The effect of comorbid personality disorder on depression outcome after short-term psychotherapy in a randomised clinical trial.

Comorbidity depressive disorders outcome studies personality disorders randomised controlled trial

Journal

BJPsych open
ISSN: 2056-4724
Titre abrégé: BJPsych Open
Pays: England
ID NLM: 101667931

Informations de publication

Date de publication:
16 Jul 2019
Historique:
entrez: 19 9 2019
pubmed: 19 9 2019
medline: 19 9 2019
Statut: epublish

Résumé

Time-limited psychotherapy for depression is effective. However, comorbid personality disorders affect therapy outcomes negatively. Studies of follow-up effects and results relating to the influence of comorbid personality disorder and treatment modality are scarce. To determine the influence of comorbid personality disorder and treatment modality on outcomes after cognitive-behavioural therapy (CBT) or short-term psychodynamic supportive psychotherapy (SPSP) for depression. This study draws on data from a previously published randomised clinical trial contrasting SPSP and CBT for depression (both 16 sessions). We compared the effectiveness of these psychotherapies for patients with and without personality disorder (n = 196). The primary measure was depression outcome; the secondary measurements were interpersonal functioning and quality of life. Collected data were analysed using multilevel analysis. Trial registration: ISRCTN31263312 (http://www.controlled-trials.com). Although participants with and without comorbid personality disorder improved at treatment termination (d = 1.04, 95% CI 0.77-1.31 and d = 1.36, 95% CI 0.97-1.76, respectively) and at follow-up (d = 1.15, 95% CI 0.87-1.43 and d = 2.12, 95% CI 1.65-2.59 respectively), personality disorder had a negative effect on depression outcome at both measurement points (P < 0.05). A similar negative effect on interpersonal functioning was no longer apparent at follow-up. Comorbid personality disorder had no influence on social functioning or quality of life outcomes, irrespective of treatment modality. CBT and SPSP contribute to the improvement of depressive symptoms and interpersonal problems in depressed patients with and without comorbid personality disorder. Both treatments are an effective first step in a stepped care approach, but - given remaining levels of depression in patients with personality disorder - they are probably inadequate for large numbers of patients with this comorbidity. None.

Sections du résumé

BACKGROUND BACKGROUND
Time-limited psychotherapy for depression is effective. However, comorbid personality disorders affect therapy outcomes negatively. Studies of follow-up effects and results relating to the influence of comorbid personality disorder and treatment modality are scarce.
AIMS OBJECTIVE
To determine the influence of comorbid personality disorder and treatment modality on outcomes after cognitive-behavioural therapy (CBT) or short-term psychodynamic supportive psychotherapy (SPSP) for depression.
METHOD METHODS
This study draws on data from a previously published randomised clinical trial contrasting SPSP and CBT for depression (both 16 sessions). We compared the effectiveness of these psychotherapies for patients with and without personality disorder (n = 196). The primary measure was depression outcome; the secondary measurements were interpersonal functioning and quality of life. Collected data were analysed using multilevel analysis. Trial registration: ISRCTN31263312 (http://www.controlled-trials.com).
RESULTS RESULTS
Although participants with and without comorbid personality disorder improved at treatment termination (d = 1.04, 95% CI 0.77-1.31 and d = 1.36, 95% CI 0.97-1.76, respectively) and at follow-up (d = 1.15, 95% CI 0.87-1.43 and d = 2.12, 95% CI 1.65-2.59 respectively), personality disorder had a negative effect on depression outcome at both measurement points (P < 0.05). A similar negative effect on interpersonal functioning was no longer apparent at follow-up. Comorbid personality disorder had no influence on social functioning or quality of life outcomes, irrespective of treatment modality.
CONCLUSIONS CONCLUSIONS
CBT and SPSP contribute to the improvement of depressive symptoms and interpersonal problems in depressed patients with and without comorbid personality disorder. Both treatments are an effective first step in a stepped care approach, but - given remaining levels of depression in patients with personality disorder - they are probably inadequate for large numbers of patients with this comorbidity.
DECLARATION OF INTEREST BACKGROUND
None.

Identifiants

DOI: 10.1192/bjo.2019.47 PMID: 31530296 PMC: PMC6646965
pubmed: 31530296
doi: 10.1192/bjo.2019.47
pii: S2056472419000474
pmc: PMC6646965
doi:

Types de publication

Journal Article

Langues

eng

Pagination

e61

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Auteurs

David Koppers (D)

Clinical Psychologist and Researcher, Department of Research and Quality of Care, ARKIN Mental Health Institute, the Netherlands.

Marit Kool (M)

Clinical Psychologist and Researcher, Department of Personality Disorders, ARKIN Mental Health Institute, the Netherlands.

Henricus Van (H)

Psychiatrist, and Researcher, Department of Personality Disorders, ARKIN Mental Health Institute, NPI, the Netherlands.

Ellen Driessen (E)

Researcher, Department of Research and Quality of Care, ARKIN Mental Health Institute, the Netherlands.

Jaap Peen (J)

Methodologist, Department of Research and Quality of Care, ARKIN Mental Health Institute, the Netherlands.

Jack Dekker (J)

Head, Department of Research and Quality of Care, ARKIN Mental Health Institute; and Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit, the Netherlands.

Classifications MeSH