Acute and long-term treatment outcome in depressed inpatients with vs. without anxious features: Results of a one-year follow-up study

Köhler, Stephan; Unger, Theresa; Hoffmann, Sabine; Steinacher, Bruno; Fydrich, Thomas

doi:10.1016/j.jad.2013.05.043

Cited by 10 publications

(5 citation statements)

References 21 publications

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“…In our sample substance abuse (8.9%) and anxiety disorders (8.7%) were the most frequent comorbidities in CD. The high prevalence especially of substance abuse and anxiety disorders is comparable with other inpatient studies (Köhler et al, 2013b). Anxiety and substance abuse disorders are especially commonly in patients with MDD (Davis et al, 2006;Kessler et al, 2003;Rush et al, 2005), this can result in poorer treatment outcome and could therefore be causally related to chronicity of depression.…”

Section: Discussionsupporting

confidence: 63%

Characteristics and differences in treatment outcome of inpatients with chronic vs. episodic major depressive disorders

Köhler

Wiethoff

Ricken

et al. 2015

Journal of Affective Disorders

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Section: Discussionsupporting

confidence: 63%

Characteristics and differences in treatment outcome of inpatients with chronic vs. episodic major depressive disorders

Köhler

Wiethoff

Ricken

et al. 2015

Journal of Affective Disorders

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“…A higher degree of psychiatric comorbidity often implies a worse course of illness or treatment prognosis. The most common Axis I comorbidity is anxiety disorders (Kessler et al, 2003), which usually imply a higher degree of severity at intake (Kohler et al, 2013), as well as a poorer natural course (Penninx et al, 2011). The presence of comorbid Axis-II disorders, of which the Cluster C diagnoses, particularly, avoidant personality disorder, are the most prevalent (Friborg et al, 2014), heightens the risk of a worse outcome following treatment (Newton-Howes, Tyrer, & Johnson, 2006).…”

Section: Client-relatedmentioning

confidence: 99%

The effects of cognitive behavioral therapy as an anti-depressive treatment is falling: A meta-analysis.

Johnsen

Friborg

2015

Psychological Bulletin

277

297

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A meta-analysis examining temporal changes (time trends) in the effects of cognitive behavioral therapy (CBT) as a treatment for unipolar depression was conducted. A comprehensive search of psychotherapy trials yielded 70 eligible studies from 1977 to 2014. Effect sizes (ES) were quantified as Hedge's g based on the Beck Depression Inventory (BDI) and the Hamilton Rating Scale for Depression (HRSD). Rates of remission were also registered. The publication year of each study was examined as a linear metaregression predictor of ES, and as part of a 2-way interaction with other moderators (Year × Moderator). The average ES of the BDI was 1.58 (95% CI [1.43, 1.74]), and 1.69 for the HRSD (95% CI [1.48, 1.89]). Subgroup analyses revealed that women profited more from therapy than did men (p < .05). Experienced psychologists (g = 1.55) achieved better results (p < .01) than less experienced student therapists (g = 0.98). The metaregressions examining the temporal trends indicated that the effects of CBT have declined linearly and steadily since its introduction, as measured by patients' self-reports (the BDI, p < .001), clinicians' ratings (the HRSD, p < .01) and rates of remission (p < .01). Subgroup analyses confirmed that the declining trend was present in both within-group (pre/post) designs (p < .01) and controlled trial designs (p = .02). Thus, modern CBT clinical trials seemingly provided less relief from depressive symptoms as compared with the seminal trials. Potential causes and possible implications for future studies are discussed. (PsycINFO Database Record

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“…This implies that MoodGYM combined with face-to-face guidance of relatively high intensity may be expected to work equally well for adult patients of varying ages, for women and men, and for various mild to moderate depressive symptom profiles, as well as for patients with comorbid anxiety of varying severity. Previous results regarding the predictive role of anxiety have been mixed [ 44 - 47 , 51 , 56 , 59 , 123 ]. With regard to depressive severity, several studies of CBT have found a larger response in terms of symptoms change for patients with higher severity (eg, [ 34 , 43 , 50 , 52 , 55 ]).…”

Section: Discussionmentioning

confidence: 99%

Predictors of Response to Web-Based Cognitive Behavioral Therapy With High-Intensity Face-to-Face Therapist Guidance for Depression: A Bayesian Analysis

Høifødt¹,

Mittner²,

Lillevoll³

et al. 2015

J Med Internet Res

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BackgroundSeveral studies have demonstrated the effect of guided Internet-based cognitive behavioral therapy (ICBT) for depression. However, ICBT is not suitable for all depressed patients and there is a considerable level of nonresponse. Research on predictors and moderators of outcome in ICBT is inconclusive.ObjectiveThis paper explored predictors of response to an intervention combining the Web-based program MoodGYM and face-to-face therapist guidance in a sample of primary care patients with mild to moderate depressive symptoms.MethodsParticipants (N=106) aged between 18 and 65 years were recruited from primary care and randomly allocated to a treatment condition or to a delayed treatment condition. The intervention included the Norwegian version of the MoodGYM program, face-to-face guidance from a psychologist, and reminder emails. In this paper, data from the treatment phase of the 2 groups was merged to increase the sample size (n=82). Outcome was improvement in depressive symptoms during treatment as assessed with the Beck Depression Inventory-II (BDI-II). Predictors included demographic variables, severity variables (eg, number of depressive episodes and pretreatment depression and anxiety severity), cognitive variables (eg, dysfunctional thinking), module completion, and treatment expectancy and motivation. Using Bayesian analysis, predictors of response were explored with a latent-class approach and by analyzing whether predictors affected the slope of response.ResultsA 2-class model distinguished well between responders (74%, 61/82) and nonresponders (26%, 21/82). Our results indicate that having had more depressive episodes, being married or cohabiting, and scoring higher on a measure of life satisfaction had high odds for positively affecting the probability of response. Higher levels of dysfunctional thinking had high odds for a negative effect on the probability of responding. Prediction of the slope of response yielded largely similar results. Bayes factors indicated substantial evidence that being married or cohabiting predicted a more positive treatment response. The effects of life satisfaction and number of depressive episodes were more uncertain. There was substantial evidence that several variables were unrelated to treatment response, including gender, age, and pretreatment symptoms of depression and anxiety.ConclusionsTreatment response to ICBT with face-to-face guidance may be comparable across varying levels of depressive severity and irrespective of the presence and severity of comorbid anxiety. Being married or cohabiting, reporting higher life satisfaction, and having had more depressive episodes may predict a more favorable response, whereas higher levels of dysfunctional thinking may be a predictor of poorer response. More studies exploring predictors and moderators of Internet-based treatments are needed to inform for whom this treatment is most effective.Trial RegistrationAustralian New Zealand Clinical Trials Registry number: ACTRN12610000257066; https://www.anzctr.org.au/trial_...

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Acute and long-term treatment outcome in depressed inpatients with vs. without anxious features: Results of a one-year follow-up study

Cited by 10 publications

References 21 publications

Characteristics and differences in treatment outcome of inpatients with chronic vs. episodic major depressive disorders

Characteristics and differences in treatment outcome of inpatients with chronic vs. episodic major depressive disorders

The effects of cognitive behavioral therapy as an anti-depressive treatment is falling: A meta-analysis.

Predictors of Response to Web-Based Cognitive Behavioral Therapy With High-Intensity Face-to-Face Therapist Guidance for Depression: A Bayesian Analysis

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