TY - JOUR
T1 - Acute phase cognitive therapy for recurrent major depressive disorder
T2 - Who drops out and how much do patient skills influence response?
AU - Jarrett, Robin B.
AU - Minhajuddin, Abu
AU - Kangas, Julie L.
AU - Friedman, Edward S.
AU - Callan, Judith A.
AU - Thase, Michael E.
N1 - Funding Information:
This report was supported by Grants Number K24 MH001571 , R01 MH058397 , R01 MH069619 (to Robin B. Jarrett, Ph.D.) and R01 MH058356 , R01 MH069618 (to Michael E. Thase, M.D.) from the National Institute of Mental Health (NIMH) . The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH or the National Institutes of Health. We are grateful to our patients, research teams, and colleagues at The University of Texas Southwestern Medical Center, The University of Pittsburgh, and The University of Pennsylvania who made this trial possible.
PY - 2013/5
Y1 - 2013/5
N2 - Objective: The aims were to predict cognitive therapy (CT) noncompletion and to determine, relative to other putative predictors, the extent to which the patient skills in CT for recurrent major depressive disorder predicted response in a large, two-site trial. Method: Among 523 outpatients aged 18-70, exposed to 12-14 weeks of CT, 21.6% dropped out. Of the 410 completers, 26.1% did not respond. To predict these outcomes, we conducted logistic regression analyses of demographics, pre-treatment illness characteristics and psychosocial measures, and mid-treatment therapeutic alliance. Results: The 17-item Hamilton Rating Scale for Depression (HRSD17) scores at entry predicted dropout and nonresponse. Patients working for pay, of non-Hispanic white race, who were older, or had more education were significantly more likely to complete. Controlling for HRSD17, significant predictors of nonresponse included: lower scores on the Skills of Cognitive Therapy-Observer Version (SoCT-O), not working for pay, history of only two depressive episodes, greater pre-treatment social impairment. Mid-phase symptom reduction was a strong predictor of final outcome. Conclusions: These prognostic indicators forecast which patients tend to be optimal candidates for standard CT, as well as which patients may benefit from changes in therapy, its focus, or from alternate modalities of treatment. Pending replication, the findings underscore the importance of promoting patients' understanding and use of CT skills, as well as reducing depressive symptoms early. Future research may determine the extent to which these findings generalize to other therapies, providers who vary in competency, and patients with other depressive subtypes or disorders.
AB - Objective: The aims were to predict cognitive therapy (CT) noncompletion and to determine, relative to other putative predictors, the extent to which the patient skills in CT for recurrent major depressive disorder predicted response in a large, two-site trial. Method: Among 523 outpatients aged 18-70, exposed to 12-14 weeks of CT, 21.6% dropped out. Of the 410 completers, 26.1% did not respond. To predict these outcomes, we conducted logistic regression analyses of demographics, pre-treatment illness characteristics and psychosocial measures, and mid-treatment therapeutic alliance. Results: The 17-item Hamilton Rating Scale for Depression (HRSD17) scores at entry predicted dropout and nonresponse. Patients working for pay, of non-Hispanic white race, who were older, or had more education were significantly more likely to complete. Controlling for HRSD17, significant predictors of nonresponse included: lower scores on the Skills of Cognitive Therapy-Observer Version (SoCT-O), not working for pay, history of only two depressive episodes, greater pre-treatment social impairment. Mid-phase symptom reduction was a strong predictor of final outcome. Conclusions: These prognostic indicators forecast which patients tend to be optimal candidates for standard CT, as well as which patients may benefit from changes in therapy, its focus, or from alternate modalities of treatment. Pending replication, the findings underscore the importance of promoting patients' understanding and use of CT skills, as well as reducing depressive symptoms early. Future research may determine the extent to which these findings generalize to other therapies, providers who vary in competency, and patients with other depressive subtypes or disorders.
KW - Attrition
KW - Cognitive therapy
KW - Depression
KW - Patient skills
KW - Predictors
KW - Response patterns
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U2 - 10.1016/j.brat.2013.01.006
DO - 10.1016/j.brat.2013.01.006
M3 - Article
C2 - 23485420
AN - SCOPUS:84874487511
SN - 0005-7967
VL - 51
SP - 221
EP - 230
JO - Behaviour Research and Therapy
JF - Behaviour Research and Therapy
IS - 4-5
ER -