Prediction of individual outcome in a group intervention for depression.

75 Ss (mean age 36 yrs) who met Research Diagnostic Criteria for a current episode of Major, Minor, or Intermittent Depressive Disorder were assessed on a number of demographic and psychological variables prior to beginning treatment. Treatment outcome was assessed by the Beck Depression Inventory and the Schedule for Affective Disorders and Schizophrenia. Ss at all levels of depression severity improved markedly, but those who were initially more depressed tended to maintain their relative ranking at posttreatment. After accounting for pretreatment depression severity (PTDS), 6 additional variables emerged as significant predictors of outcome: Ss who improved most had expected to be least depressed posttreatment, had greater perceptions of mastery, had greater reading ability, were younger, perceived their families as more supportive, and were not receiving additional concurrent treatment for depression. These 7 variables, including PTDS, accounted for 51% of the variance in posttreatment depression level. These same variables, excluding PTDS, significantly discriminated between Ss who still met diagnostic criteria for depression at the posttreatment assessment and those who were no longer depressed. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lifetime diagnosis of major depression as a multivariate predictor of treatment outcome for inpatients with substance use disorders from abstinence-based programs

A multisite, longitudinal study of patients undergoing inpatient alcohol and drug dependence treatment was conducted in private inpatient facilities, consisting of 4339 subjects from 38 independent programs enrolled in a national addiction treatment outcomes registry. Structured interviews were conducted upon admission, including documentation of current alcohol/drug disorder (DSM-III-R) and lifetime diagnosis of major depressive syndrome; structured interviews were conducted prospectively at 6- and 12-month follow-up periods. The prevalence rate of lifetime diagnosis of major depression in the sample was 39%. Comorbidity varied according to gender and substance of choice. Lifetime depressive symptoms did not correlate with differential length-of-stay, treatment completion, or follow-up consent and, at best, were very weakly associated with follow-up contact. Patients diagnosed with lifetime depression showed the same frequency of participation in posttreatment continuing care: they also showed statistically significant reductions in job absenteeism, inpatient hospitalizations, and arrest rates pre- vs. posttreatment comparable to those of patients without lifetime depression diagnosis. Lifetime major depressive syndrome was not a predictor of outcome in response to abstinence-based treatment. Involvement in posttreatment continuing care accounted for far greater outcome variance. Posttreatment vs. pretreatment factors may be more decisive in influencing risk for relapse.     

Examination of predictors and moderators for self-help treatments of binge-eating disorder.

Predictors and moderators of outcomes were examined in 75 overweight patients with binge-eating disorder (BED) who participated in a randomized clinical trial of guided self-help treatments. Age variables, psychiatric and personality disorder comorbidity, and clinical characteristics were tested as predictors and moderators of treatment outcomes. Current age and age of BED onset did not predict outcomes. Key dimensional outcomes (binge frequency, eating psychopathology, and negative affect) were predominately predicted, but not moderated, by their respective pretreatment levels. Presence of personality disorders, particularly Cluster C, predicted both posttreatment negative affect and eating disorder psychopathology. Negative affect, but not major depressive disorder, predicted attrition, posttreatment negative affect, and eating disorder psychopathology. Despite the prognostic significance of these findings for dimensional outcomes, none of the variables tested were predictive of binge remission (i.e., a categorical outcome). No moderator effects were found. The present study found poorer prognosis for patients with negative affect and personality disorders, suggesting that treatment outcomes may be enhanced by attending to the cognitive and personality styles of these patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does pretreatment severity moderate the efficacy of psychological treatment of adult outpatient depression? A meta-analysis.

