Inpatient psychotherapy for depression in a large routine clinical care sample: A Bayesian approach to examining clinical outcomes and predictors of change.

Anxiety Disorders Bayes Theorem Depression / therapy Humans Inpatients Psychotherapy / methods Treatment Outcome
Depression Effectiveness Prediction Predictors of change Routine clinical care

Journal

Journal of affective disorders
ISSN: 1573-2517
Titre abrégé: J Affect Disord
Pays: Netherlands
ID NLM: 7906073

Informations de publication

Date de publication:
15 05 2022
Historique:
received: 11 08 2021
revised: 16 02 2022
accepted: 20 02 2022
pubmed: 28 2 2022
medline: 21 4 2022
entrez: 27 2 2022
Statut: ppublish

Résumé

A routinely collected dataset was analyzed (1) to determine the naturalistic effectiveness of inpatient psychotherapy for depression in routine psychotherapeutic care, and (2) to identify potential predictors of change. In a sample of 22,681 inpatients with depression, pre-post and pre-follow-up effect sizes were computed for various outcome variables. To build a probabilistic model of predictors of change, an independent component analysis generated components from demographic and clinical data, and Bayesian EFA extracted factors from the available pre-test, post-test and follow-up questionnaires in a subsample (N = 6377). To select the best-fitted model, the BIC of different path models were compared. A Bayesian path analysis was performed to identify the most important factors to predict changes. Effect sizes were large for the primary outcome and moderate for various secondary outcomes. Almost all pretreatment factors exerted significant influences on different baseline factors. Several factors were found to be resistant to change during treatment: suicidality, agoraphobia, life dissatisfaction, physical disability and pain. The strongest cross-loadings were observed from suicidality on negative cognitions, from agoraphobia on anxiety, and from physical disability on perceived disability. No causal conclusions can be drawn directly from our results as we only used cross-lagged panel data without control group. The results indicate large effects of inpatient psychotherapy for depression in routine clinical care. The direct influence of pretreatment factors decreased over the course of treatment. However, some factors appeared stable and difficult to treat, which might hinder treatment outcome. Findings of different predictors of change are discussed.

Sections du résumé

BACKGROUND
A routinely collected dataset was analyzed (1) to determine the naturalistic effectiveness of inpatient psychotherapy for depression in routine psychotherapeutic care, and (2) to identify potential predictors of change.
METHODS
In a sample of 22,681 inpatients with depression, pre-post and pre-follow-up effect sizes were computed for various outcome variables. To build a probabilistic model of predictors of change, an independent component analysis generated components from demographic and clinical data, and Bayesian EFA extracted factors from the available pre-test, post-test and follow-up questionnaires in a subsample (N = 6377). To select the best-fitted model, the BIC of different path models were compared. A Bayesian path analysis was performed to identify the most important factors to predict changes.
RESULTS
Effect sizes were large for the primary outcome and moderate for various secondary outcomes. Almost all pretreatment factors exerted significant influences on different baseline factors. Several factors were found to be resistant to change during treatment: suicidality, agoraphobia, life dissatisfaction, physical disability and pain. The strongest cross-loadings were observed from suicidality on negative cognitions, from agoraphobia on anxiety, and from physical disability on perceived disability.
LIMITATIONS
No causal conclusions can be drawn directly from our results as we only used cross-lagged panel data without control group.
CONCLUSIONS
The results indicate large effects of inpatient psychotherapy for depression in routine clinical care. The direct influence of pretreatment factors decreased over the course of treatment. However, some factors appeared stable and difficult to treat, which might hinder treatment outcome. Findings of different predictors of change are discussed.

Identifiants

DOI: 10.1016/j.jad.2022.02.057 PMID: 35219740
pubmed: 35219740
pii: S0165-0327(22)00206-3
doi: 10.1016/j.jad.2022.02.057
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

133-143

Informations de copyright

Copyright © 2022 Elsevier B.V. All rights reserved.

Auteurs

Philipp Herzog (P)

Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany; University of Greifswald, Department of Clinical Psychology and Psychotherapy, Franz-Mehring-Straße 47, D-17489 Greifswald, Germany; University of Koblenz-Landau, Department of Clinical Psychology and Psychotherapy, Ostbahnstraße 10, D-76829 Landau, Germany. Electronic address: herzog@uni-landau.de.

Matthias Feldmann (M)

Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany.

Tobias Kube (T)

Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany; University of Koblenz-Landau, Department of Clinical Psychology and Psychotherapy, Ostbahnstraße 10, D-76829 Landau, Germany.

Gernot Langs (G)

Schön-Klinik Bad Bramstedt, Psychosomatic Clinic, Birkenweg 10, D-24576 Bad Bramstedt, Germany.

Thomas Gärtner (T)

Schön-Klinik Bad Arolsen, Psychosomatic Clinic, Hofgarten 10, D-34454 Bad Arolsen, Germany.

Elisabeth Rauh (E)

Schön-Klinik Bad Staffelstein, Psychsomatic Clinic, Am Kurpark 11, D-96231 Bad Staffelstein, Germany.

Robert Doerr (R)

Schön-Klinik Berchtesgadener Land, Psychosomatic Clinic, Malterhöh 1, D-83471 Schönau am Königssee, Germany.

Andreas Hillert (A)

Schön-Klinik Roseneck, Psychosomatic Clinic, Am Roseneck 6, D-83209 Prien am Chiemsee, Germany.

Ulrich Voderholzer (U)

Schön-Klinik Roseneck, Psychosomatic Clinic, Am Roseneck 6, D-83209 Prien am Chiemsee, Germany; University Hospital of Munich, Department of Psychiatry and Psychotherapy, Nußbaumstraße 7, D-80336 München, Germany.

Winfried Rief (W)

Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany.

Dominik Endres (D)

Philipps-University of Marburg, Department of Theoretical Neuroscience, Gutenbergstraße 18, D-35032 Marburg, Germany.

Eva-Lotta Brakemeier (EL)

Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany; University of Greifswald, Department of Clinical Psychology and Psychotherapy, Franz-Mehring-Straße 47, D-17489 Greifswald, Germany.

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Classifications MeSH

questionsmedicales.fr › Troubles mentaux › Troubles anxieux › Inpatient psychotherapy for depression in a...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Théorème de Bayes › Inpatient psychotherapy for depression in a...
questionsmedicales.fr › Comportement et mécanismes comportementaux › Émotions › Dépression › Inpatient psychotherapy for depression in a...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Inpatient psychotherapy for depression in a...
questionsmedicales.fr › Personnes › Patients › Patients hospitalisés › Inpatient psychotherapy for depression in a...
questionsmedicales.fr › Disciplines et activités comportementales › Psychothérapie › Inpatient psychotherapy for depression in a...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Inpatient psychotherapy for depression in a...