The association between medical comorbidity and psychotherapy processes and outcomes for major depressive disorder in a community mental health setting.

Abstract

Many individuals seeking mental health services for depression often suffer from a comorbid medical condition. The goal of the present study was to assess the presence of medical comorbidity in a community mental health center setting that primarily serves a Medicare and Medicaid population, characterize the types of comorbid medical conditions experienced in this setting, and explore the association between medical conditions on the alliance, attrition from services, and outcome. Medical diagnoses were collected from patient charts and structured clinical interviews from 353 participants who had a baseline assessment as part of a comparative effectiveness study of cognitive and dynamic therapies for major depressive disorder. We calculated the Charlson Comorbidity Index and the number of total medical diagnoses for each patient. Results from this study revealed that a high percentage of patients in this setting experienced a comorbid medical condition. No significant associations were found between the number of medical conditions or the Charlson Comorbidity Index and the alliance. No significant relationship was found between the number of medical conditions or the Charlson Comorbidity Index and early attrition from treatment or treatment outcome. However, exploratory analyses found that presence of a nervous system disorder was associated with relatively poorer treatment outcomes after initial engagement. Implications of these findings are discussed. Treatments for major depressive disorder may benefit from addressing the impact of medical disorders on physical functioning.

Addressing health in psychotherapy from a community wellness framework: Introduction to the special section.

“…They found that approximately 70% of their sample seeking treatment for depression also had at least one medical condition, consistent with the prevalence rates reported by Fuhrmann et al (2022). King et al (2021) found that the despite the complex medical issues experienced, clients engaged in psychotherapy, developed strong therapeutic alliances, and anticipated positive treatment outcomes; they conclude that perhaps the clinicians in their study had adequate training in treating depression and medical symptoms. These first two articles of this special section are novel for their attention to psychotherapy process and outcome variables at the level of personal (i.e., patient depression, patient physical health issues) and relational (i.e., therapeutic alliance) sites of well-being when attending to both physical and mental health.…”

“…The second article in this part of the special section by King et al (2021) investigates the extent to which clients receiving treatment for depression in a community mental health setting experience a comorbid medical condition, and the extent to which such comorbidity is associated with the therapeutic alliance, early attrition from treatment, and treatment outcomes. They found that approximately 70% of their sample seeking treatment for depression also had at least one medical condition, consistent with the prevalence rates reported by Fuhrmann et al (2022).…”

Addressing health in psychotherapy: Future directions from a community wellness lens.

“…Research examining the benefits of psychotherapy among populations navigating physical health conditions or employed in the health care setting is needed. As described and replicated in articles within this special section (Almeida et al, 2022;Kilkus, 2022;King et al, 2021;Richey & Pointer, 2021;Piers et al, 2021), much of the literature in this area has focused on cognitive behavioral therapy. This highlights a critical need for future studies to examine the efficacy and effectiveness of other psychotherapy theories when working with populations navigating physical health issues or employed in the health care setting.…”

“…This work can dovetail in future research by examining the ways in which psychotherapy constructs and processes such as the alliance (Bordin, 1976;Flückiger et al, 2018), the real relationship (Gelso, 2009;Gelso et al, 2018), and empathy (Elliott et al, 2018) are meaningful for indicators of physiological and physical health among populations navigating physical health conditions. Studies exploring these research questions will be meaningful for discerning mixed findings found in this special section related to the role of the working alliance in clients with physical health issues, including disclosure, perceived distress and burden associated with physical health, and psychotherapy outcomes (Fuhrmann et al, 2021;King et al, 2021;Piers et al, 2021).…”