Influence of childhood adversities and defense styles on the 1-year follow-up of psychosomatic- psychotherapeutic inpatient treatment

Meta-Analysis of the Effect of Psychotherapy in an Inpatient Setting: Examining the Moderating Role of Diagnosis and Therapeutic Approach

OBJECTIVE

The current meta-analysis investigates the efficacy of psychotherapy during psychiatric hospitalization and examines the moderating role of diagnosis and therapeutic approach.

METHODS

We conducted systematic searches in literature databases, including PubMed, PsycInfo, and Google Scholar. In total, 37 samples were included for the meta-analysis with a total of 4,443 patients. The primary outcome was the standardized mean differences in clinical status measured by symptomatic and functional measures.

RESULTS

The meta-analysis of 22 samples without a control group resulted in the upper end of the medium effect size for the overall effect of treatment during psychiatric hospitalization that included psychotherapy (k = 22, Cohen's d = 0.70, and 95% Cl 0.36 to 1.04). The meta-analysis of 15 samples with a control group resulted in the upper end of the low effect size for the contribution of psychotherapy to the improvement of patients' clinical status measured by symptomatic and functional measures (k = 15, Cohen's d = 0.43, and 95% CI 0.06 to 0.81). No significant effects were uncovered for psychotherapy orientation. Diagnosis was found to moderate the contribution of psychotherapy in an inpatient setting to the improvement of patients' clinical condition.

CONCLUSION

Psychotherapy during psychiatric hospitalization may be an effective treatment. Across the various samples, psychotherapy has a moderate effect on the reduction of psychiatric symptoms beyond the overall effect of ward treatment.

Do patients' symptoms and interpersonal problems improve in psychotherapeutic hospital treatment in Germany? A systematic review and meta-analysis

Background

In Germany, inpatient psychotherapy plays a unique role in the treatment of patients with common mental disorders of higher severity. In addition to psychiatric inpatient services, psychotherapeutic hospital treatment and psychosomatic rehabilitation are offered as independent inpatient treatment options. This meta-analysis aims to provide systematic evidence for psychotherapeutic hospital treatment in Germany regarding its effects on symptomatic and interpersonal impairment.

Methodology

Relevant papers were identified by electronic database search and hand search. Randomized controlled trials as well as naturalistic prospective studies (including post-therapy and follow-up assessments) evaluating psychotherapeutic hospital treatment of mentally ill adults in Germany were included. Outcomes were required to be quantified by either the Symptom-Checklist (SCL-90-R or short versions) or the Inventory of Interpersonal Problems (IIP-64 or short versions). Effect sizes (Hedges’ g) were combined using random effect models.

Principal Findings

Sixty-seven papers representing 59 studies fulfilled inclusion criteria. Meta-analysis yielded a medium within-group effect size for symptom change at discharge (g = 0.72; 95% CI 0.68–0.76), with a small reduction to follow-up (g = 0.61; 95% CI 0.55–0.68). Regarding interpersonal problems, a small effect size was found at discharge (g = 0.35; 95% CI 0.29–0.41), which increased to follow-up (g = 0.48; 95% CI 0.36–0.60). While higher impairment at intake was associated with a larger effect size in both measures, longer treatment duration was related to lower effect sizes in SCL GSI and to larger effect sizes in IIP Total.

Conclusions

Psychotherapeutic hospital treatment may be considered an effective treatment. In accordance with Howard’s phase model of psychotherapy outcome, the present study demonstrated that symptom distress changes more quickly and strongly than interpersonal problems. Preliminary analyses show impairment at intake and treatment duration to be the strongest outcome predictors. Further analyses regarding this relationship are required.

[The effectiveness of psychosomatic inpatient treatment - results of a multicenter follow-up study]

OBJECTIVES

This multicenter follow-up study examines the effectiveness of psychosomatic inpatient treatment under the conditions of routine practice.

METHODS

We chose a naturalistic design with one pre- and two postmeasurements: admission, discharge, and 1-year follow-up with a follow-up sample of 935 patients from five psychosomatic hospitals.We assessed the effectiveness of inpatient psychosomatic treatments with the Global Severity Index (GSI) of the SCL-90-R at admission (M = 1.20, SD = 0.68), discharge (M = 0.67, SD = 0.58), and 1-year follow-up (M = 0.83, SD = 0.68) as well as with the Veränderungsfragebogen des Erlebens und Verhaltens (VEV-K) at discharge (M = 125.42, SD = 27.27) and follow-up (M = 115.50, SD = 31.16).

RESULTS

Significant improvements were shown in the GSI from admission to discharge (F = 802.70, df = 1, p <or= 0.001) and from admission to follow-up (F = 312.84, df = 1, p < or = 0.001) as well as in the VEV-K at discharge (T = 25.78, df = 764, p < or = 0.001) and at follow-up (T = 15.05, df = 914, p < or = 0.001), showing the effectiveness of psychosomatic inpatient treatments.