The INDDEP study: inpatient and day hospital treatment for depression – symptom course and predictors of change

BMC Psychiatry

Armin Hartmann¹  Manfred Beutel²  Heinz Weiss³  Joern von Wietersheim⁴  Almut Zeeck¹ 

[1] Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital, Freiburg, Germany;Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital, Mainz, Germany;Department for Psychosomatic Medicine and Psychotherapy, Robert-Bosch-Krankenhaus, Stuttgart, Germany;Clinic for Psychosomatic Medicine and Psychotherapy, Medical University Clinic, Ulm, Germany

关键词: Subgroups;    Outcome;    Naturalistic study;    Predictors;    Day hospital;    Inpatient;    Depression;   

Others  :  1124094
DOI  :  10.1186/1471-244X-13-100

 received in 2013-01-28, accepted in 2013-03-21,  发布年份 2013

【 摘 要 】

Background

Depression can be treated in an outpatient, inpatient or day hospital setting. In the German health care system, episodes of inpatient or day hospital treatment are common, but there is a lack of studies evaluating effectiveness in routine care and subgroups of patients with a good or insufficient treatment response. Our study aims at identifying prognostic and prescriptive outcome predictors as well as comparative effectiveness in psychosomatic inpatient and day hospital treatment in depression.

Methods/Design

In a naturalistic study, 300 consecutive inpatient and 300 day hospital treatment episodes in seven psychosomatic hospitals in Germany will be included. Patients are assessed at four time points of measurement (admission, discharge, 3-months follow-up, 12-months follow-up) including a broad range of variables (self-report and expert ratings). First, the whole sample will be analysed to identify prognostic and prescriptive predictors of outcome (primary outcome criterion: Quick Inventory of Depressive Symptoms QIDS-total score, expert rating). Secondly, for a comparison of inpatient and day hospital treatment, samples will be matched according to known predictors of outcome.

Discussion

Naturalistic studies with good external validity are needed to assess treatment outcome in depression in routine care and to identify subgroups of patients with different therapeutic needs.