Objective: It is widely believed that psychological treatment has little effect on more severely depressed patients. This study assessed whether pretreatment severity moderates psychological treatment outcome relative to controls by means of meta-analyses. Method: We included 132 studies (10,134 participants) from a database of studies (www.evidencebasedpsychotherapies.org) in which the effects of psychological treatment on adult outpatients with a depressive disorder or an elevated level of depressive symptoms were compared with a control condition in a randomized controlled trial. Two raters independently extracted outcome data and rated study characteristics. We conducted metaregression analyses assessing whether mean pretreatment depression scores predicted psychological treatment versus control condition posttreatment effect size and subgroup analyses summarizing the results of studies reporting within-study analyses of depression severity and psychological treatment outcome. Results: Psychological treatment was found to be consistently superior to control conditions (d = 0.40–0.88). We found no indication that pretreatment mean depression scores predicted psychological treatment versus control condition posttreatment effect size, even after adjusting for relevant study characteristics. However, among the smaller subset of studies that reported within-study severity analyses, posttreatment effect sizes were higher for high-severity patients (d = 0.63) than for low-severity patients (d = 0.22) when psychological treatment was efficacious relative to a more stringent control. Conclusion: Contrary to conventional wisdom, our findings suggest that when compared with control conditions, psychological treatment might be more efficacious for high-severity than for low-severity patients. Because the number of studies reporting within-study severity analyses is small, we recommend that future studies routinely report tests for Severity × Treatment interactions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Marital adjustment and outcome following treatments for depression.

Marital adjustment and treatment outcome were evaluated in the Treatment of Depression Collaborative Research Program, a multicenter clinical trial evaluating interpersonal psychotherapy, cognitive therapy, imipramine, and placebo. Marital adjustment and depression were assessed pre- and posttreatment, and depression was assessed at 6, 12, and 18 months after treatment. Results indicate that (1) there was a significant improvement in marital adjustment after treatment, (2) this effect was not moderated by treatment type, and (3) this effect was mediated by change in depression. Poor pretreatment marital adjustment was modestly associated with negative outcome, whereas poor posttreatment marital adjustment was strongly associated with negative outcome during follow-up. The findings suggest that poor marital adjustment at the end of active treatment is a risk factor for increases in depression severity during follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identification of therapist differences in a group treatment for depression.

Examined therapist variables presumed to be related to outcome in a structured, cognitive-behavioral group treatment for depression. Each of 8 leaders conducted 2 consecutive psychoeducational treatment groups consisting of 5–8 Ss. Of the 106 Ss (aged 17–67 yrs) who participated in the study, 79 were clinically depressed; measures of depression included the Beck Depression Inventory, Hamilton Rating Scale for Depression, and a measure of social adjustment. A broad multivariate assessment was conducted of pretreatment leader characteristics, leader behavior and style during treatment, group behavior and process, and depression outcome. Results indicate that leaders differed significantly on behavioral and group-process measures, but differences in depression outcome between leaders did not attain statistical significance. (5 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnostic comorbidity in panic disorder: effect on treatment outcome and course of comorbid diagnoses following treatment

The impact and course of additional diagnoses was examined in 126 patients undergoing cognitive-behavioral treatment for panic disorder. With the Anxiety Disorders Interview Schedule--Revised, a high comorbidity rate (51%) was observed at pretreatment. Pretreatment comorbidity was not predictive of premature termination, nor did it have a substantial impact on short-term treatment outcome. However, patients with comorbidity at posttreatment were more likely to have sought additional treatment over the follow-up interval. Although a significant and dramatic decline in the overall comorbidity rate was found at posttreatment (17%), at 24-month follow-up this rate had increased to a level (30.2%) that was no longer significantly different from pretreatment. This was despite the fact that patients maintained or improved on treatment gains for panic disorder over this interval. The implications of these findings for the treatment, conceptualization, and classification of emotional disorders are discussed.     

"Prospective study of postpartum depression: Prevalence, course, and predictive factors": Correction.

Reports an error in "Prospective study of postpartum depression: Prevalence, course, and predictive factors" by Michael W. O'Hara, Danny J. Neunaber and Ellen M. Zekoski (Journal of Abnormal Psychology, 1984[May], Vol 93[2], 158-171). Much of the data reported in Tables 4 and 5 are incorrect. Most of the errors are small and they do not affect the p values shown in the tables, with three exceptions which are provided in the erratum. (The following abstract of the original article appeared in record 1984-23277-001.) 99 women (mean age 26.5 yrs) were followed from the 2nd trimester of pregnancy until about 6 mo postpartum. Depression diagnostic and severity assessments were conducted during pregnancy and after delivery. Instruments included the Beck Depression Inventory and an interview adapted from the Schedule of Affective Disorders and Schizophrenia. Depression severity decreased steadily from the 2nd trimester until 9 wks postpartum. Approximately 9% of the Ss during pregnancy and 12% of the Ss during the postpartum period were diagnosed as having a major or minor depression. A model of depression was constructed to account for both postpartum depression symptomatology and the syndrome of postpartum depression. Predictor variables (e.g., prepartum depression symptomatology, obstetric risk factors) accounted for about 50% of the variance in depressive symptomatology. Predictor variables (e.g., depression history, stressful childcare events) accounted for about 30% of the variance in diagnostic status. Findings underscore the importance of studying changes in depression diagnostic status as well as changes in level of depressive symptomatology in prospective studies. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder.

