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Boon AE, de Boer SBB, van Dorp M, Nijssen YAM. Reliable and clinically significant change based on the Health of the Nation Outcome Scales. Psychiatry Res 2019; 281:112587. [PMID: 31629304 DOI: 10.1016/j.psychres.2019.112587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 11/19/2022]
Abstract
To evaluate treatment outcomes of individual patients based on clinician-rated instruments, the assessment of reliable and clinically significant change (RCSC) is essential. In heterogeneous samples, RCSC underestimates treatment outcome. Therefore, the Reliable Change Index (RCI) was adjusted by a stratification into subsamples. This method was tested on the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) ratings (n = 12,547) at admission and discharge of youths (age 6-18 years) treated in ten psychiatric institutions. Based on the test-retest reliability of a subsample (n = 397), the RCI was calculated for three severity groups ("very severe," "moderately severe," and "subclinical/mild"). Individuals who accomplished reliable change during treatment and moved to a subclinical score were classified as recovered. Using the traditional RCSC calculation, the large majority (75.1%) of the sample would be considered as unchanged, 2.9% as deteriorated, 18.9% as improved, and 3.1% as recovered. Using RCI cutoff points based on the severity ratings at admission results in a more representative distribution of outcome groups, where 54.6% of the sample was stable, 7.5% worsened, 21.6% improved, and 16.3% recovered. This methodological framework for calculating RCSC for heterogeneous populations is applicable for all HoNOS instruments, making it very useful for mental health professionals.
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Affiliation(s)
- Albert E Boon
- Parnassia Psychiatric Institute. Youz: child and adolescent psychiatry, Netherlands; Curium-LUMC: child and adolescent psychiatry, Leiden University, Leiden, Netherlands.
| | - Sjoukje B B de Boer
- Parnassia Psychiatric Institute. Youz: child and adolescent psychiatry, Netherlands
| | - Melissa van Dorp
- Parnassia Psychiatric Institute. Youz: child and adolescent psychiatry, Netherlands; Academische Werkplaats Risicojeugd/Intermetzo, Netherlands
| | - Yolanda A M Nijssen
- Parnassia Psychiatric Institute. Youz: child and adolescent psychiatry, Netherlands; Tranzo, Tilburg University, Tilburg, Netherlands
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Abstract
BACKGROUND Couple therapy for depression has the twofold aim of modifying negative interaction patterns and increasing mutually supportive aspects of intimate relationships, changing the interpersonal context of depression. Couple therapy is included in several guidelines among the suggested treatments for depression. OBJECTIVES 1. The main objective was to examine the effects of couple therapy compared to individual psychotherapy for depression.2. Secondary objectives were to examine the effects of couple therapy compared to drug therapy and no/minimal treatment for depression. SEARCH METHODS The Cochrane Common Mental Disorders Group Controlled Trials Register (CCMDCTR), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid) and PsycINFO (Ovid) were searched to 19 February 2018. Relevant journals and reference lists were checked. SELECTION CRITERIA Randomised and quasi-randomised controlled trials examining the effects of couple therapy versus individual psychotherapy, drug therapy, or no treatment/minimal treatment for depression were included in the review. DATA COLLECTION AND ANALYSIS We considered as primary outcomes the depressive symptom level, the depression persistence, and the dropouts; the relationship distress level was a secondary outcome. We extracted data using a standardised spreadsheet. Where data were not included in published papers, we tried to obtain the data from the authors. We synthesised data using Review Manager software version 5.3. We pooled dichotomous data using the relative risk (RR), and continuous data calculating the standardised mean difference (SMD), together with 95% confidence intervals (CIs). We employed the random-effects model for all comparisons and also calculated a formal test for heterogeneity, the natural approximate Chi2 test. MAIN RESULTS We included fourteen studies from Europe, North America, and Israel, with 651 participants. Eighty per cent of participants were Caucasian. Therefore, the findings cannot be considered as applicable to non-Western countries or to other ethnic groups in Western countries. On