TY - JOUR
T1 - Combining baseline characteristics to disentangle response differences to disorder-specific versus supportive psychotherapy in patients with persistent depressive disorder
AU - Serbanescu, Ilinca
AU - Walter, Henrik
AU - Schnell, Knut
AU - Kessler, Henrik
AU - Weber, Bernd
AU - Drost, Sarah
AU - Groß, Magdalena
AU - Neudeck, Peter
AU - Klein, Jan Philipp
AU - Assmann, Nele
AU - Zobel, Ingo
AU - Backenstrass, Matthias
AU - Hautzinger, Martin
AU - Meister, Ramona
AU - Härter, Martin
AU - Schramm, Elisabeth
AU - Schoepf, Dieter
N1 - Funding Information:
This trial was funded by grants of the German Research Foundation ( SCHR443/11-1 , SCHR 443/11-2 , and WA1539/4-1 ). The sponsor ( German Research Foundation ) has reviewed and approved the study protocol in the context of the grant application process. It had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. We want to express our thanks to Professor Helena Chmura Kraemer, Stanford University, USA, for her invaluable help regarding the statistical analyses. We are grateful to all participating patients and their families, as well as to all therapists and outcome evaluators. This study would not have been possible without their efforts and dedication. Appendix A
Publisher Copyright:
© 2019 Elsevier Ltd
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/1
Y1 - 2020/1
N2 - Does the pre-treatment profile of individuals with persistent depressive disorder (PDD) moderate their benefit from disorder-specific Cognitive Behavioral System of Psychotherapy (CBASP) versus supportive psychotherapy (SP)? We investigated this question by analyzing data from a multi-center randomized clinical trial comparing the effectiveness of 48 weeks of CBASP to SP in n = 237 patients with early-onset PDD who were not taking antidepressant medication. We statistically developed an optimal composite moderator as a weighted combination of 13 preselected baseline variables and used it for identifying and characterizing subgroups for which CABSP may be preferable to SP or vice versa. We identified two distinct subgroups: 58.65% of the patients had a better treatment outcome with CBASP, while the remaining 41.35% had a better outcome with SP. At baseline, patients responding more favorably to CBASP were more severely depressed and more likely affected by moderate-to-severe childhood trauma including early emotional, physical, or sexual abuse, as well as emotional or physical neglect. In contrast, patients responding more favorably to SP had a higher pre-treatment global and social functioning level, a higher life quality and more often a recurrent illness pattern without complete remission between the episodes. These findings emphasize the relevance of considering pre-treatment characteristics when selecting between disorder-specific CBASP and SP for treating PDD. The practical implementation of this approach would advance personalized medicine for PDD by supporting mental health practitioners in their selection of the most effective psychotherapy for an individual patient.
AB - Does the pre-treatment profile of individuals with persistent depressive disorder (PDD) moderate their benefit from disorder-specific Cognitive Behavioral System of Psychotherapy (CBASP) versus supportive psychotherapy (SP)? We investigated this question by analyzing data from a multi-center randomized clinical trial comparing the effectiveness of 48 weeks of CBASP to SP in n = 237 patients with early-onset PDD who were not taking antidepressant medication. We statistically developed an optimal composite moderator as a weighted combination of 13 preselected baseline variables and used it for identifying and characterizing subgroups for which CABSP may be preferable to SP or vice versa. We identified two distinct subgroups: 58.65% of the patients had a better treatment outcome with CBASP, while the remaining 41.35% had a better outcome with SP. At baseline, patients responding more favorably to CBASP were more severely depressed and more likely affected by moderate-to-severe childhood trauma including early emotional, physical, or sexual abuse, as well as emotional or physical neglect. In contrast, patients responding more favorably to SP had a higher pre-treatment global and social functioning level, a higher life quality and more often a recurrent illness pattern without complete remission between the episodes. These findings emphasize the relevance of considering pre-treatment characteristics when selecting between disorder-specific CBASP and SP for treating PDD. The practical implementation of this approach would advance personalized medicine for PDD by supporting mental health practitioners in their selection of the most effective psychotherapy for an individual patient.
UR - http://www.scopus.com/inward/record.url?scp=85074763441&partnerID=8YFLogxK
U2 - 10.1016/j.brat.2019.103512
DO - 10.1016/j.brat.2019.103512
M3 - Journal articles
C2 - 31734568
AN - SCOPUS:85074763441
SN - 0005-7967
VL - 124
JO - Behaviour Research and Therapy
JF - Behaviour Research and Therapy
M1 - 103512
ER -