to depressive disorder and depression) and a manual search of the literature and Index Medicus for the years 1960-2006.
Most patients report residual symptoms despite apparently successful treatment. Residual symptoms upon remission have a strong prognostic value. There appears to be a relationship between residual and prodromal symptomatology. The concept of recovery should involve psychological well-being.
Appraisal of subclinical symptomatology in depression has important implications for pathophysiological models of disease and relapse prevention. New therapeutic strategies for improving the level of remission, such as treatment on residual symptoms that progress to become prodromes of relapse, may yield more lasting benefits.
Available from: Gunnar Ahlborg
- "Thus, it seems important to identify low mental well-being to avoid lingering absence and, in the longer-term perspective, disability pensions. In psychiatric research, it has been suggested that well-being is an important complement to diagnostic procedures of symptoms because it has higher relevance to an individual’s quality of life, and it may better capture recovery or subclinical symptoms [35,38,39]. "
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ABSTRACT: Mental health problems are common in the work force influence work capacity and sickness absence. The aim was to examine self-assessed mental health problems and work capacity as determinants of time until return to work (RTW).
Employed women and men (n=6140), aged 19--64 years, registered as sick with all-cause sickness absence between February 18 and April 15, 2008 received a self-administered questionnaire covering health, and work situation(response rate 54%). Demographic data was collected from official registers. This follow-up study included 2502 individuals. Of these, 1082 were currently off sick when answering the questionnaire. Register data on total number of benefit compensated sick-leave days in the end of 2008 were used to determine the time until RTW. Self-reported persistent mental illness, the WHO (Ten) Mental Well-Being Index and self-assessed work capacity in relation to knowledge, mental, collaborative and physical demands at work were used as determinants. Multinomial and binary logistic regression analyses were used to estimate odds ratios with 95% confidence intervals (CI) for the likelihood of RTW.
The likelihood of RTW (>=105 days) was higher among those with persistent mental illness OR=1.75 (95 % CI, 1.21-2.52) and those with low mental well-being OR= 2.18 (95% CI, 1.69-2.82) after adjusting for age and gender. An analysis of employee who were off sick when they answered the questionnaire, the likelihood of RTW (>=105 days) was higher among those who reported low capacity to work in relation to knowledge, mental, collaborative and physical demands at work. In a multivariable analysis, the likelihood of RTW (>=105 days) among those with low mental well-being remained significant OR=1.93 (95% CI 1.46-2.55) even after adjustment for all dimensions of capacity to work.
Self-assessed persistent mental illness, low mental well-being and low work capacity increased the likelihood of prolonged RTW. This study is unique because it is based on new sick-leave spells and is the first to show that low mental well-being was a strong determinant of RTW even after adjustment for work capacity. Our findings support the importance of identifying individuals with low mental well-being as a way to promote RTW.
- "In the Stockholm Outcome of Psychoanalysis and Psychotherapy Project (Sandell et al., 2000), the development of social functioning was virtually the same whether a patient had been in psychoanalysis or psychotherapy; mean improvement was almost exactly equal in both groups, and within-group effect sizes were small for both groups. Personality functioning is hypothesized to play a contributing role in the development of depression (Akiskal, Hirschfeld, & Yerevanian, 1983; Kendler, Gatz, Gardner , & Pedersen, 2006; Krueger, 2005; Morey et al., 2007), and impairment in personality functioning, beyond its significance for social adjustment and life satisfaction, has been shown to predispose individuals for symptom persistence, relapse, and recurrence (Fava et al., 2007). Therefore, improvement in personality functioning may function as a mediator for the stability of symptom change, and Grande and colleagues (2009) indeed found that personality change at post-treatment was a predictor of patient self-reported symptom change at 3-year follow-up. "
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ABSTRACT: The aim of this study was to investigate the effectiveness of long-term psychoanalytic and psychodynamic psychotherapies. In a prospective, randomized outcome study, psychoanalytic (mean duration: 39 months, mean dose: 234 sessions) and psychodynamic (mean duration: 34 months, mean dose: 88 sessions) therapy were compared at post-treatment and at one-, two-, and three-year follow-up in the treatment of patients with a primary diagnosis of unipolar depression. All treatments were carried out by experienced psychotherapists. Primary outcome measures were the Beck Depression Inventory and the Scales of Psychological Capacities, and secondary outcome measures were the Global Severity Index of the Symptom Checklist 90-R, the Inventory of Interpersonal Problems, the Social Support Questionnaire, and the INTREX Introject Questionnaire. Interviewers at pre- and post-treatment and at one-year follow-up were blinded; at two- and threeyear follow-up, all self-report instruments were mailed to the patients. Analyses of covariance, effect sizes, and clinical significances were calculated to contrast the groups. We found significant outcome differences between treatments in terms of depressive and global psychiatric symptoms, personality functioning, and social relations at three-year follow-up, with psychoanalytic therapy being more effective. No outcome differences were found in terms of interpersonal problems. We concluded that psychoanalytic therapy associated with its higher treatment dose shows longer-lasting effects.
- "Together with the investigation of long-term stability, the research question of how and why treatments achieve stable results became central (Kazdin 2007). Meanwhile, empirical evidence has accumulated that impaired personality structures like inadequate personality functioning or distorted self-schemata (Beshai et al. 2011) may predispose patients to relapse and recurrence (Fava et al. 2007). Therefore, outcome research increasingly targets personality structures but still empirical findings are only tentative (e.g., which treatment models enable patients to change maladaptive personality structures). "
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ABSTRACT: The study investigates the effectiveness of long-term psychotherapies. Cognitive-behaviour therapy was compared with psychoanalytic and psychodynamic therapy in the treatment of patients with a primary diagnosis of unipolar depression.
In a prospective, quasi-experimental design 100 patients were compared at pre- and post-treatment and three-year follow-up. Outcome measures were the Beck Depression Inventory and Global Severity Index for measuring symptoms, the Inventory of Interpersonal Problems and the Social Support Questionnaire for measurement of social-interpersonal functioning, and the INTREX Introject Questionnaire for measuring personality structure. Comparative effectiveness of the experimental groups was analyzed using mixed models.
We found significant outcome differences between psychoanalytic therapy and cognitive-behaviour therapy in depressive and global psychiatric symptoms, partly social-interpersonal and personality structure at three-year follow-up. Psychodynamic therapy was superior to cognitive-behaviour therapy in the reduction of interpersonal problems.
Psychoanalytic therapy shows significantly longer-lasting effects compared to cognitive-behaviour therapy three years after termination of treatment, which is discussed as a dose-effect.
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