average, participants had moderate depression, preventing the extension of results to severely depressed patients. Almost all participants were aged between 36 and 47 years.There was no evidence of difference in effect at the end of treatment between couple therapy and individual psychotherapy, either for the continuous outcome of depressive symptoms, based on nine studies with 304 participants (SMD -0.17, 95% CI -0.44 to 0.10, low-quality evidence), or the proportion of participants remaining depressed, based on six studies with 237 participants (RR 0.94, 95% CI 0.72 to 1.22, low-quality evidence). Findings from studies with 6-month or longer follow-up confirmed the lack of difference between the two conditions.No trial gave information on harmful effects. However, we considered rates of treatment discontinuation for any reason as a proxy indicator of adverse outcomes. There was no evidence of difference for dropout rates between couple therapy and individual psychotherapy, based on eight studies with 316 participants (RR 0.85, 95% CI 0.51 to 1.41, low-quality evidence).Few data were available for the comparison with drug therapy. Data from a small study with 12 participants showed no difference for the continuous outcome of depressive symptoms at end of treatment (SMD -0.51, 95% CI -1.69 to 0.66, very low-quality evidence) and at 6-month follow-up (SMD -1.07, 95% CI -2.45 to 0.31, very low-quality evidence). Data on dropouts from two studies with 95 participants showed a clear advantage for couple therapy (RR 0.31, 95% CI 0.15 to 0.61, very low-quality evidence). However, this finding was heavily influenced by a single study, probably affected by a selection bias favouring couple therapy.The comparison between couple therapy plus drug therapy and drug therapy alone showed no difference in depressive symptom level, based on two studies with 34 participants (SMD -1.04, 95% CI -3.97 to 1.89, very low-quality evidence) and on dropouts, based on two studies with 45 participants (RR 1.03, 95% CI 0.07 to 15.52, very low-quality evidence).The comparison with no/minimal treatment showed a large significant effect favouring couple therapy both for depressive symptom level, based on three studies with 90 participants: (SMD -0.95, 95% CI -1.59 to -0.32, very low-quality evidence) and persistence of depression, based on two studies with 65 participants (RR 0.48, 95% CI 0.32 to 0.70, very low-quality evidence). No data were available for dropouts for this comparison.Concerning relationship distress, the comparison with individual psychotherapy showed that couple therapy appeared more effective in reducing distress level at the end of treatment, based on six studies with 187 participants (SMD -0.50, CI -0.97 to -0.02, very low-quality evidence) and the persistence of distress, based on two studies with 81 participants (RR 0.71, 95% CI 0.51 to 0.98, very low-quality evidence). The quality of evidence was heavily affected by substantial heterogeneity (I2 = 59%). In the analysis restricted to studies including only distressed couples, no heterogeneity was found and the effect in distress level at the end of treatment was larger (SMD -1.10, 95% CI -1.59 to -0.61). Very few data on this outcome were available for other comparisons.We assessed the certainty of the evidence using the GRADE system. The results were weakened by the low quality of evidence related to the effects on depressive symptoms, in comparison with individual psychotherapy, and by very low quality evidence for all other comparisons and for the effects on relationship distress. Most studies were affected by problems such as the small number of cases, performance bias, assessment bias due to the non-blinding outcome assessment, incomplete outcome reporting and the allegiance bias of investigators. Heterogeneity was, in particular, a problem for data about relationship distress. AUTHORS' CONCLUSIONS Although there is suggestion that couple therapy is as effective as individual psychotherapy in improving depressive symptoms and more effective in improving relations in distressed couples, the low or very low quality of the evidence seriously limits the possibility of drawing firm conclusions. Very few data were available for comparisons with no/minimal treatment and drug therapy. Future trials of high quality should test in large samples with a long follow-up of the effects of couple therapy in comparison to other interventions in discordant couples with a depressed partner, considering the role of relationship quality as a potential effect mediator in the improvement of depression.
