Inpatient treatment decreases depression but antidepressants may not contribute. A prospective quasi-experimental study

[Self-Responsibility: Relationship with Depression and Anxiety and Relevance for the Treatment Outcome of Inpatients with Major Depression]

OBJECTIVE

Though in most psychotherapy schools a high self-responsibility (SR) of patients is considered as the basis necessary for the success of psychological treatment, there is neither a uniform definition nor a psychometric operationalisation of SR. Hence, there is no empirical evidence for the actual importance of SR in psychotherapy. This work aims (1) to introduce a definition of SR as well as to develop a questionnaire for its measurement and (2) to evaluate SR in the treatment of depression.

METHODS

In two studies with samples of healthy adults (n=233, n=301), the "Self-Responsibility Inventory" (German: "Selbstverantwortungs-Inventar", SV-I) was developed. In a third study, the SV-I was administered to n=231 psychiatric inpatients with major depression according to the ICD-10 diagnostic criteria. Patients were mainly treated with psychotherapy.

RESULTS

The final SV-I version consisted of three scales with 10 items each: "Being determined by others", "Self-determination", "Orientation towards the expectations of others". In healthy adults, poor SR was accompanied by high levels of depression, and high trait anxiety. Inpatients with mental disorders show less SR than healthy individuals. During treatment, SR increased from admission to discharge. It was found that the higher the SR at discharge, the stronger the decrease of depression from admission to discharge.

DISCUSSION

The SV-I appears to be suitable for use in healthy individuals and in clinical groups. Our findings suggest that low SR is related to the development of psychological symptoms and illnesses.

CONCLUSIONS

SR may be a critical factor for outcome in the psychotherapy of major depression. The SV-I could be a useful tool for understanding psychotherapeutic processes.

Step Away from Depression-Study protocol for a multicenter randomized clinical trial for a pedometer intervention during and after in-patient treatment of depression

OBJECTIVES

Increasing the number of daily steps by using a pedometer and a diary leads to an activity increase and improved health outcomes in a variety of somatic disorders. Hence, for the inpatient treatment of depression, supervised exercise interventions are more widespread. We aim to examine if a self-managed pedometer intervention (PI) with the option of being proceeded after discharge leads to reduction of depression and to a physical activity (PA) increase.

METHODS

The Step Away from Depression (SAD) study is a multicenter randomized controlled trial targeting 400 patients with major depressive disorder. Treatment as usual (TAU) is compared to TAU plus PI after 4 weeks, at discharge, and 6 months after hospital admission. Primary outcomes are clinically rated depression severity and accelerometer-measured step counts. Secondary outcomes include self-reported depression symptoms and PA level, psychiatric symptoms, health-related quality of life, self-efficacy, and components of the Motivation Volition Process Model.

RESULTS

We report the design of the SAD study considering several methodological aspects for exercise studies, in general.

CONCLUSIONS

Results of our study will provide information about efficacy of PI for inpatient treatment and about interrelating processes of change concerning depression, PA, and aspects of motivation and volition.