Objective: Effective treatments for obsessive-compulsive disorder (OCD) exist, but additional treatment options are needed. The effectiveness of 8 sessions of acceptance and commitment therapy (ACT) for adult OCD was compared with progressive relaxation training (PRT). Method: Seventy-nine adults (61% female) diagnosed with OCD (mean age = 37 years; 89% Caucasian) participated in a randomized clinical trial of 8 sessions of ACT or PRT with no in-session exposure. The following assessments were completed at pretreatment, posttreatment, and 3-month follow-up by an assessor who was unaware of treatment conditions: Yale–Brown Obsessive Compulsive Scale (Y-BOCS), Beck Depression Inventory–II, Quality of Life Scale, Acceptance and Action Questionnaire, Thought Action Fusion Scale, and Thought Control Questionnaire. Treatment Evaluation Inventory was completed at posttreatment. Results: ACT produced greater changes at posttreatment and follow-up over PRT on OCD severity (Y-BOCS: ACT pretreatment = 24.22, posttreatment = 12.76, follow-up = 11.79; PRT pretreatment = 25.4, posttreatment = 18.67, follow-up = 16.23) and produced greater change on depression among those reporting at least mild depression before treatment. Clinically significant change in OCD severity occurred more in the ACT condition than PRT (clinical response rates: ACT posttreatment = 46%–56%, follow-up = 46%–66%; PRT posttreatment = 13%–18%, follow-up = 16%–18%). Quality of life improved in both conditions but was marginally in favor of ACT at posttreatment. Treatment refusal (2.4% ACT, 7.8% PRT) and dropout (9.8% ACT, 13.2% PRT) were low in both conditions. Conclusions: ACT is worth exploring as a treatment for OCD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical outcomes of an integrated treatment for depression and substance use disorders.

The authors compared longitudinal treatment outcomes for depressed substance-dependent veterans (N = 206) assigned to integrated cognitive–behavioral therapy plus standard pharmacotherapy (ICBT + P) or 12-step facilitation therapy plus standard pharmacotherapy (TSF + P). Drug and alcohol involvement and depressive symptomology were measured at intake and at 3-month intervals during treatment and up to 1 year posttreatment. Participants in both treatment conditions showed decreased depression and substance use from intake. ICBT + P participants maintained improvements in substance involvement over time, whereas TSF + P participants had more rapid increases in use in the months following treatment. Decreases in depressive symptoms were more pronounced for TSF + P than ICBT + P in the 6 months posttreatment. Within both treatment groups, higher attendance was associated with improved substance use and depression outcomes over time. Initial levels of depressive symptomology had a complex predictive relationship with long-term depression outcomes. Early treatment response predicted long-term substance use outcomes for a portion of the sample. Although both treatments were associated with improvements in substance use and depression, ICBT + P may lead to more stable substance use reductions compared with TSF + P. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Guidelines for differential diagnoses in a population with posttraumatic stress disorder.

In a large posttraumatic stress disorder (PTSD) and depression treatment outcome study, thorough diagnostic assessments of veterans at pretreatment, posttreatment, and 3 follow-up times were completed. The research team that reviewed these assessments encountered several challenges in the differential diagnosis of PTSD because of high comorbidity and symptoms shared with or resembling other disorders. For example, how do mental health professionals distinguish symptoms of agoraphobia from avoidance and hypervigilance symptoms of PTSD? When are hallucinations symptomatic of PTSD (e.g., flashbacks) versus a nonpsychotic near-death experience or an independent psychotic disorder? How do mental health professionals differentiate overlapping symptoms of PTSD and depressive disorders? To help make reliable diagnoses, the team developed clarifying questions and diagnostic guidelines, which may prove useful to other clinicians and researchers working with PTSD populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relation of depression diagnoses to 2-year outcomes in cocaine-dependent patients in a randomized continuing care study.