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Affiliation(s)
- Angelo Barbato
- IRCCS‐Istituto di Ricerche Farmacologiche Mario NegriUnit for quality of care and rights promotion in mental health, Department of NeuroscienceVia La Masa 19MilanoItaly20156
| | - Barbara D'Avanzo
- IRCCS‐Istituto di Ricerche Farmacologiche Mario NegriUnit for quality of care and rights promotion in mental health, Department of NeuroscienceVia La Masa 19MilanoItaly20156
| | - Alberto Parabiaghi
- IRCCS‐Istituto di Ricerche Farmacologiche Mario NegriUnit for quality of care and rights promotion in mental health, Department of NeuroscienceVia La Masa 19MilanoItaly20156
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Doose M, Ziegenbein M, Hoos O, Reim D, Stengert W, Hoffer N, Vogel C, Ziert Y, Sieberer M. Self-selected intensity exercise in the treatment of major depression: A pragmatic RCT. Int J Psychiatry Clin Pract 2015; 19:266-75. [PMID: 26265421 DOI: 10.3109/13651501.2015.1082599] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of the study was to determine the therapeutic effect of physical exercise for patients with unipolar depression. Participants took part in an 8-week walking/running aerobic exercise program at a local sports club. METHODS Forty-six outpatients aged 18-65 years and diagnosed with mild to severe depression (ICD-10 criteria) were randomly assigned to an intervention group or wait list. Treatment as usual was continued. The Hamilton Rating Scale for Depression (HRSD-17) served as the main outcome measure. Secondary outcome measures were Beck Depression Inventory (BDI-II), Fitness Index (FI), and VO(2) max as estimated by Urho Kaleka Kekkonen or UKK 2-km Walk Test. RESULTS Out of forty-six participants, 24% dropped out. Participants attended 58% of exercise sessions. All randomized participants were included in intention-to-treat (ITT) analysis. Analysis of covariance or ANCOVA showed a large reduction of depressive symptoms in HRSD-17 scores (Cohen's d: 1.8; mean change 8.2, p < .0001). BDI-II (Cohen's d: 0.50; mean change: 4.7, p = 0.09), FI scores (Cohen's d: 0.27; mean change: 5.3, p = 0.08), and VO2 max did not change significantly. CONCLUSIONS We observed a large and clinically significant change in HRSD-17 scores. Moderate changes in BDI-II scores without clinical significance and small changes in physical fitness assessments were observed.
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Affiliation(s)
- Michael Doose
- a Department of Psychiatry , Social Psychiatry and Psychotherapy, Hannover Medical School , Germany.,b Department of Neurology , Klinikum Emden , Emden , Germany
| | | | - Olaf Hoos
- d Sports Center, Julius-Maximilians-University , Wuerzburg , Germany
| | - Dominik Reim
- d Sports Center, Julius-Maximilians-University , Wuerzburg , Germany
| | - Wojciech Stengert
- a Department of Psychiatry , Social Psychiatry and Psychotherapy, Hannover Medical School , Germany
| | - Niklas Hoffer
- a Department of Psychiatry , Social Psychiatry and Psychotherapy, Hannover Medical School , Germany
| | - Charlotte Vogel
- e Institute for Biostatistics, Hannover Medical School , Germany
| | - Yvonne Ziert
- e Institute for Biostatistics, Hannover Medical School , Germany
| | - Marcel Sieberer
- a Department of Psychiatry , Social Psychiatry and Psychotherapy, Hannover Medical School , Germany
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McCarthy KS, Keefe JR, Barber JP. Goldilocks on the couch: Moderate levels of psychodynamic and process-experiential technique predict outcome in psychodynamic therapy. Psychother Res 2014; 26:307-17. [DOI: 10.1080/10503307.2014.973921] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Harned MS, Korslund KE, Linehan MM. A pilot randomized controlled trial of Dialectical Behavior Therapy with and without the Dialectical Behavior Therapy Prolonged Exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. Behav Res Ther 2014; 55:7-17. [PMID: 24562087 DOI: 10.1016/j.brat.2014.01.008] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 01/27/2014] [Accepted: 01/30/2014] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This study evaluates the efficacy of integrating PTSD treatment into Dialectical Behavior Therapy (DBT) for women with borderline personality disorder, PTSD, and intentional self-injury. METHODS Participants were randomized to DBT (n=9) or DBT with the DBT Prolonged Exposure (DBT PE) protocol (n=17) and assessed at 4-month intervals during the treatment year and 3-months post-treatment. RESULTS Treatment expectancies, satisfaction, and completion did not differ by condition. In DBT+DBT PE, the DBT PE protocol was feasible to implement for a majority of treatment completers. Compared to DBT, DBT+DBT PE led to larger and more stable improvements in PTSD and doubled the remission rate among treatment completers (80% vs. 40%). Patients who completed the DBT PE protocol were 2.4 times less likely to attempt suicide and 1.5 times less likely to self-injure than those in DBT. Among treatment completers, moderate to large effect sizes favored DBT+DBT PE for dissociation, trauma-related guilt cognitions, shame, anxiety, depression, and global functioning. CONCLUSIONS DBT with the DBT PE protocol is feasible, acceptable, and safe to administer, and may lead to larger improvements in PTSD, intentional self-injury, and other outcomes than DBT alone. The findings require replication in a larger sample.