Trial registration

Current Controlled Trials ISRCTN20317064

【 授权许可】

   
2013 Zeeck et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Jacobi F, Wittchen H, Hölting C, Höfler M, Pfister H, Müller N, Lieb R: Prevalence, co-morbidity, and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychol Med 2004, 34:597-611.
• [2]World Health Organisation: The global burden of disease: 2004 update. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf webcite
• [3]DGPPN, BÄK, KBV, AWMF, AkdÄ, BPtK, BApK, DAGSHG, DEGAM, DGPM, DGPs, DGRW: S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression. Berlin: Düsseldorf; 2009. http://www.awmf.org/uploads/tx_szleitlinien/nvl-005l_S3_Unipolare_Depression_2012-01.pdf webcite
• [4]Franz M, Janssen P, Lensche H, Schmidtke V, Tetzlaff M, Martin K, Wöller W, Hartkamp N, Schneider G, Heuft G: Effekte stationärer psychoanalytisch orientierter Psychotherapie - eine Multizenterstudie. Zeitschrift für Psychosomatische Medizin 2000, 46:242-258.
• [5]Zeeck A, Hartmann A, Küchenhoff J, Weis H, Sammet I, Gaus E, Semm E, Harms D, Eisenberg A, Rahm R, von Wietersheim J: Differentielle Indikationsstellung stationärer und tagesklinischer Psychotherapie: die DINSTAP-Studie. Psychother Psychosom 2009, 59:354-363.
• [6]Probst T: Effektivität stationärer psychosomatischer Krankenhausbehandlung – Ergebnisse einer multizentrischen Katamnesestudie. Z Psychosom Med Psychother 2009, 55(4):410-420.
• [7]Von Wietersheim J, Zeeck A, Küchenhoff J: Status, Möglichkeiten und Grenzen der Therapie in psychosomatischen Tageskliniken. Psychother Psychosom 2005, 55:79-83.
• [8]Marshall M, Crowther R, Almaraz-Serrano A, Creed F, Sledge W, Kluiter H, Roberts C, Hill E, Wiersma D, Bond G, Huxley P, Tyrer P: Systematic reviews of the effectiveness of day care with severe mental disorders: (1) acute day hospital versus admission; (2) vocational rehabilitation; (3) day hospital versus outpatient care. Health Technol Assess 2001, 5(21):1-75.
• [9]Blatt S, Zuroff D, Hawley L, Auerbach J: Predictors of sustained therapeutic change. Psychother Res 2010, 20(1):37-54.
• [10]Tritt K, von Heymann F, Loew T, Benker B, Bleichner F, Buchmüller R, Findeisen P, Galuska J, Kalleder W, Lettner F, Michelitsch B, Pfitzer F, Stadtmüller G, Zaudig M: Patienten in stationärer psychosomatischer Krankenhausbehandlung: Patientencharakteristika und Behandlungsergebnisse anhand der Psy-BaDo-PTM. Psychother Psychiatr Psychother Med Klin Psych 2003, 8:244-251.
• [11]Zeeck A, Scheidt C, Hartmann A, Wirsching M: Stationäre oder teilstationäre Psychotherapie? Psychotherapeut 2003, 48:420-425.
• [12]Zeeck A, Hartmann A, Kuhn K: Psychotherapy in a day clinic - results of a 1.5 year follow-up. Psychiatr Serv 2003, 76(1):1-17.
• [13]Härter M, Sitta P, Keller F, Metzger R, Wiegand W, Schell G, Stieglitz RD, Wolfersdorf M, Felsenstein M, Berger M: Stationäre und psychiatrisch-psychotherapeutische Depressionsbehandlung. Prozess- und Ergebnisqualität eines Modellprojektes in Baden-Württemberg. Nervenarzt 2004, 75(11):1083-1091.
• [14]Schramm E, van Calker D, Dykierek P, Lieb K, Kech S, Zobel I, Leonhardt R, Berger M: An intensive treatment program of interpersonal psychotherapy plus pharmacotherapy for depressed inpatients: acute and long-term results. Am J Psychiatry 2007, 164(5):768-777.
• [15]Hölzel L, von Wolff A, Kriston L, Härter : Unter welchen Bedingungen bleibt eine stationäre Depressionsbehandlung erfolglos? Psychiat Prax 2010, 37(1):27-33.
• [16]Mitchell A, Subramaniam H: Prognosis of depression in old age compared to middle age: s systematic review of comparative studies. Am J Psychiatry 2005, 162(9):1588-1601.
• [17]Heim C, Newport D, Mletzko T, Miller A, Nemeroff C: The link between childhood trauma and depression: insights from HPA axis studies in humans. Psychoneuroendocrinology 2008, 33(6):693-710.
• [18]Blatt SJ, Quinlan DM, Chevron ES, McDonald C, Zuroff D: Dependency and self-criticism: Psychological dimensions of depression. J Consult Clin Psychol 1982, 50:113-124.
• [19]Zeeck A, Weber S, Sandholz A, Wetzler-Burmeister E, Wirsching M, Scheidt C, Hartmann A: Inpatient versus day treatment for Bulimia nervosa: Results of a one-year follow-up. Psychother Psychosom 2009, 78:317-319.
• [20]Zeeck A, Hartmann A, Wetzler-Burmeister E, Wirsching M: Zum Vergleich stationärer und tagesklinischer Behandlung von Anorexia Nervosa. Z Psychosom Med Psychother 2006, 52:190-203.
