Pro Persona Research, Renkum, The Netherlands.
Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
BMC Psychiatry. 2019 Jul 24;19(1):228. doi: 10.1186/s12888-019-2214-4.
An adequate frequency of treatment might be a prerequisite for a favorable outcome. Unfortunately, there is a diversity of factors that interfere with an adequate frequency of sessions. This occurs especially in the first phase of treatment, while the first phase seems vital for the rest of treatment. The aim of this naturalistic study was to explore the impact of the initial frequency of treatment sessions on treatment outcome in a diverse mental health care population.
Anonymized data were analyzed from 2,634 patients allocated for anxiety disorders, depressive disorders, and personality disorders to outpatient treatment programs in a large general mental health care facility. Patients' treatment outcome was routinely monitored with the Outcome Questionnaire-45 (OQ-45.2), every 12 weeks. Frequency of sessions was assessed for the first three months of treatment. Using Cox-proportional-hazard models, we explored the associations between initial frequency and improvement (reliable significant change) and recovery (reliable and clinically significant change).
Improvement and recovery were associated with symptom severity and functional impairment at start of treatment, the year the treatment started, number of measurements, the treatment program (anxiety disorders, depressive disorders, and personality disorders) and receiving group therapy other than psychotherapy. In all diagnostic groups, both improvement and recovery were associated with a higher frequency of sessions during the first three months of treatment. For improvement, this effect diminished after three years in treatment; however, for recovery this association was sustained.
In addition to severity at start of treatment and other predictors of outcome, a low frequency of initial treatment sessions might lead to a less favorable outcome and a more chronic course of the mental disorder. This association seems not to be limited to a specific diagnostic group, but was found in a large group of patients with common mental disorders (depression and anxiety disorders) and patients with a personality disorder. Despite organizational obstacles, more effort should be made to start treatment quickly by an effective frequency of session.
足够的治疗频率可能是取得良好效果的前提。遗憾的是，有许多因素会干扰治疗的频率。这种情况尤其出现在治疗的初始阶段，而初始阶段对于治疗的其余阶段似乎至关重要。本自然主义研究旨在探讨初始治疗次数对不同精神卫生保健人群治疗结果的影响。
对在一家大型综合精神卫生保健机构接受焦虑障碍、抑郁障碍和人格障碍门诊治疗方案的 2634 名患者的匿名数据进行了分析。患者的治疗结果采用《症状问卷-45 项》（OQ-45.2）每 12 周进行一次常规监测。在治疗的前三个月评估治疗次数。使用 Cox 比例风险模型，我们探讨了初始频率与改善（可靠显著变化）和康复（可靠且临床显著变化）之间的关联。
改善和康复与治疗开始时的症状严重程度和功能障碍、治疗开始的年份、测量次数、治疗方案（焦虑障碍、抑郁障碍和人格障碍）以及接受除心理治疗以外的团体治疗有关。在所有诊断组中，改善和康复都与治疗前三个月的治疗次数较多有关。对于改善，这种效果在治疗三年后减弱；然而，对于康复，这种关联持续存在。
除了治疗开始时的严重程度和其他结果预测因素外，初始治疗次数较低可能导致治疗结果较差和精神障碍的慢性病程。这种关联似乎不仅限于特定的诊断组，而是在患有常见精神障碍（抑郁和焦虑障碍）和人格障碍的大量患者中发现的。尽管存在组织障碍，但应更加努力通过有效的治疗次数尽快开始治疗。
