Effectiveness of inpatient versus outpatient complex treatment programs in depressive disorders: a quasi-experimental study under naturalistic conditions

Abstract

BackgroundDue to long waiting periods for outpatient psychotherapy and the high resource requirements of inpatient treatment, there is a need for alternative treatment programs for patients with depressive disorders. Thus, we investigated the effectiveness of the “Bielefeld Outpatient Intensive Treatment Program of Depression” (BID) in comparison with a typical inpatient treatment program by using a prospective quasi-experimental observational study. We assumed (i) that both complex programs are effective in pre-post analyses after 6 weeks and (ii) that inpatient treatment is more effective compared with the outpatient program.MethodsFour hundred patients with depressive psychopathology – a majority with depressive episodes (ICD-10 F3X) - took part in the BID and 193 in the inpatient program. Different self- (i.e., BDI) and expert measures (i.e., MADRS) of psychopathology at baseline (t1) and 6 weeks later (t2) were applied to examine treatment effects.ResultsTreatment effects were high in separate analyses of both groups with Cohen’s d ranging from 1.10 to 1.76., while ANOVA comparative analyses did not reveal any significant differences between both treatment settings nor did a set of independent covariates analyzed here. Response rates of BDI (p = .002) and MADRS (p = .001) were higher in the outpatient group. Results indicate BID not to be inferior compared to an inpatient program, although diverging pathways to treatment, higher rates of clinical recurrent depressive disorders and severe episodes as well as lower rates of employment and partnership in the inpatient treatment group have to be considered.ConclusionOutpatient intensive treatment programs may represent a solution for patients needing more than a treatment session once per week but less than a complex inpatient or day clinic program.

Barriers to Building More Effective Treatments: Negative Interactions Among Smoking-Intervention Components

“…There are clear reasons that more intense or multicomponent treatment might be significantly more beneficial than less intensive treatments (Blankers, 2020;Carroll et al, 2020;Driessen et al, 2019;Duffy et al, 2020;Lotfizadeh et al, 2020;Smits et al, 2020). In keeping with this notion, researchers have evaluated such adjuvants as relapse prevention training, social-support interventions, mindfulness content, motivational interviewing (MI) content, cognitive-game interventions, physical-exercise interventions, distraction via computer games, "resistance training," and medicationadherence interventions (e.g., Ciccolo et al, 2014;Fiore et al, 2008;Gruder et al, 1993;Loughead et al, 2016;Schlam & Baker, 2020).…”

Recuperación emocional para disminuir la sintomatología depresiva en adolescentes abusados sexualmente

“…En ese sentido, actualmente el Instituto nacional de Salud asume el liderazgo en la investigación y reporta varios estudios como el de Furukawa, Weitz, Tanaka, Hollon, Hofmann, Andersson et al (2017) quienes realizan un metaanálisis de varias investigaciones sobre terapias psicológicas y concluyen que la terapia cognitiva conductual es la que tiene mayor eficacia en la disminución de la sintomatología depresiva. Otro estudio reportado es el de Driessen (2019) quien mediante el metaanálisis -revisión de artículos sobre aplicación de tratamiento psicoterapéutico-llega a la conclusión de que la psicoterapia soluciona la problemática depresiva cuando tiene niveles de leve a moderada, lo cual se observó en el presente trabajo. En ese mismo sentido, se plantearon objetivos específicos orientados a determinar de qué manera la aplicación del programa disminuye la sintomatología afectivo -cognitiva y somática en un grupo experimental a la que se aplicó el tratamiento y un grupo control que no recibió el tratamiento.…”

Leveraging Neuroscience to Fight Stigma Around Mental Health

“…On the other hand, asylum-like institutions exist in many poorer countries, partly reflecting gaps in treatment and neglect of human rights. Here, it is worthwhile noting that treatment outcomes for many psychiatric conditions are often better, or at least not worse when patients attend outpatient clinics, complemented by support from their communities than when they are hospitalized (Driessen et al, 2019 ). Notwithstanding the fact that hospitalization is the only (and best) option for some patients (e.g., those with severe episodes of disease, or who cannot be adequately served by existing outpatient and community care, may be a potential danger to self or others, live alone, have other comorbidities, or who are unlikely to comply with treatment regimens), unnecessary admissions to institutions only fuel stigma by suggesting that persons with mental health issues are “beyond help”.…”