Intensive Transitional Post-discharge Service for Patients with Depression

Abstract

Introduction: Psychiatric treatment for depression initiated during admission is often planned to be continued after discharge, yet outpatient follow-up service frequently fails to meet even modest standards for service regarding timeliness and frequency of contact. Here we present data from a newly designed transitional, day-to-day, CBTbased psychiatric aftercare service. Methods:The program consisted of at least one psychiatric consultation, week-day telephone outreach and CBT-based individual therapy twice a week (in total five times), followed by group therapy twice a week for four weeks. In individual therapy, focus was on collaborative goal setting and next-of-kin participation. The group format was open, trans-diagnostic and highly structured. Self-ratings (WHO-5 Well-Being Scale (WHO-5); Becks Depression Inventory -II (BDI)) were obtained at the first day, at the end of individual therapy (after 3 weeks) and at end of group therapy (after 6-10 weeks). User evaluations were obtained at the latter two time points. Descriptive data is presented and ratings are analysed in an intention-to-treat design.Results: In 23 months 189 patients with unipolar depression were referred to the aftercare program. 165 patients completed the initial questionnaires, which showed a high level of depression symptoms (BDI 30.9 (STD 11.4 N=166) the first day of the program (right after discharge). 114 patients continued in group therapy. 11 (5.8 %) patients were re-admitted, 74 (39.2%) patients continued treatment in regional mental health clinics and 89 (47.1%) patients were discharged to primary sector service. BDI scores improved at each time point. Overall user satisfaction, measured with Client Satisfaction Questionnaire (CSQ), was high. Conclusion:Symptom reduction was evident during the aftercare program, and patients were satisfied with the service content. However, the results have to be interpreted with caution as we lack data from a comparable patient group receiving no service or a different type of post-discharge aftercare.