This study examined the relation between depression diagnoses and outcomes in 132 cocaine-dependent patients who were randomized to relapse prevention (RP) or standard 12-step focused group continuing rare and followed for 2 years. Depressed patients attended more treatment sessions and had more cocaine-free urines during treatment than participants without depression, but they drank alcohol more frequently before treatment and during the 18-month posttreatment follow-up. Cocaine outcomes in depressed patients deteriorated to a greater degree after treatment than did cocaine outcomes in patients without depression, particularly in patients in RP who had a current depressive disorder at baseline. The best alcohol outcomes were obtained in nondepressed patients who received RIP. The results suggest that extended continuing care treatment may be warranted for cocaine-dependent patients with co-occurring depressive disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting outcome in computerized cognitive behavioral therapy for depression in primary care: A randomized trial.

Objective: To explore pretreatment and short-term improvement variables as potential moderators and predictors of 12-month follow-up outcome of unsupported online computerized cognitive behavioral therapy (CCBT), usual care, and CCBT combined with usual care for depression. Method: Three hundred and three depressed patients were randomly allocated to (a) unsupported online CCBT, (b) treatment as usual (TAU), or (c) CCBT and TAU combined (CCBT&TAU). Potential predictors and moderators were demographic, clinical, cognitive, and short-term improvement variables. Outcomes were the Beck Depression Inventory–II score at 12 months of follow-up and reliable change. Results: Those with higher levels of extreme (positive) responding had a better outcome in CCBT compared with TAU, whereas those having a parental psychiatric history or a major depressive disorder diagnosis had a better outcome in CCBT&TAU compared with TAU. Predictors regardless of treatment type included current employment, low pretreatment illness severity, and short-term improvement on clinical variables. Conclusions: Optimistic patients, holding approach-oriented coping strategies, might benefit most from CCBT, whereas CCBT&TAU might be the most suitable option for those with more severe vulnerability characteristics. Those with the least impairment improve the most, regardless of treatment type. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health-related quality of life in head and neck cancer survivors: Impact of pretreatment depressive symptoms.

Objective: Symptoms of depression are common in those with cancer. The authors investigated whether depressive symptoms assessed before the initiation of cancer treatment predicted diminished health-related quality of life (HRQOL) at follow-up. Design: As part of a large, prospective study of oncologic outcomes, 306 patients with head and neck cancer (HNC) were assessed on several clinical and psychosocial characteristics during a pretreatment clinic visit and then at 3- and 12-month follow-up appointments. Main Outcome Measures: Depressive symptomatology was assessed with the Beck Depression Inventory and HNC-specific HRQOL (main outcome measure) was assessed with the Head and Neck Cancer Inventory. Results: Controlling for age, gender, marital status, cancer site, stage of disease, alcohol and tobacco use, comorbidity status, and pretreatment HRQOL, simultaneous multiple regression analyses revealed that depressive symptoms present at study enrollment, before the initiation of cancer treatment, significantly predicted lower HRQOL at 3- and 12-month follow-up assessments across the 4 HNC-specific domains of speech, eating, aesthetics, and social disruption (all ps ≤ .01). Conclusion: Results suggest that depressive symptomatology present near the time of diagnosis can have a significant, deleterious impact on HRQOL over time in HNC survivors. Thus, it may be useful to assess depression at diagnosis to identify individuals at greater risk for poor HRQOL outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How does cognitive therapy work? Cognitive change and symptom change in cognitive therapy and pharmacotherapy for depression.

The effects of changes in depression-relevant cognition were examined in relation to subsequent change in depressive symptoms for outpatients with major depressive disorder randomly assigned to cognitive therapy (COT; n?=?32) vs those assigned to pharmacotherapy only (NoCT; n?=?32). Depression severity scores were obtained at the beginning, middle, and end of the 12-wk treatment period, as were scores on 4 measures of cognition: Attributional Styles Questionnaire (ASQ), Automatic Thoughts Questionnaire (S. D. Hollon and P. E. Kendall; see record 1981-20180-001), Dysfunctional Attitudes Scale (DAS), and the Hopelessness Scale (HS). Change from pretreatment to midtreatment on the ASQ, DAS, and HS predicted change in depression from midtreatment to posttreatment in the COT group, but not in the NoCT group. It is concluded that cognitive phenomena play mediational roles in COT. However, data do not support their status as sufficient mediators. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The prevalence and impact of large sudden improvements during adolescent therapy for depression: A comparison across cognitive-behavioral, family, and supportive therapy.

