Treatment matching in the posthospital care of depressed patients.
OBJECTIVE
This study assessed the efficacy of 1) matching patients to treatments and 2) adding additional family therapy or cognitive therapy in a group of recently discharged patients with major depression.


METHODS
Patients with major depression were recruited during a psychiatric hospitalization. After discharge, they were randomly assigned to one of four treatment conditions that were either "matched" or "mismatched" to their pattern of cognitive distortion and family impairment. The four treatment conditions were 1) pharmacotherapy alone; 2) combined pharmacotherapy and cognitive therapy; 3) combined pharmacotherapy and family therapy; and 4) combined pharmacotherapy, cognitive therapy, and family therapy. Randomly assigned treatment continued for 24 weeks on an outpatient basis.


RESULTS
Among patients with at least moderate depressive symptoms at hospital discharge, low rates of remission (16%) and improvement (29%) were obtained. Matched treatment led to a significantly greater proportion of patients who improved and greater reductions over time in interviewer-rated depressive symptoms than mismatched treatment. However, matched treatment did not produce greater change in self-reported depression or interviewer-rated suicidal ideation. Treatment that included a family therapy component also led to a greater proportion of patients who improved and to significant reductions in interviewer-rated depression and suicidal ideation than treatment without family therapy.


CONCLUSIONS
These results suggest that 1) current treatments are not very efficacious in the aftercare of hospitalized depressed patients, 2) treatment matching moderately improves outcome for patients who are symptomatic at hospital discharge, and 3) inclusion of family therapy improves the outcome of posthospital care for depressed patients.
Miller
Ivan W
IW
Psychosocial Research Program, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906, USA. ivan_miller@brown.edu
Keitner
Gabor I
GI
Ryan
Christine E
CE
Solomon
David A
DA
Cardemil
Esteban V
EV
Beevers
Christopher G
CG
D000328:Adult; D000359:Aftercare / Q000379:methods*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy*; D005196:Family Therapy / Q000379:methods*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D010347:Patient Care Planning; D016896:Treatment Outcome