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Affiliation(s)
- Melanie S Harned
- Behavioral Research and Therapy Clinics, Box 355915, University of Washington, Seattle, WA 98195-5915, USA.
| | - Kathryn E Korslund
- Behavioral Research and Therapy Clinics, Box 355915, University of Washington, Seattle, WA 98195-5915, USA
| | - Marsha M Linehan
- Behavioral Research and Therapy Clinics, Box 355915, University of Washington, Seattle, WA 98195-5915, USA
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Parabiaghi A, Kortrijk HE, Mulder CL. Defining multiple criteria for meaningful outcome in routine outcome measurement using the Health of the Nation Outcome Scales. Soc Psychiatry Psychiatr Epidemiol 2014; 49:291-305. [PMID: 23918197 DOI: 10.1007/s00127-013-0750-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 07/24/2013] [Indexed: 01/28/2023]
Abstract
PURPOSE Using the reliable and clinically significant change approach, we aimed to identify meaningful outcome indicators for the Health of the Nation Outcome Scales (HoNOS) and to combine them in a single model. We applied these indicators to the 1-year outcome of two large samples of people attending community mental health services in Italy (cohort 1) and the Netherlands (cohort 2). METHODS Data were drawn from two studies on routine outcome assessment. The criteria for meaningful outcome were defined on both study cohorts and both language versions of the scale. The model combined (a) two criteria for adequate change (at least 4 or 8 points change), (b) two cut-offs for clinically significant change (a total score of 10 was the threshold between mild and moderate illness, 13 between moderate and severe illness), and (c) a method for classifying stable subjects in three degrees of severity (stable in mild, moderate or severe illness). Results were compared with those given by the effect size (ES) and analysis of variance and covariance (ANOVA and ANCOVA). RESULTS For the proposed approach the outcome of cohort 1 was better than cohort 2, with 65-67% of its subjects showing a positive outcome compared to only 45-46%. The other reference methods (ES and ANOVA), however, showed a greater improvement for cohort 2. ANCOVA indicated that the differences were due to regression to the mean (RTM) which showed opposite effects across the two cohorts. CONCLUSIONS The proposed approach proved valuable and generalizable for interpreting outcome on HoNOS, scarcely influenced by the RTM effect. Its introduction could benefit outcome evaluation and management.
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Affiliation(s)
- Alberto Parabiaghi
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via la Masa 19, 20156, Milan, Italy,
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Nasiakos G, Cribbie RA, Arpin-Cribbie CA. Equivalence-based measures of clinical significance: assessing treatments for depression. Psychother Res 2010; 20:647-56. [PMID: 20803383 DOI: 10.1080/10503307.2010.501039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Treatment efficacy is largely determined by statistical significance testing, and clinical significance testing is often used to quantify or qualify the efficacy of a treatment at the individual or group level. This study applies the equivalence-based clinical significance model proposed by Kendall, Marrs-Garcia, Nath, and Sheldrick (1999) and a revised model proposed by Cribbie and Arpin-Cribbie (2009) to the assessment of treatments for depression. Using several studies that investigated treatments for depression, the authors tested whether the posttreatment means were equivalent to those for a similar normal comparison group. All of the studies had significant improvement from pretest to posttest, although for many of the studies the treated group was not equivalent to a normal comparison group at posttest. Further, there are important differences between the conclusions drawn from the Kendall et al. and Cribbie and Arpin-Cribbie methods for assessing equivalence-based clinical significance.