• [21]Zeeck A, von Wietersheim J, Hartmann A, Einsele S, Weiss H, Sammet I, Gaus E, Semm E, Harms D, Eisenberg A, Rahm R, Küchenhoff J: Inpatient or day clinic treatment? Results of a multi-site-study. GMS Psycho-Social-Medicine 2009., 9ISSN 1860–5214
• [22]Fournier J, DeRubeis R, Shelton R, Hollon S, Amsterdam J, Gallop R: Prediction of response to medication and cognitive therapy in the treatment of moderate to severe depression. J Consult Clin Psychol 2009, 7:775-87.
• [23]Rush AJ, Trivedi MH, Ibrahim HM, Carmody TJ, Arnow B, Klein DN, Markowitz JC, Ninan PT, Kornstein S, Manber R, Thase ME, Kocsis JH, Keller MB: The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatr 2003, 54(5):573-83.
• [24]First MB, Spitzer RL, Williams JBW, Gibbon M: Structured Clinical Interview for DSM-IV (SCID). Washington, DC: American Psychiatric Association; 1997.
• [25]Wittchen H-U, Zaudig M, Fydrich T: SKID Strukturiertes Klinisches Interview für DSM-IV (Achse I+II). Göttingen: Hogrefe-Verlag; 1997.
• [26]Franke G: Symptom-Checkliste von L.R. Derogatis - Deutsche Version (2. vollständig überarbeitete und neu normierte Auflage). Beltz Test GmbH: Göttingen; 2002.
• [27]Weisman AN, Beck AT: Development and the validation of the Dysfunctional Attitudes Scale. Chicago; 1978. [Paper presented at the annual meeting of the Association for the Advancement of Behavior Therapy]
• [28]Hautzinger M, Luka U, Trautman RD: Skala dysfunktionaler Einstellungen, Eine deutsche Version der Dysfunctional Attitudes Scale. Diagnostica 1985, 31(4):312-323.
• [29]Blatt SJ, ďÁfflitti JP, Quinlan DM: Depressive Experiences Questionnaire. New Haven (CT): Yale University Press; 1976.
• [30]Beutel M, Wiltink J, Hafner C, Reiner I, Bleichner F, Blatt S: Abhängigkeit und Selbstkritik als psychologische Dimensionen der Depression – Validierung der deutschsprachigen Version des Depressive Experience Questionnaire (DEQ). Z Klin Psychol Psychiatr Psychother 2004, 52:1-14.
• [31]Goldman H, Skodol A, Lave T: Revising axis V for DSM-IV: A review of measures of social functioning. Am J Psychiatr 1992, 149:1148-1156.
• [32]Barkham M, Hardy GE, Startup M: The IIP-32: A short version of the Inventory of Interpersonal Problems. Br J Clin Psychol 1996, 35:21-35.
• [33]Thomas A, Brähler E, Strauss B: Die Entwicklung und Validierung einer Kurzform des Inventars zur Erfassung interpersonaler Probleme (IIP-32). Diagnostica 2011, 57:68-83.
• [34]Fydrich T, Sommer G, Tydecks S, Brähler E: Fragebogen zur sozialen Unterstützung (F-SozU): Normierung der Kurzform (K-14). Zeitschrift für Medizinische Psychologie 2009, 18:43-48.
• [35]Radoschewski M, Bellach B-M: Der SF-36 im Bundes-Gesundheits-Survey - Möglichkeiten und Anforderungen der Nutzung auf der Bevölkerungsebene. Das Gesundheitswesen 1999, 61:191-199.
• [36]Bernstein DP, Fink L: Childhood Trauma Questionnaire – a retrospective self-report manual. San Antonio: The Psychological Cooperation; 1998.
• [37]Bader K, Hänny C, Schäfer V, Neuckel A, Kuhl C: Childhood Trauma Questionnaire – Psychometrische Eigenschaften einer deutschsprachigen Version. Z Klin Psychol Psychiatr Psychother 2009, 38(4):223-230.
• [38]Keller MB, Lavori PW, Friedman B, Nielson E, Endicott J, McDonald-Scott P, Andreason NC: The Longitudinal Interval Follow-up Evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies. Arch Gen Psychiatry 1987, 44:540-548.
• [39]Beutel ME, Leutzinger-Bohleber M, Rüger B, Bahrke U, Negele A, Haselbacher A, Fiedler G, Keller W, Hautzinger M: Psychoanalytic versus cognitive-behavioral therapy for chronic depression: study protocol for a randomized controlled trial. Trials 2012, 13:117. BioMed Central Full Text
• [40]Crismon M, Trivedi M, Pigott T, Rush A, Hirschfeld E, Kahn D, DeBattista C, Nelson JC, Nierenberg A, Sackeim HA, Thase ME: The Texas Medication Algorithm Project: report of the Texas Consensus Conference Panel on Medication Treatment of Major Depressive Disorder. J Clin Psychiatry 1999, 60(3):142-56.
• [41]Kraemer HC, Wilson GT, Fairburn CG, Agras WS: Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry 2002, 59(10):877-83.
• [42]Hartmann A, van der Kooji A, Zeeck A: Exploring nonlinear relations: Models of clinical decision making by regression with optimal scaling. Psychother Res 2009, 19(4–5):482-92.