Herzog Philipp, Feldmann Matthias, Kube Tobias, Langs Gernot, Gärtner Thomas, Rauh Elisabeth, Doerr Robert, Hillert Andreas, Voderholzer Ulrich, Rief Winfried, Endres Dominik, Brakemeier Eva-Lotta
Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany; University of Greifswald, Department of Clinical Psychology and Psychotherapy, Franz-Mehring-Straße 47, D-17489 Greifswald, Germany; University of Koblenz-Landau, Department of Clinical Psychology and Psychotherapy, Ostbahnstraße 10, D-76829 Landau, Germany.
Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany.
J Affect Disord. 2022 May 15;305:133-143. doi: 10.1016/j.jad.2022.02.057. Epub 2022 Feb 25.
A routinely collected dataset was analyzed (1) to determine the naturalistic effectiveness of inpatient psychotherapy for depression in routine psychotherapeutic care, and (2) to identify potential predictors of change.
In a sample of 22,681 inpatients with depression, pre-post and pre-follow-up effect sizes were computed for various outcome variables. To build a probabilistic model of predictors of change, an independent component analysis generated components from demographic and clinical data, and Bayesian EFA extracted factors from the available pre-test, post-test and follow-up questionnaires in a subsample (N = 6377). To select the best-fitted model, the BIC of different path models were compared. A Bayesian path analysis was performed to identify the most important factors to predict changes.
Effect sizes were large for the primary outcome and moderate for various secondary outcomes. Almost all pretreatment factors exerted significant influences on different baseline factors. Several factors were found to be resistant to change during treatment: suicidality, agoraphobia, life dissatisfaction, physical disability and pain. The strongest cross-loadings were observed from suicidality on negative cognitions, from agoraphobia on anxiety, and from physical disability on perceived disability.
No causal conclusions can be drawn directly from our results as we only used cross-lagged panel data without control group.
The results indicate large effects of inpatient psychotherapy for depression in routine clinical care. The direct influence of pretreatment factors decreased over the course of treatment. However, some factors appeared stable and difficult to treat, which might hinder treatment outcome. Findings of different predictors of change are discussed.
对一个常规收集的数据集进行分析，目的如下：（1）确定住院心理治疗在常规心理治疗护理中对抑郁症的实际疗效；（2）识别变化的潜在预测因素。
在一个包含22681名抑郁症住院患者的样本中，计算了各种结局变量的前后效应量以及随访前效应量。为构建变化预测因素的概率模型，独立成分分析从人口统计学和临床数据中生成成分，贝叶斯探索性因素分析从一个子样本（N = 6377）中可用的测试前、测试后和随访问卷中提取因素。为选择最佳拟合模型，比较了不同路径模型的贝叶斯信息准则（BIC）。进行贝叶斯路径分析以识别预测变化的最重要因素。
主要结局的效应量较大，各种次要结局的效应量中等。几乎所有治疗前因素对不同的基线因素都有显著影响。发现几个因素在治疗期间对变化具有抗性：自杀观念、广场恐惧症、生活不满意、身体残疾和疼痛。观察到最强的交叉负荷为从自杀观念到消极认知、从广场恐惧症到焦虑、从身体残疾到感知到的残疾。
由于我们仅使用交叉滞后面板数据且无对照组，因此不能直接从我们的结果中得出因果结论。
结果表明住院心理治疗在常规临床护理中对抑郁症有显著效果。治疗前因素的直接影响在治疗过程中有所下降。然而，一些因素似乎较为稳定且难以治疗，这可能会阻碍治疗效果。讨论了不同变化预测因素的研究结果。
