Outcomes of combined treatment: Evaluating split versus integrated treatment for depression.

Abstract

As combined medication and psychotherapy is increasingly recommended and provided for patients with depression, clinicians frequently choose between integrated or split treatment delivery with little empirical evidence upon which to base these decisions. The purpose of the current study was to compare outcomes (satisfaction and adherence) between split and integrated treatment for patients with depression. Utilizing a cross-sectional design, 120 adults with major depressive disorder currently receiving combined treatment (60 integrated and 60 split) were recruited on Amazon.com's Mechanical Turk and at Fordham University. Participants were asked to complete measures of satisfaction, adherence, as well as predictors of these variables including preference strength, attachment, symptom severity, and alliance. Importantly, this study did not find overall significant differences in satisfaction or adherence between participants in split and integrated treatment. The results indicated that therapeutic alliance and preference strength predicted satisfaction regardless of treatment model, while secure attachment style predicted medication adherence. This study affirms the current practice trends toward split treatment as working equally well for most patients, and supports. Furthermore, findings highlight the person-centered movement's emphasis on therapeutic alliance, and nondiagnostic patient characteristics, in contributing to overall outcome. Therefore, clinicians are encouraged to consider matching patients based on projected alliance and current preference when making such treatment referrals for split or integrated treatment. Public Significance StatementThis study suggests that patients with depression receiving both medication and psychotherapy treatments experience similar levels of satisfaction and adherence whether their care is split between a psychiatrist and psychotherapist or integrated (i.e., provided by a psychiatrist alone). While several patient factors were found to influence these outcomes, our findings broadly affirm that current practice trends-in which psychiatric care is routinely split between prescribers and psychotherapists-are no better or worse than the previously dominant integrated treatment model.