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Affiliation(s)
- George Nasiakos
- Department of Psychology, York University, Toronto, Ontario, Canada
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Skapinakis P, Bakola E, Salanti G, Lewis G, Kyritsis AP, Mavreas V. Efficacy and acceptability of selective serotonin reuptake inhibitors for the treatment of depression in Parkinson's disease: a systematic review and meta-analysis of randomized controlled trials. BMC Neurol 2010; 10:49. [PMID: 20565960 PMCID: PMC2903535 DOI: 10.1186/1471-2377-10-49] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Accepted: 06/21/2010] [Indexed: 12/22/2022] Open
Abstract
Background Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants for the treatment of depression in patients with Parkinson's Disease (PD) but data on their efficacy are controversial. Methods We conducted a systematic review and meta-analysis of randomized controlled trials to investigate the efficacy and acceptability of SSRIs in the treatment of depression in PD. Results Ten studies were included. In the comparison between SSRIs and Placebo (n = 6 studies), the combined risk ratio (random effects) was 1.08 (95% confidence interval: 0.77 - 1.55, p = 0.67). In the comparison between SSRIs and Tricyclic Antidepressants (TCAs) (n = 3 studies) the combined risk ratio was 0.75 (0.39 - 1.42, p = 0.37). An acceptability analysis showed that SSRIs were generally well tolerated. Conclusions These results suggest that there is insufficient evidence to reject the null hypothesis of no differences in efficacy between SSRIs and placebo in the treatment of depression in PD. Due to the limited number of studies and the small sample sizes a type II error (false negative) cannot be excluded. The comparison between SSRIs and TCAs is based on only three studies and further trials with more pragmatic design are needed.
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Affiliation(s)
- Petros Skapinakis
- Department of Psychiatry, University of Ioannina School of Medicine, Ioannina 45110, Greece.
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Lambert MJ, Ogles BM. Using clinical significance in psychotherapy outcome research: The need for a common procedure and validity data. Psychother Res 2009; 19:493-501. [DOI: 10.1080/10503300902849483] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Michael J. Lambert
- a Department of Psychology , Brigham Young University , Provo, Utah
- b Department of Psychology , Ohio University , Athens, Ohio, USA
| | - Benjamin M. Ogles
- a Department of Psychology , Brigham Young University , Provo, Utah
- b Department of Psychology , Ohio University , Athens, Ohio, USA
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Neimeyer RA, Kazantzis N, Kassler DM, Baker KD, Fletcher R. Group cognitive behavioural therapy for depression outcomes predicted by willingness to engage in homework, compliance with homework, and cognitive restructuring skill acquisition. Cogn Behav Ther 2009; 37:199-215. [PMID: 18608311 DOI: 10.1080/16506070801981240] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
There is a need to understand the mechanism through which homework contributes to clinically meaningful change in therapy. Theoretically meaningful factors such as willingness to complete therapeutic assignments and cognitive skill acquisition have not been carefully studied in prior research. Depressed outpatients (N = 46) received cognitive behavioural group therapy for a 10-week period and were assigned relevant homework activities. Patient self-report and independent ratings of homework compliance were obtained on a session-by-session basis. Using path analysis, the authors found evidence that willingness to complete homework assignments and mastery of skill in cognitive restructuring helped account for the relationship between homework compliance and reduced symptom severity (R2 = .40). However, paths were only significant when patient self-report of homework compliance was used in the model. The present study highlights the problems in assessing homework compliance and in assuming that independent assessment of compliance is more accurate than patient self-report.
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Affiliation(s)
- Robert A Neimeyer
- Department of Psychology, The University of Memphis, Memphis, TN 38152, USA.
