The Impact of Childhood Maltreatment on Long-Term Outcomes in Disorder-Specific vs. Nonspecific Psychotherapy for Chronic Depression

Bausch, Paul; Fangmeier, Thomas; Meister, Richard; Elsaeßer, Moritz; Kriston, Levente; Klein, Jan Philipp; Zobel, Ingo; Hautzinger, Martin; Härter, Martin; Schramm, Elisabeth

doi:10.1016/j.jad.2020.03.164

Cited by 11 publications

(11 citation statements)

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“…Pseudo R-square according to Nagelkerke [25] was calculated as overall effect size measure [26]. All predictors were selected a priori [27][28][29][30][31] to reduce the risk of capitalization on chance and alpha-error accumulation. Further details on the statistical analyses are depicted in the supplement.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Clusters of Long-Term Trajectories in Patients with Early-Onset Chronic Depression: 2 Years of Naturalistic Follow-Up after Extensive Psychological Treatment

Elsaesser,

Feige,

Kriston

et al. 2023

Psychother Psychosom

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Introduction: In clinical trials, mostly group-level treatment effects of repeated cross-sectional measures are analyzed. However, substantial heterogeneity regarding individual symptom profiles and the variability of treatment effects are often neglected, especially over the long-term course. To provide effective personalized treatments, investigations of these characteristics are urgently needed. Methods: Depression severity ratings over 104 weeks of follow-up after year-long treatment with the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) or Supportive Psychotherapy (SP) were analyzed. Longitudinal cluster analysis and multinomial logistic regression analysis were conducted to investigate intraindividual trajectories from one of the largest psychotherapy trials in early-onset chronic depression. Results: Two-year post-study-treatment trajectories of N = 188 patients with early-onset chronic depression were grouped into four prototypical clusters. Overall, 16.0% of patients remitted (cluster 1) and most of them did not receive any treatment during the 2-year follow-up. However, 84.0% of patients continued to experience subthreshold (37.2% cluster 2) or major depressive symptoms (46.8% clusters 3–4) and spent on average more than half of the follow-up in pharmacological and psychological treatment. Hierarchical regression analysis indicated that previous study treatment with CBASP or SP did not significantly predict cluster allocation, while baseline variables accounted for a large proportion of explained variance (R2 N = 0.64). Conclusion: While some patients experienced stable remission over 2 years of follow-up, the majority of patients experienced subthreshold or major depressive symptoms regardless of former study treatment with CBASP or SP. This calls for a long-term perspective implementing staging and innovative treatment approaches such as the sequential model or modular psychotherapy.

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Section: Discussionmentioning

confidence: 99%

Longitudinal Clusters of Long-Term Trajectories in Patients with Early-Onset Chronic Depression: 2 Years of Naturalistic Follow-Up after Extensive Psychological Treatment

Elsaesser,

Feige,

Kriston

et al. 2023

Psychother Psychosom

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“…Individual parameter estimates were used for pairwise comparison of the baseline outcome category and the remaining clusters. All predictors were selected a priori based on previous group-level analyses (27)(28)(29)(30)(31). This theory-driven approach reduces the risk of capitalization on chance and incidental findings due to alpha-error accumulation.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal clusters of long-term trajectories in patients with early-onset chronic depression: Two years of naturalistic follow-up after extensive psychological treatment

Elsaeßer¹,

Feige²,

Kriston³

et al. 2023

Preprint

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Introduction: In randomized trials, mostly group-level treatment effects of repeated cross-sectional measures are analyzed. However, substantial heterogeneity regarding individual symptom profiles and variability of treatment effects are often neglected, particularly over the long-term course.Objective: Ratings of depression severity over 104 weeks of follow-up after yearlong acute and continuation treatment with the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) or Supportive Psychotherapy (SP) were investigated to cluster intraindividual trajectories and identify risk and protective factors. Methods: Longitudinal cluster analysis and multinomial logistic regression analysis were conducted to group intraindividual long-term trajectories from one of the largest psychotherapy trials in early-onset chronic depression.Results: Two-year post-treatment trajectories of N=176 patients with early-onset chronic depression were clustered into four groups. Only 16.5% of patients remitted (Cluster 1), while the majority continued to experience subthreshold (35.8% Cluster 2) or major depressive symptoms (47.7% Cluster 3-4). Patients previously treated with the CBASP had a 45% lower risk of experiencing major depressive symptoms (Cluster 3) than patients in the SP group (RR=0.55, 95% CI=0.31 to 0.97, p=.03). Further treatment in the health care system during follow-up, especially psychological outpatient treatment, reduced depression severity. Comorbid disorders or childhood emotional/physical abuse had detrimental effects.Conclusion: Despite significant effects in favor of acute treatment with CBASP compared to SP, the majority of patients experienced subthreshold or major depressive symptoms over two years of follow-up. This calls for a long-term perspective with innovative treatment approaches such as the sequential model or modular psychotherapy.

