Cost Analysis for Inpatient Treatment of Recurrent Depressive Disorder in Russia

AbstractAdopting a personalized medicine approach beyond genetic/epigenetic profiling within psychiatric diagnostic and treatment is challenging. For the first time, we studied the influence of two patient resources (resilience and illness representation) on the success of an inpatient treatment of major depressive disorder (MDD). Using a 5-week observational real-world-study, the treatment- success was measured by the difference between the subjective depression- severity (according to the German short form of Beck’s Depression-Inventory) at baseline (i.e., days four to six post-admission) and study- endpoint. In the intention-to-treat sample (n = 60, 47.3 ± 12.8 years old; 58% females), the patients’ illness representation [measured by the “Krankheitskonzeptskala” (KK)] did not predict their treatment- success. The KK-dimension ‘trust-in-doctors’ was associated with resilience but not with the treatment-success. Albeit, the patients’ resilience (determined by Resilience- Scale, 11-item-version (RS-11)) negatively predicted their positive treatment- success (b = − 0.09, p = 0.017, f2 = 0.11). This influence of resilience on treatment- success was completely mediated by the baseline-depression- severity. This means, patients with low resilience reported high baseline-depression- levels which predicted a significant positive treatment- success. And, patients with high resilience reported low baseline-depression-levels which predicted no relevant or even negative inpatient treatment-success. The latter “high-resilience”- group (n = 27) was especially interesting. Remarkably, these patients appeared to have experienced within the first four-to-six inpatient treatment-days an “early sudden gain” against their considerable MDD- burden that initially had led to their admission. Thus, a stronger resilience might serve as a proxy of the development of an early MDD-relief as well as of lower baseline-depression- levels. Further studies are warranted to support the value of a patient’s resilience to predict his treatment response and inpatient treatment duration.

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Sensitivity to Social Exclusion in Major Depressive Disorder Predicts Therapeutic Outcome after Inpatient Treatment

Psychotherapy and Psychosomatics ◽

10.1159/000437147 ◽

2015 ◽

Vol 85 (1) ◽

pp. 50-52 ◽

Cited By ~ 5

Author(s):

Sven C. Mueller ◽

Jannika De Rubeis ◽

Diane Lange ◽

Markus R. Pawelzik ◽

Stefan S�tterlin

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Social Exclusion ◽

Inpatient Treatment ◽

Therapeutic Outcome ◽

Major Depressive

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How effective is a web-based mental health intervention (“deprexis”) if started at psychiatric routine inpatient treatment of major depressive disorder? A pragmatic parallel-group randomized controlled trial

10.31219/osf.io/4rbdj ◽

2018 ◽

Author(s):

Udo Bonnet

Keyword(s):

Major Depressive Disorder ◽

Depressive Disorder ◽

Outpatient Treatment ◽

Daily Activity ◽

Inpatient Treatment ◽

Real Life ◽

Well Being ◽

Hospital Treatment ◽

Hamilton Depression Scale ◽

Major Depressive

Internet-based self-help-programs like “deprexis” have been increasingly shown to reduce depressive symptoms in non-clinical and adjunctive to outpatient treatment settings. But how about the effectiveness of “deprexis” if being blended into routine psychiatric hospital treatment of major depressive disorder (MDD)? To examine, sixty-nine adult MDD-inpatients were randomly assigned to a 12-week-period of treatment-as-usual (TAU, N=33) or TAU plus guided “deprexis” (TAU-PLUS, N=36). As usual in everyday clinical practice, patients could be discharged from the ward at any time when they felt sufficiently stabilized for outpatient treatment. Modified intention-to-treat analyses included thirty-two inpatients of each group. At week 12, TAU-PLUS-patients were significantly more improved (p=.03, d=.75) than TAU-patients citing the primary-outcome measure (Beck-Depression-Inventory-II). Furthermore, TAU-PLUS-patients showed greater daily activity in the Work-Productivity-and-Activity-Impairment-Questionnaire (p=.04, d=.70) and had been discharged earlier from inpatient treatment (p=.003). Additional outcome measures (i.e. Hamilton-Depression-Scale, Clinical-Global-Impression-Severity, WHO-Well-Being-Index) were not significantly different between the groups. Post-discharge, the TAU-PLUS-group reported a lower rate of post-hospital care (p=.01) and re-admissions (p=.04). The study was limited by lack of blinding of the primary investigator and strengthened by its pragmatic approach to involve real-life treatment conditions. To conclude, TAU plus “deprexis” was superior to TAU without “deprexis” to improve subjective depression-severity (BDI-II) and daily activity in patients having sought psychiatric inpatient MDD-treatment before. This beneficial effect appeared 12 weeks after inpatient “deprexis”-initiation, i.e. when the vast majority of patients were back in general practitioner care. Adjunctive “deprexis” was associated with earlier discharges and an advantage in post-hospital stabilization.

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