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Abstract
BACKGROUND Marital therapy for depression has the two-fold aim of modifying negative interaction patterns and increasing mutually supportive aspects of couple relationships, thus changing the interpersonal context linked to depression. OBJECTIVES 1. To conduct a meta-analysis of all intervention studies comparing marital therapy to other psychosocial and pharmacological treatments, or to non-active treatments. 2. To conduct an assessment of the internal validity and external validity. 3. To assess the overall effectiveness of marital therapy as a treatment for depression. 4. To identify mediating variables through which marital therapy is effective in depression treatment. SEARCH STRATEGY CCDANCTR-Studies was searched on 5-9-2005, Relevant journals and reference lists were checked. SELECTION CRITERIA Randomised controlled trials examining the effectiveness of marital therapy versus individual psychotherapy, drug therapy or waiting list/no treatment/minimal treatment for depression were included in the review. Quasi-randomised controlled trials were also included. DATA COLLECTION AND ANALYSIS Data were extracted using a standardised spreadsheet. Where data were not included in published papers, two attempts were made to obtain the data from the authors. Data were synthesised using Review Manager software. Dichotomous data were pooled using the relative risk (RR), and continuous data were pooled using the standardised mean difference (SMD), and 95% confidence intervals (CIs) were calculated. The random effects model was employed for all comparisons. A formal test for heterogeneity, the natural approximate chi-squared test, was also calculated. MAIN RESULTS Eight studies were included in the review. No significant difference in effect was found between marital therapy and individual psychotherapy, either for the continuous outcome of depressive symptoms, based on six studies: SMD -0.12 (95% CI -0.56 to 0.32), or the dichotomous outcome of proportion of subjects remaining at caseness level, based on three studies: RR 0.84 (95% CI 0.32 to 2.22). In comparison with drug therapy, a lower drop-out rate was found for marital therapy: RR 0.31 (95% CI 0.15 to 0.61), but this result was greatly influenced by a single study. The comparison with no/minimal treatment, showed a large significant effect in favour of marital therapy for depressive symptoms, based on two studies: SMD -1.28 (95% CI -1.85 to -0.72) and a smaller significant effect for persistence of depression, based on one study only. The findings were weakened by methodological problems affecting most studies, such as the small number of cases available for analysis in almost all comparisons, and the significant heterogeneity among studies. AUTHORS' CONCLUSIONS There is no evidence to suggest that marital therapy is more or less effective than individual psychotherapy or drug therapy in the treatment of depression. Improvement of relations in distressed couples might be expected from marital therapy. Future trials should test whether marital therapy is superior to other interventions for distressed couples with a depressed partner, especially considering the role of potential effect moderators in the improvement of depression.
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Affiliation(s)
- A Barbato
- Istituto di Ricerche Farmacologiche "Mario Negri", Unit of Epidemiology and Social Psychiatry, Via Eritrea 62, Milano, Italy.
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Parabiaghi A, Barbato A, D'Avanzo B, Erlicher A, Lora A. Assessing reliable and clinically significant change on Health of the Nation Outcome Scales: method for displaying longitudinal data. Aust N Z J Psychiatry 2005; 39:719-25. [PMID: 16050926 DOI: 10.1080/j.1440-1614.2005.01656.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Many authors recommended that reliable and clinically significant change (RCSC) should be calculated when reporting results of interventions. To test the reliability of the Health of the Nation Outcome Scales (HoNOS) in identifying RCSC, we applied the Jacobson and Truax model to two HoNOS assessments in a large group of people evaluated in 10 community mental health services in Lombardy, Italy, in 2000. METHOD The HoNOS was administered to 9817 patients; of these, 4759 (48%) were re-assessed. Reliable change (RC) was calculated using Cronbach's alpha (alpha), as a parameter of the reliability of the measure. Clinical significance cut-offs were calculated using a classification of severity based on HoNOS items. RESULTS In the whole sample, the clinical improvement cut-off was 11 and the remission cut-off was 5. Considering the severe patients, the clinical improvement cut-off was 12. The RC index calculated on the whole group and on the subgroup of severe patients indicated that eight-point and seven-point changes, respectively, were needed to be confident that a real change had occurred. Longitudinal changes were depicted on two-dimensional graphs as examples of reporting RCSC on HoNOS total scores in a routine data collection: 91.6% of the whole sample (4361) was stable, 5.6% (269) improved and 1.8% (129) worsened. CONCLUSION Our study proposes a methodological framework for computing RCSC normative data on a widely used outcome scale and for identifying different degrees of clinical change.