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“…17 18 An emerging body of evidence suggests a significant relationship between emotional maltreatment (abuse and/or neglect) in particular and depression. [19][20][21][22] Maltreated individuals are 2.7-3.7 times more likely to develop depression in adulthood, have an earlier depression onset and are twice as likely to develop a chronic or treatment-resistant course. 16 CM was also associated with an elevated risk for comorbid disorders.…”

Section: Childhood Maltreatmentmentioning

confidence: 99%

“…In depressive disorders, CM is highly prevalent (~46%),16 especially in early-onset and persistent depression with up to 80% 17 18. An emerging body of evidence suggests a significant relationship between emotional maltreatment (abuse and/or neglect) in particular and depression 19–22. Maltreated individuals are 2.7–3.7 times more likely to develop depression in adulthood, have an earlier depression onset and are twice as likely to develop a chronic or treatment-resistant course 16.…”

Section: Introductionmentioning

confidence: 99%

Modular-based psychotherapy (MoBa) versus cognitive–behavioural therapy (CBT) for patients with depression, comorbidities and a history of childhood maltreatment: study protocol for a randomised controlled feasibility trial

et al. 2022

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IntroductionIn depression treatment, most patients do not reach response or remission with current psychotherapeutic approaches. Major reasons for individual non-response are interindividual heterogeneity of etiological mechanisms and pathological forms, and a high rate of comorbid disorders. Personalised treatments targeting comorbidities as well as underlying transdiagnostic mechanisms and factors like early childhood maltreatment may lead to better outcomes. A modular-based psychotherapy (MoBa) approach provides a treatment model of independent and flexible therapy elements within a systematic treatment algorithm to combine and integrate existing evidence-based approaches. By optimally tailoring module selection and application to the specific needs of each patient, MoBa has great potential to improve the currently unsatisfying results of psychotherapy as a bridge between disorder-specific and personalised approaches.Methods and analysisIn a randomised controlled feasibility trial, N=70 outpatients with episodic or persistent major depression, comorbidity and childhood maltreatment are treated in 20 individual sessions with MoBa or standard cognitive–behavioural therapy for depression. The three modules of MoBa focus on deficits associated with early childhood maltreatment: the systems of negative valence, social processes and arousal. According to a specific questionnaire-based treatment algorithm, elements from cognitive behavioural analysis system of psychotherapy, mentalisation-based psychotherapy and/or mindfulness-based cognitive therapy are integrated for a personalised modular procedure.As a proof of concept, this trial will provide evidence for the feasibility and efficacy (post-treatment and 6-month follow-up) of a modular add-on approach for patients with depression, comorbidities and a history of childhood maltreatment. Crucial feasibility aspects include targeted psychopathological mechanisms, selection (treatment algorithm), sequence and application of modules, as well as training and supervision of the study therapists.Ethics and disseminationThis study obtained approval from the independent Ethics Committees of the University of Freiburg and the University of Heidelberg. All findings will be disseminated broadly via peer-reviewed articles in scientific journals and contributions to national and international conferences.Trial registration numberDRKS00022093.

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The Impact of Childhood Maltreatment on Long-Term Outcomes in Disorder-Specific vs. Nonspecific Psychotherapy for Chronic Depression

Cited by 11 publications

References 32 publications

Longitudinal Clusters of Long-Term Trajectories in Patients with Early-Onset Chronic Depression: 2 Years of Naturalistic Follow-Up after Extensive Psychological Treatment

Longitudinal Clusters of Long-Term Trajectories in Patients with Early-Onset Chronic Depression: 2 Years of Naturalistic Follow-Up after Extensive Psychological Treatment

Longitudinal clusters of long-term trajectories in patients with early-onset chronic depression: Two years of naturalistic follow-up after extensive psychological treatment

Modular-based psychotherapy (MoBa) versus cognitive–behavioural therapy (CBT) for patients with depression, comorbidities and a history of childhood maltreatment: study protocol for a randomised controlled feasibility trial

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