Annette Schaub1, Ulrich Goldmann2, T Kim Mueser3, Stephan Goerigk4, Martin Hautzinger5, Elisabeth Roth6, Marketa Charypar7, Rolf Engel8, Hans-Jürgen Möller9. 1. Clinical Research Psychologist and psychotherapist, Ph.D., Department of Psychiatry and Psychotherapy, University Hospital Ludwig Maximilian University Munich, Nussbaumstr.7, Munich D-80336, Germany. Electronic address: annette.schaub@med.uni-muenchen.de. 2. Psychologist, Ph.D., Department of Psychology, Ludwig Maximilian University of Munich and private practice, Munich D-80333, Germany. Electronic address: goldmann@psy.lmu.de. 3. Professor of Occupational Therapy, Psychology and Psychiatry, Ph.D., Executive Director, Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Avenue, West Boston, MA 02215, USA. Electronic address: mueser@bu.edu. 4. Psychologist M. Sc. Psych, Department of Psychological Methodology and Assessment, Ludwig Maximilian University of Munich, Munich D-80336, Germany. Electronic address: stephan.goerigk@med.uni-muenchen.de. 5. Professor of Clinical Psychology and Psychotherapy, Ph.D., Department of Clinical Psychology and Psychotherapy, University of Tübingen, D-72026 Tübingen. Electronic address: martin.hautzinger@uni-tuebingen.de. 6. Psychologist, private and non-private practice in, Munich 80333, Germany. Electronic address: lisaroth@t-online.de. 7. Psychologist, Ph.D., Johannesbad Klinik, Furth im Wald D-93237, Germany. Electronic address: marketa.charypar@fachklinik-furth.de. 8. Professor of Clinical Psychology and Psychophysiology emeritus, Ph.D., Department of Psychiatry and Psychotherapy, University of Munich, Munich D-80336, Germany. Electronic address: rolf.engel@med.uni-muenchen.de. 9. Professor of Psychiatry emeritus, M.D., Department of Psychiatry and Psychotherapy, University of Munich, Munich D-80336, Germany. Electronic address: hans-juergen.moeller@med.uni-muenchen.de.
Abstract
OBJECTIVE:Cognitive therapy has gained prominence in the treatment of major depression, however, little is known about its long-term benefits when delivered during inpatient treatment or combined with outpatient treatment with severely ill inpatients (HAM-D > 20). METHOD: To evaluate this question, we conducted a randomized controlled trial investigating the efficacy of extended clinical management (E-CM), psychoeducational cognitive behavioural group therapy (PCBT-G) or PCBT-G and 16 outpatient individual treatment sessions (PCBT-G+I). All patients were treated with pharmacotherapy. 177 inpatients with DSM-IV major depression were randomized either to E-CM or PCBT-G or PCBT-G+I. Outcome measures were collected in the hospital at pre- and posttreatment and following discharge into the community every six months for two years. We compared the study groups on symptom changes, psychosocial functioning, knowledge about depression and rehospitalization. RESULTS: All three treatment interventions are equally effective at reducing depressive symptoms and increasing psychosocial functioning at posttreatment. There was significant group by time interaction for knowledge about depression in favor of PCBT-G and PCBT-G+I over E-CM. We did not find significantly lower rehospitalisation rates at the two-year follow-up for PCBT-G+I compared to E-CM, however, comparing PCBT-G to E-CM. CONCLUSIONS: We conclude that with cognitive psychoeducational group therapy a successful, in the long-term other interventions superior psychological intervention for major depression is available as gains were sustained for two years following discharge from the hospital. More research is needed to evaluate the long-term impact of group treatment starting in inpatient treatment.
RCT Entities:
OBJECTIVE: Cognitive therapy has gained prominence in the treatment of major depression, however, little is known about its long-term benefits when delivered during inpatient treatment or combined with outpatient treatment with severely ill inpatients (HAM-D > 20). METHOD: To evaluate this question, we conducted a randomized controlled trial investigating the efficacy of extended clinical management (E-CM), psychoeducational cognitive behavioural group therapy (PCBT-G) or PCBT-G and 16 outpatient individual treatment sessions (PCBT-G+I). All patients were treated with pharmacotherapy. 177 inpatients with DSM-IV major depression were randomized either to E-CM or PCBT-G or PCBT-G+I. Outcome measures were collected in the hospital at pre- and posttreatment and following discharge into the community every six months for two years. We compared the study groups on symptom changes, psychosocial functioning, knowledge about depression and rehospitalization. RESULTS: All three treatment interventions are equally effective at reducing depressive symptoms and increasing psychosocial functioning at posttreatment. There was significant group by time interaction for knowledge about depression in favor of PCBT-G and PCBT-G+I over E-CM. We did not find significantly lower rehospitalisation rates at the two-year follow-up for PCBT-G+I compared to E-CM, however, comparing PCBT-G to E-CM. CONCLUSIONS: We conclude that with cognitive psychoeducational group therapy a successful, in the long-term other interventions superior psychological intervention for major depression is available as gains were sustained for two years following discharge from the hospital. More research is needed to evaluate the long-term impact of group treatment starting in inpatient treatment.