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Affiliation(s)
- Alberto Parabiaghi
- Unit of Epidemiology and Social Psychiatry, 'Mario Negri' Institute for Pharmacological Research, Via Eritrea 62, 20157 Milan, Italy.
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Zimmerman M, Chelminski I, Posternak M. A review of studies of the Hamilton depression rating scale in healthy controls: implications for the definition of remission in treatment studies of depression. J Nerv Ment Dis 2004; 192:595-601. [PMID: 15348975 DOI: 10.1097/01.nmd.0000138226.22761.39] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Hamilton Rating Scale for Depression (HRSD) is the most commonly used symptom severity scale to evaluate the efficacy of antidepressant treatment. On the basis of an expert consensus panel, an HRSD score of < or = 7 was recommended as a cutoff to define remission. Since that recommendation, little empirical work has been conducted to confirm the validity of this threshold. One approach toward determining a cutoff score for defining remission is to establish the range of values for healthy controls. We therefore conducted a literature review of studies of the HRSD in healthy controls to determine the normal range of values. Studies of the HRSD in healthy control groups were identified in two ways. First, a MEDLINE search for the years 1966 to 2002 was conducted using the key words Hamilton, depression, and controls, and articles were reviewed. Second, the 69 studies included in two review articles written by the authors were examined. We identified 27 studies that included data on the HRSD for 1014 healthy controls. Across all studies, the weighted mean (SD) HRSD score, adjusting for sample size, was 3.2 (3.2; 95% CI, 3.0 to 3.4). HRSD scores were similar in geriatric and nongeriatric samples, and in men and women. Because HRSD scores in healthy controls are more likely to follow a skewed than a normal distribution, based on a mean of 3.2 and a SD of 3.2, at least 84% of healthy controls scored 7 or less on the HRSD, and 97.5% scored 10 or less. Thus, these results can be taken as support for the recommended cutoff of 7 on the HRSD to define remission. The results can also be used for normative comparisons in which posttreatment group mean scores are compared with mean scores from normative samples.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, USA
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Ogles BM, Lunnen KM, Bonesteel K. Clinical significance: history, application, and current practice. Clin Psychol Rev 2001; 21:421-46. [PMID: 11288608 DOI: 10.1016/s0272-7358(99)00058-6] [Citation(s) in RCA: 157] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The meaningfulness of psychotherapy outcome as measured in therapy research is a persistent and important issue. Following a period of emphasis on statistically significant findings for treated versus control groups, many researchers are renewing efforts to investigate the meaningfulness of individual change. Several statistical methods are available to evaluate the meaningfulness of client's changes occurring as a result of treatment. This article reviews the history of the clinical significance concept; describes the various methods for defining improvement, recovery, and clinically significant change; examines current criticisms of the methods; and describes the current use of the methods in practice.
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Affiliation(s)
- B M Ogles
- Ohio University, Department of Psychology, 241 Porter Hall, Athens, OH 45701, USA.
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Margison FR, Barkham M, Evans C, McGrath G, Clark JM, Audin K, Connell J. Measurement and psychotherapy. Evidence-based practice and practice-based evidence. Br J Psychiatry 2000; 177:123-30. [PMID: 11026951 DOI: 10.1192/bjp.177.2.123] [Citation(s) in RCA: 219] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Measurement is the foundation of evidence-based practice. Advances in measurement procedures should extend to psychotherapy practice. AIMS To review the developments in measurement relevant to psychotherapy. METHOD Domains reviewed are: (a) interventions; (b) case formulation; (c) treatment integrity; (d) performance (including adherence, competence and skillfulness); (e) treatment definitions; (f) therapeutic alliance; and (g) routine outcome measurement. RESULTS Modern methods of measurement can support 'evidence-based practice' for psychological treatments. They also support 'practice-based evidence', a complementary paradigm to improve clinical effectiveness in routine practice via the infrastructure of Practice Research Networks (PRNs). CONCLUSIONS Advances in measurement derived from psychotherapy research support a model of professional self-management (practice-based evidence) which is widely applicable in psychiatry and medicine.
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Affiliation(s)
- F R Margison
- Department of Psychotherapy, Manchester Royal Infirmary, UK.
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