Lübke Laura, Flemming Eva, Mestel Robert, Masuhr Oliver, Jaeger Ulrich, Spitzer Carsten
Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin Rostock, Deutschland.
Qualitätssicherung, Vamed Rehaklinik, Bad Grönenbach, Deutschland.
Psychother Psychosom Med Psychol. 2021 Nov;71(11):456-463. doi: 10.1055/a-1425-7618. Epub 2021 Apr 29.
The transdiagnostic concept of personality structure plays a key role in psychodynamic nosology, since many mental and psychosocial disorders are considered mainfestations of structural vulnerabilities and deficits. Therefore, structural diagnostics is of particular importance, especially with respect to the planning of tailor-made psychotherapeutic interventions. Because changes in personality structure are increasingly being considered as a relevant therapeutic goal, any measures employed towards achieving this goal should be sensitive enough to capture these changes appropriately. Although the short form of the OPD Structure Questionnaire (OPD-SQS) can easily be administered and is therefore frequently used in clinical and research settings, its sensitivity to change has not yet been analyzed. Two large, independent and diagnostically heterogeneous samples of inpatient psychotherapy patients (n=1183 and n=967, respectively) completed the OPD-SQS both at admission and before discharge. Standardized Effect Size (SES), Standardized Response Mean (SRM) and Smallest Real Difference (SRD) were computed as indicators of the measure's ability to capture change. For the OPD-SQS and its subscales, low effect sizes were found in both samples (SES between 0.23 and 0.48; SRM between 0.27 and 0.53). Additionally, it was demonstrated that greater changes among patients with structural deficits were detectable with the OPD-SQS compared to those without structural deficits, and that these group differences were significant. By means of the SRD, we determined a proportion of about 22% of patients with significantly structurally improved changes in both samples. Despite some methodological issues, our findings suggest that the OPD-SQS is suitable for measuring changes in personality structure in inpatients between the beginning and the end of treatment. Since studies on the sensitivity to change of similar assessment tools are still pending, it is not yet possible to formulate any empirically validated recommendations as to which of the measure best captures therapeutically induced changes in personality structure.
人格结构的跨诊断概念在心理动力学疾病分类学中起着关键作用，因为许多精神和心理社会障碍被视为结构脆弱性和缺陷的表现。因此，结构诊断尤为重要，特别是在规划量身定制的心理治疗干预措施方面。由于人格结构的变化越来越被视为一个相关的治疗目标，为实现这一目标所采取的任何措施都应足够敏感，以适当地捕捉这些变化。虽然OPD结构问卷简版（OPD-SQS）易于实施，因此在临床和研究环境中经常使用，但其对变化的敏感性尚未得到分析。两个大型、独立且诊断异质性的住院心理治疗患者样本（分别为n = 1183和n = 967）在入院时和出院前都完成了OPD-SQS。计算标准化效应大小（SES）、标准化反应均值（SRM）和最小实际差异（SRD）作为该测量捕捉变化能力的指标。对于OPD-SQS及其子量表，在两个样本中均发现效应大小较低（SES在0.23至0.48之间；SRM在0.27至0.53之间）。此外，还表明与没有结构缺陷患者相比，OPD-SQS能够检测出有结构缺陷患者中更大的变化，并且这些组间差异具有显著性。通过SRD，我们确定在两个样本中约22%的患者在结构上有显著改善。尽管存在一些方法学问题，但我们的研究结果表明，OPD-SQS适用于测量住院患者在治疗开始和结束之间人格结构的变化。由于关于类似评估工具对变化敏感性的研究仍在进行中，目前还无法就哪种测量方法最能捕捉治疗引起的人格结构变化提出任何经实证验证的建议。
