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

Abstract

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 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 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 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 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 None.

Real-World Treatment Costs and Care Utilization in Patients with Major Depressive Disorder With and Without Psychiatric Comorbidities in Specialist Mental Healthcare

“…The prevalence of a comorbid personality disorder (PD) in patients with MDD is high at 45% and rises to 60% in patients with dysthymic disorders [16]. Although the majority of studies demonstrated that a comorbid PD with MDD was associated with poorer outcomes for depression than MDD alone [17][18][19], other studies found no differences (at long-term follow-up) [19,20] or did find a negative effect on depression outcome but not on functioning or quality-of-life outcomes [21]. Looking at healthcare utilization, patients with PD had more psychiatric inpatient, outpatient, and pharmacological treatment than patients with MDD as a single diagnosis [22].…”

Is bouldering-psychotherapy a cost-effective way to treat depression when compared to group cognitive behavioral therapy – results from a randomized controlled trial

“…Another US-based study concluded that individuals with major depressive disorder were willing to invest about 15% (i.e. $676) of their net income over a one year timeframe to receive treatment with an anti-depressant that cures without side effects [ 52 ]. Based on a German net household income of €3399 per month in 2017, this creates a range of €1835 to €6118 as presumable WTP for remission.…”

It’s time to replace the personality disorders with the interpersonal disorders.

“…Like most forms of psychopathology, they are persistent and pervasive in their impact, albeit variably so over the course of years (Morey & Hopwood, 2013; Zanarini et al, 2010). Research suggests that they exacerbate other forms of psychopathology and interfere with their treatment (Hein et al, 2022; Koppers et al, 2019; Skodol et al, 2014; Wiegand & Godemann, 2017). In their various forms, PDs are associated with high social costs, including excessive psychiatric and physical medical treatment utilization, interpersonal and sexual violence, other criminal behavior, and lower educational and occupational attainment (Gatner et al, 2022; Soeteman et al, 2008; Tyrer et al, 2010).…”