This study assessed the treatment specificity and impact on outcome of large, abrupt symptomatic improvements occurring prior to and during cognitive- behavioral, family, and supportive therapy. Eighty-seven depressed adolescents receiving at least 8 therapy sessions were included. Abrupt large decreases in depressive symptoms were identified by changes in weekly Beck Depression Inventory scores. Overall, 28% experienced a pretreatment gain and 39% a sudden within-treatment gain. Both types of gains were associated with superior outcome on self-report and interviewer ratings of depression. Among those participants failing to experience a pretreatment or sudden within-treatment gain, cognitive-behavioral therapy produced the superior outcomes. These findings suggest pretreatment and sudden within-treatment gains are important therapeutic events worthy of further investigation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Success and failure in the behavioral treatment of obsessive-compulsives.

Attempted to construct a model for predicting success and failure in the behavioral treatment (exposure and response prevention) of obsessive-compulsives (N?=?50, mean age 34 yrs). Three sets of variables—demographic, pretreatment level of neurotic symptomatology, and S's responses during exposure sessions—were examined. Seven variables were found to be related to outcome at posttreatment and/or at follow-up: Pretreatment level of depression and of anxiety, reactivity, and habituation of reported anxiety to feared stimuli within- and between-sessions were all found to affect outcome at posttreatment. Posttreatment outcome as well as age at symptom onset were significantly related to maintenance of gains. A model of the interrelationships of these variables was constructed and tested by a path analysis. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prospective study of postpartum depression: Prevalence, course, and predictive factors.

[Correction Notice: An erratum for this article was reported in Vol 94(2) of Journal of Abnormal Psychology (see record 2008-10964-001). Much of the data reported in Tables 4 and 5 are incorrect. Most of the errors are small and they do not affect the p values shown in the tables, with three exceptions which are provided in the erratum.] 99 women (mean age 26.5 yrs) were followed from the 2nd trimester of pregnancy until about 6 mo postpartum. Depression diagnostic and severity assessments were conducted during pregnancy and after delivery. Instruments included the Beck Depression Inventory and an interview adapted from the Schedule of Affective Disorders and Schizophrenia. Depression severity decreased steadily from the 2nd trimester until 9 wks postpartum. Approximately 9% of the Ss during pregnancy and 12% of the Ss during the postpartum period were diagnosed as having a major or minor depression. A model of depression was constructed to account for both postpartum depression symptomatology and the syndrome of postpartum depression. Predictor variables (e.g., prepartum depression symptomatology, obstetric risk factors) accounted for about 50% of the variance in depressive symptomatology. Predictor variables (e.g., depression history, stressful childcare events) accounted for about 30% of the variance in diagnostic status. Findings underscore the importance of studying changes in depression diagnostic status as well as changes in level of depressive symptomatology in prospective studies. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationship between depression, fatigue, subjective cognitive impairment, and objective neuropsychological functioning in patients with multiple sclerosis.

Objective: This study explored the influence of depression and fatigue on subjective cognitive complaints and objective neuropsychological impairment in patients with multiple sclerosis (MS). Methods: Data for this study were taken from a randomized controlled trial, comparing 16 weeks of telephone-administered cognitive-behavioral therapy and telephone-administered supportive emotion focused therapy for the treatment of depression. The sample includes 127 patients with MS. The following self-report measures were collected pre- and posttreatment: Perceived Deficits Questionnaire, Beck Depression Inventory-II, and Modified Fatigue Impact Scale. Measures of objective cognitive functioning and the Hamilton Rating Scale for Depression were administered over the telephone. Results: Our results showed that changes in depression and fatigue significantly predicted changes in subjective cognitive complaints from pre- to posttreatment, with patients perceiving fewer cognitive problems at posttreatment (β = .36, p     

Atypical depression. A valid clinical entity?

The history of atypical depression is summarized, and the results of several treatment outcome studies are reviewed. A number of clinical course, family, and biologic variables in patients with atypical depression are investigated, and these patients are compared with patients with other depressive conditions. The Atypical Depression Diagnostic Scale Question Book also is presented.