Effectiveness of inpatient versus outpatient complex treatment programs in depressive disorders: a quasi-experimental study under naturalistic conditions.
Clinical trial
Depression
Effectiveness
Inpatient treatment
Outpatient treatment
Journal
BMC psychiatry
ISSN: 1471-244X
Titre abrégé: BMC Psychiatry
Pays: England
ID NLM: 100968559
Informations de publication
Date de publication:
02 12 2019
02 12 2019
Historique:
received:
27
12
2018
accepted:
22
11
2019
entrez:
4
12
2019
pubmed:
4
12
2019
medline:
11
6
2020
Statut:
epublish
Résumé
Due to long waiting periods for outpatient psychotherapy and the high resource requirements of inpatient treatment, there is a need for alternative treatment programs for patients with depressive disorders. Thus, we investigated the effectiveness of the "Bielefeld Outpatient Intensive Treatment Program of Depression" (BID) in comparison with a typical inpatient treatment program by using a prospective quasi-experimental observational study. We assumed (i) that both complex programs are effective in pre-post analyses after 6 weeks and (ii) that inpatient treatment is more effective compared with the outpatient program. Four hundred patients with depressive psychopathology - a majority with depressive episodes (ICD-10 F3X) - took part in the BID and 193 in the inpatient program. Different self- (i.e., BDI) and expert measures (i.e., MADRS) of psychopathology at baseline (t1) and 6 weeks later (t2) were applied to examine treatment effects. Treatment effects were high in separate analyses of both groups with Cohen's d ranging from 1.10 to 1.76., while ANOVA comparative analyses did not reveal any significant differences between both treatment settings nor did a set of independent covariates analyzed here. Response rates of BDI (p = .002) and MADRS (p = .001) were higher in the outpatient group. Results indicate BID not to be inferior compared to an inpatient program, although diverging pathways to treatment, higher rates of clinical recurrent depressive disorders and severe episodes as well as lower rates of employment and partnership in the inpatient treatment group have to be considered. Outpatient intensive treatment programs may represent a solution for patients needing more than a treatment session once per week but less than a complex inpatient or day clinic program.
Sections du résumé
BACKGROUND
Due to long waiting periods for outpatient psychotherapy and the high resource requirements of inpatient treatment, there is a need for alternative treatment programs for patients with depressive disorders. Thus, we investigated the effectiveness of the "Bielefeld Outpatient Intensive Treatment Program of Depression" (BID) in comparison with a typical inpatient treatment program by using a prospective quasi-experimental observational study. We assumed (i) that both complex programs are effective in pre-post analyses after 6 weeks and (ii) that inpatient treatment is more effective compared with the outpatient program.
METHODS
Four hundred patients with depressive psychopathology - a majority with depressive episodes (ICD-10 F3X) - took part in the BID and 193 in the inpatient program. Different self- (i.e., BDI) and expert measures (i.e., MADRS) of psychopathology at baseline (t1) and 6 weeks later (t2) were applied to examine treatment effects.
RESULTS
Treatment effects were high in separate analyses of both groups with Cohen's d ranging from 1.10 to 1.76., while ANOVA comparative analyses did not reveal any significant differences between both treatment settings nor did a set of independent covariates analyzed here. Response rates of BDI (p = .002) and MADRS (p = .001) were higher in the outpatient group. Results indicate BID not to be inferior compared to an inpatient program, although diverging pathways to treatment, higher rates of clinical recurrent depressive disorders and severe episodes as well as lower rates of employment and partnership in the inpatient treatment group have to be considered.
CONCLUSION
Outpatient intensive treatment programs may represent a solution for patients needing more than a treatment session once per week but less than a complex inpatient or day clinic program.
Identifiants
pubmed: 31791279
doi: 10.1186/s12888-019-2371-5
pii: 10.1186/s12888-019-2371-5
pmc: PMC6889566
doi:
Types de publication
Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
380Références
Psychol Med. 1999 Jul;29(4):847-53
pubmed: 10473311
Behav Res Methods. 2009 Nov;41(4):1149-60
pubmed: 19897823
Nervenarzt. 2007 Jun;78(6):651-6
pubmed: 16832698
Psychol Med. 2010 Feb;40(2):211-23
pubmed: 19490745
Am J Med. 2000 Jan;108(1):54-64
pubmed: 11059441
Biol Psychiatry. 2002 Sep 15;52(6):610-30
pubmed: 12361671
Soc Psychiatry Psychiatr Epidemiol. 1998 Dec;33(12):587-95
pubmed: 9857791
Nervenarzt. 2014 Jul;85(7):856-64
pubmed: 24149773
Cochrane Database Syst Rev. 2013 Sep 12;(9):CD004366
pubmed: 24026850
Psychother Psychosom Med Psychol. 2013 Sep;63(9-10):355-64
pubmed: 23828216
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2004 Aug;47(8):736-44
pubmed: 15340716
BMC Health Serv Res. 2006 Jul 16;6:88
pubmed: 16842629
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013 May;56(5-6):733-9
pubmed: 23703492
Br J Psychiatry. 1979 Apr;134:382-9
pubmed: 444788
Am J Psychiatry. 1999 Jul;156(7):1007-13
pubmed: 10401443
Nervenarzt. 2014 Jan;85(1):77-87
pubmed: 24441882
J Affect Disord. 1998 Apr;49(1):59-72
pubmed: 9574861
Lancet. 2006 May 27;367(9524):1747-57
pubmed: 16731270
Br J Psychiatry. 2012 Mar;200(3):184-90
pubmed: 22383765
Nervenarzt. 2006 Nov;77(11):1399-403
pubmed: 17695061
Lancet. 2006 Jan 14;367(9505):153-67
pubmed: 16413879
Arch Gen Psychiatry. 2004 Jul;61(7):714-9
pubmed: 15237083
N Engl J Med. 2000 May 18;342(20):1462-70
pubmed: 10816183
Arch Gen Psychiatry. 1999 Dec;56(12):1109-15
pubmed: 10591288
J Psychiatr Res. 2012 Jun;46(6):697-702
pubmed: 22410207