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Müller J, Elsaesser M, Müller W, Hellmich M, Hammen M, Zehender N, Riedel-Heller S, Bewernick BH, Wagner M, Frölich L, Peters O, Dafsari FS, Domschke K, Jessen F, Hautzinger M, Schramm E. Differential Psychological Treatment Effects in Patients With Late-Life Depression and a History of Childhood Maltreatment. Am J Geriatr Psychiatry 2024:S1064-7481(24)00335-X. [PMID: 38824050 DOI: 10.1016/j.jagp.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 05/13/2024] [Accepted: 05/13/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVE This is the first interventional study to assess the impact of childhood maltreatment (CM) on psychological treatment outcomes in patients with late-life depression (LLD). METHODS This is a secondary analysis of a multicenter, randomized controlled trial with 251 participants aged ≥60 years with moderate to severe depression. Participants were randomly assigned to cognitive behavioral therapy for late life depression (LLD-CBT) or to a supportive intervention (SUI). Treatment outcomes were measured by changes in the Geriatric Depression Scale (GDS). RESULTS In the intention-to-treat sample (n = 229), both LLD-CBT (n = 115) and SUI (n = 114) significantly reduced depressive symptoms in patients with CM, with large effects at post-treatment (d = 0.95 [95% CI: 0.65 to 1.25] in LLD-CBT; d = 0.82 [95% CI: 0.52 to 1.12] in SUI). A significant treatment group*CM interaction (F(1,201.31) = 4.71; p = .031) indicated greater depressive symptom reduction in LLD-CBT compared to SUI at week 5 and post-treatment for patients without CM, but not at 6-month follow-up. Across both treatments, higher severity of the CM subtype 'physical neglect' was associated with a smaller depressive symptom reduction (F(1,207.16) = 5.37; p = .021). CONCLUSIONS Specific and non-specific psychotherapy effectively reduced depressive symptoms in older individuals with depression and early trauma. For patients without early trauma, LLD-CBT may be preferable over SUI. Considering early trauma subtypes may contribute to develop personalized treatment approaches.
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Affiliation(s)
- Julia Müller
- Department of Psychiatry and Psychotherapy (JM, ME, NZ, MH, KD, ES), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Moritz Elsaesser
- Department of Psychiatry and Psychotherapy (JM, ME, NZ, MH, KD, ES), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wiebke Müller
- Institute of Medical Statistics and Computational Biology (WM, MH), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology (WM, MH), Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Magdalena Hammen
- Department of Psychiatry and Psychotherapy (JM, ME, NZ, MH, KD, ES), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nadine Zehender
- Department of Psychiatry and Psychotherapy (JM, ME, NZ, MH, KD, ES), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Steffi Riedel-Heller
- Institute for Social Medicine (SRH), Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Bettina H Bewernick
- Department of Neurodegenerative Diseases and Geriatric Psychiatry (BHB, MW), University Hospital Bonn, Bonn, Germany
| | - Michael Wagner
- Department of Neurodegenerative Diseases and Geriatric Psychiatry (BHB, MW), University Hospital Bonn, Bonn, Germany
| | - Lutz Frölich
- Department of Geriatric Psychiatry (LF), Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Oliver Peters
- Department of Psychiatry and Psychotherapy (OP), Charité, Campus Benjamin Franklin, Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany
| | - Forugh S Dafsari
- Department of Psychiatry and Psychotherapy(FJ), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy (JM, ME, NZ, MH, KD, ES), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Frank Jessen
- Department of Psychiatry and Psychotherapy(FJ), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Martin Hautzinger
- Department of Clinical Psychology and Psychotherapy (MH), Eberhard Karls University, Tuebingen, Germany
| | - Elisabeth Schramm
- Department of Psychiatry and Psychotherapy (JM, ME, NZ, MH, KD, ES), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Cetin S, Sozeri Varma G, Toker Ugurlu T, Ozdel IO. Theory of Mind in Somatization and Depression: Is It Cause or Phenomenon? J Nerv Ment Dis 2021; 209:911-917. [PMID: 34310521 DOI: 10.1097/nmd.0000000000001399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Although mentalization is important in somatic symptom disorder (SSD) and major depressive disorder (MDD), it is not fully understood. In this study, we aimed to investigate the relation between somatic and depressive symptoms with mentalization. A total of 48 patients diagnosed with SSD, 50 patients diagnosed with MDD, and 50 healthy individuals, participated the study. The Montgomery-Asperg Depression Scale, Symptom Checklist-90 Revised, and Reading the Mind in the Eyes Test (RMET) were applied to the participants. The patients with SSD showed significantly the lowest performance of theory of mind. There was no significant difference between MDD and healthy controls. High somatization score was found to be a predictor for low RMET scores (95% confidence interval, -0.339; p = 0.014). Mentalization deficit seems to be associated with somatization rather than depression.
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Affiliation(s)
| | - Gulfizar Sozeri Varma
- Department of Psychiatry, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Tugce Toker Ugurlu
- Department of Psychiatry, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ismail Osman Ozdel
- Department of Psychiatry, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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Frick A, Thinnes I, Hofmann SG, Windmann S, Stangier U. Reduced Social Connectedness and Compassion Toward Close Others in Patients With Chronic Depression Compared to a Non-clinical Sample. Front Psychiatry 2021; 12:608607. [PMID: 33815163 PMCID: PMC8012512 DOI: 10.3389/fpsyt.2021.608607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 02/19/2021] [Indexed: 11/19/2022] Open
Abstract
Reduced social functioning in depression has been explained by different factors. Reduced social connectedness and prosocial motivation may contribute to interpersonal difficulties, particularly in chronic depression. In the present study, we tested whether social connectedness and prosocial motivation are reduced in chronic depression. Forty-seven patients with persistent depression and 49 healthy controls matched for age and gender completed the Inclusion of the Other in the Self Scale (IOS), the Compassionate Love Scale (CLS), the Beck Depression Inventory-II, and the Childhood Trauma Questionnaire. A Multivariate analysis of variance (MANOVA) with IOS and CLS as dependent variables revealed a highly significant difference between both groups. The IOS and the CLS-subscale Close Others were lower in persistent depression, whereas there was no difference in the CLS-subscale Strangers/Humanity. IOS and CLS-Close Others showed significant negative correlations with depressive symptoms. Connectedness to family members as measured by the IOS was negatively correlated with childhood trauma in patients with chronic depression. The results indicate that compassion and perceived social connection are reduced in depressed patients toward close others, but not to others in general. Implications for the treatment of depression are discussed.
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Affiliation(s)
- Artjom Frick
- Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Isabel Thinnes
- Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, United States
| | - Sabine Windmann
- Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Ulrich Stangier
- Department of Psychology, Goethe University Frankfurt, Frankfurt, Germany
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