Premium
Moderating effect of comorbid anxiety disorders on treatment outcome in a randomized controlled psychotherapy trial in early‐onset persistently depressed outpatients
Author(s) -
Assmann Nele,
Schramm Elisabeth,
Kriston Levente,
Hautzinger Martin,
Härter Martin,
Schweiger Ulrich,
Klein Jan Philipp
Publication year - 2018
Publication title -
depression and anxiety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.634
H-Index - 129
eISSN - 1520-6394
pISSN - 1091-4269
DOI - 10.1002/da.22839
Subject(s) - psychology , interpersonal psychotherapy , clinical psychology , anxiety , randomized controlled trial , psychiatry , comorbidity , major depressive disorder , rating scale , generalizability theory , depression (economics) , medicine , mood , developmental psychology , economics , macroeconomics
Background Persistent depressive disorder (PDD) is associated with high rates of comorbid psychiatric disorders, mostly anxiety disorders (ADs). Comorbid AD was found to be associated with poorer treatment outcome in PDD patients. The effect of comorbid AD on disorder‐specific treatment for PDD (Cognitive Behavioral Analysis System of Psychotherapy [CBASP]) has not been studied yet. Methods We analyzed whether the presence of a comorbid AD was moderating the effectiveness of disorder‐specific (CBASP) versus nonspecific psychotherapy (supportive therapy [SP]) on depressive symptoms (24‐item Hamilton Rating Scale for Depression [HRSD‐24]) in a sample of unmedicated early‐onset PDD outpatients ( N = 268). Secondary outcomes were response and remission of depressive symptoms and the extent of interpersonal problems (Inventory of Interpersonal Problems [IIP‐64]). Results The superiority of CBASP over SP was significantly stronger in PDD patients with comorbid AD compared to patients without AD (in HRSD‐24 and IIP‐64). There was no significant moderation for remission or response of depressive symptoms. Discussion Our hypothesis of a moderating effect of comorbid AD was confirmed. The main limitation might be the exclusion criteria of our sample limiting the generalizability. The major strength is the systematic analysis of the effect of AD in treating early‐onset PDD with high quality of psychotherapy in both arms of this trial. Conclusion Patients suffering from PDD comorbid with AD might experience greater benefit when they are treated with specific as opposed to unspecific therapy. Analyzing subgroups of patients with PDD seems worthwhile to improve treatment effectiveness even within disorder‐specific treatment programms.