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Psychotherapy effectiveness for major depression: a randomized trial in a Finnish community.

https://arctichealth.org/en/permalink/ahliterature278030
Source
BMC Psychiatry. 2016 May 06;16:131
Publication Type
Article
Date
May-06-2016
Author
Hannu P Saloheimo
John Markowitz
Tuija H Saloheimo
Jarmo J Laitinen
Jari Sundell
Matti O Huttunen
Timo A Aro
Tuitu N Mikkonen
Heikki O Katila
Source
BMC Psychiatry. 2016 May 06;16:131
Date
May-06-2016
Language
English
Publication Type
Article
Keywords
Adult
Antidepressive Agents - therapeutic use
Combined Modality Therapy
Depression - therapy
Depressive Disorder, Major - psychology - therapy
Female
Finland
Follow-Up Studies
Humans
Male
Middle Aged
Psychotherapy - methods
Psychotherapy, Group - methods
Treatment Outcome
Abstract
The purpose of this study is to assess the relative effectiveness of Interpersonal Psychotherapy (IPT), Psychoeducative Group Therapy (PeGT), and treatment as usual (TAU) for patients with Major Depressive Disorder (MDD) in municipal psychiatric secondary care in one Finnish region.
All adult patients (N?=?1515) with MDD symptoms referred to secondary care in 2004-2006 were screened. Eligible, consenting patients were assigned randomly to 10-week IPT (N?=?46), PeGT (N?=?42), or TAU (N?=?46) treatment arms. Antidepressant pharmacotherapy among study participants was evaluated. The Hamilton Depression Rating scale (HAM-D) was the primary outcome measure. Assessment occurred at 1, 5, 3, 6, and 12 months. Actual amount of therapists' labor was also evaluated. All statistical analyses were performed with R software.
All three treatment cells showed marked improvement at 12-month follow-up. At 3 months, 42 % in IPT, 61 % in PeGT, and 42 % in TAU showed a mean =50 % in HAM-D improvement; after 12 months, these values were 61 %, 76 %, and 68 %. Concomitant medication and limited sample size minimized between-treatment differences. Statistically significant differences emerged only between PeGT and TAU favoring PeGT. Secondary outcome measures (CGI-s and SOFAS) showed parallel results.
All three treatments notably benefited highly comorbid MDD patients in a public sector secondary care unit.
ClinicalTrials.gov NCT02314767 (09.12.2014).
Notes
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PubMed ID
27153942 View in PubMed
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Quality of treatment and disability compensation in depression: comparison of 2 nationally representative samples with a 10-year interval in Finland.

https://arctichealth.org/en/permalink/ahliterature159609
Source
J Clin Psychiatry. 2007 Dec;68(12):1886-93
Publication Type
Article
Date
Dec-2007
Author
Teija I Honkonen
Timo A Aro
Erkki T Isometsä
E Marianna Virtanen
Heikki O Katila
Author Affiliation
Finnish Institute of Occupational Health, Helsinki, Finland. teija.honkonen@ttl.fi
Source
J Clin Psychiatry. 2007 Dec;68(12):1886-93
Date
Dec-2007
Language
English
Publication Type
Article
Keywords
Antidepressive Agents - therapeutic use
Data Collection
Depressive Disorder - complications - economics - therapy
Disabled Persons - psychology
Electroconvulsive Therapy
Female
Finland
Humans
Insurance, Disability - statistics & numerical data
Male
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Psychotherapy
Quality of Health Care
Workers' Compensation - statistics & numerical data
Abstract
Depressive disorders cause substantial work impairment that can lead to disability compensation. The authors compared treatment received for depression preceding disability pension between 2 nationally representative samples with a 10-year interval.
The medical statements for 2 random samples drawn from the Finnish national disability pension registers, representing populations granted a disability pension for DSM-III-R major depression during a 12-month period from October 1993 through September 1994 (N = 277) and for ICD-10 depressive disorders (F32-F33) from October 2003 through September 2004 (N = 265) were examined. The proportions of persons receiving weekly psychotherapy, antidepressants, adequate antidepressant dosage, sequential antidepressant trials, lithium augmentation, and electroconvulsive therapy (ECT) were compared.
No significant differences emerged between the 2 samples, except for the adequacy of antidepressant dosage. Few subjects in either of the samples (8.7% for 1993-1994 vs. 10.6% for 2003-2004, p = .45) had received weekly psychotherapy. Most had received antidepressants (87.4% vs. 85.6%, p = .55) with increasingly adequate dosage (75.6% vs. 85.0%, p = .02), but only a minority had received sequential antidepressant trials (39.5% vs. 44.5%, p = .24). Lithium augmentation and ECT were rare (1.1% vs. 1.5%, p = .66 and 4.0% vs. 1.5%, p = .08, respectively). Even in 2003-2004, over half of the subjects were granted a disability pension without sequential antidepressant trials.
This nationally representative study indicates that, despite an increased antidepressant use and improved practice guidelines for depression, a considerable proportion of the people granted long-term compensation for depression seem to be suboptimally treated. Given the enormous costs of the disability, attention to the quality of treatment provided for depression is warranted before long-term disability compensations are granted.
PubMed ID
18162019 View in PubMed
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