[Treatment motivation and results of inpatient psychotherapy for women with depressive disorders: a prospective study]

Improving Employment Through Interpersonal Psychotherapy: A Case Series of Patients With Treatment-Refractory Depression

Patients with treatment-refractory depression (TRD) have significantly great losses in work productivity and employment. Interpersonal psychotherapy (IPT) is considered an approach for the treatment of TRD. However, the effectiveness of IPT in patients with TRD remains unclear. In this study, we report cases of TRD patients who underwent IPT after a detailed evaluation, along with their employment status. Of 112 patients who experienced 1-week examination administration for TRD at Kyorin University Hospital, which aimed to determine appropriate diagnosis and treatment approaches for each patient, four patients who met the criteria for major depressive disorder according to DSM-IV-TR and were determined suitable for IPT were included in this report. Two patients had moderate, one had mild, and one had remission levels of depressive symptoms according to the Montgomery-Asberg Depression Rating Scale at the time of admission. All four patients completed the scheduled sessions of IPT (6-16 sessions) in the outpatient clinic and achieved remission. All four patients attained full-time employment within 6 months after receiving IPT. This study suggests that the appropriate selection of IPT might be effective for TRD patients, possibly leading to positive outcomes, including work productivity and employment status.

Perceived Psychotherapist's Empathy and Therapy Motivation as Determinants of Long-Term Therapy Success-Results of a Cohort Study of Short Term Psychodynamic Inpatient Psychotherapy

Objective: Outcome predictors and determinants for treatment outcome of inpatient psychotherapy will be assessed in a follow-up-study. Sociodemographic factors and the level of depressiveness at admission, the perceived psychotherapist's empathy rated by patients and the therapy motivation as possible moderators of treatment outcome (reduction of depressive symptoms) are analyzed. Methods: In a cohort study, the outcome of inpatient multimodal psychotherapy was examined with Beck-Depression-Inventory (BDI) at admission (T1), discharge (T2) and at follow-up (1-3 years after treatment) (T3). Inclusion criteria were: Inpatient psychotherapy between 2007 and 2010 with a duration of at least 1 week and complete data set. The influence on therapy success of (1) sociodemographic factors, (2) the perceived psychotherapist's empathy rated by patients using the Consultation and Relational Empathy Measure (CARE), and (3) the therapy motivation of the patients rated by therapists are examined by means of correlation analysis, distribution comparisons and subsequently logistic regression. Results: Ninety-two (64 females, average age 39 yrs.) of 182 eligible patients participated in the follow-up survey. Duration of inpatient psychotherapy lasted 8.7 weeks ± 3.6 [min. 1, max. 33 weeks]. The perceived psychotherapist's empathy, therapy motivation, education level and depression at baseline had a significant impact on therapy success. Gender, age, and partnership were not significant. The length between discharge and follow-up had no influence on the results. Based on these variables a multiple logistic regression explained 42% of the variation (goodness-of-fit). Conclusion: Due to the shown relevance of the psychotherapist's empathy perceived by patients and the therapy motivation of patients for therapy success, both factors should be considered already at the beginning of the therapy. Consequently, they should be recognized in the context of postgraduate training and education.

Motivation for Psychotherapy and Illness Beliefs in Turkish Immigrant Inpatients in Germany: Results of a Cultural Comparison Study

OBJECTIVE

Some immigrant populations, for instance, Turkish immigrants, suffer from worse mental health than the general population. Moreover, psychotherapeutic treatment does not work well in this group. This might be explained by lower motivation for psychotherapy and particular illness beliefs as important early predictors of treatment outcome. We investigate differences in these predictors between Turkish immigrant inpatients and inpatients without a migration background and evaluate whether particular illness beliefs have a negative impact on motivation for psychotherapy.

METHOD

Turkish immigrant inpatients and inpatients without a migration background (N = 100), suffering from depressive disorder, somatoform disorder, and/or adjustment disorder, completed questionnaires assessing motivation for psychotherapy, depressive and somatic symptoms, illness perception, illness-related locus of control, and causal illness attributions.

RESULTS

Despite a higher symptom burden, motivation for psychotherapy was lower in Turkish immigrant inpatients than in inpatients without a migration background (d = 0.54). This was fully explained by stronger beliefs in supernatural causes of illness and higher fatalistic-external illness-related locus of control in the Turkish immigrant sample (mediation analysis; R (2) = 0.27).

CONCLUSIONS

Turkish immigrants believe in supernatural or fatalistic causes of illness and fatalistic-external locus of control to a greater extent than German inpatients without a migration background. These beliefs reduce motivation for psychotherapy and need to be addressed in psychotherapeutic treatment in order to secure positive treatment outcomes.