title: A comparison of cognitive-behavioral therapy, antidepressants, their combination and standard treatment for Chinese patients with moderate-severe major depressive disorders.
abstract: BACKGROUND
  No study has examined the effect of cognitive-behavioral therapy (CBT) on moderate-severe major depressive disorders (MDD) in China. The objective of this study was to evaluate the effect of CBT, antidepressants alone (MED), combined CBT and antidepressants (COMB) and standard treatment (ST; i.e., receiving psycho-educational intervention and/or medication treatment determined by treating psychiatrists) on depressive symptoms and social functioning in Chinese patients with moderate-severe MDD.
  
  
  METHODS
  A total of 180 patients diagnosed with MDD according to ICD-10 were randomly allocated to one of the four treatment regimens for a period of 6 months. Depressive symptoms were measured using the Hamilton Rating Scale for Depression (HAMD) and the Quick Inventory of Depressive Symptomatology-Self-Report (C-QIDS-SR). Remission threshold was defined as a C-QIDS-SR total score of <5. Social functioning was evaluated with the Work and Social Adjustment Scale (WSAS). All outcome measures were evaluated at entry, and at 3- and 6-months follow-up.
  
  
  RESULTS
  At the 6-months assessment, the remission rates in the whole sample (n=96), the MED, the CBT, the COMB and the ST groups were 54.2%, 48%, 75%, 53.5% and 50%, respectively. Following the treatment periods, there was no significant difference in any of the study outcomes between the four groups. However, the CBT showed the greatest effect in the HAMD total score with the effect size=0.94, whereas the ST has only a moderate effect size in the WSAS total score (effect size=0.47).
  
  
  CONCLUSIONS
  The findings support the feasibility and effectiveness of CBT as a psychosocial intervention for Chinese patients with moderate-severe MDD. We also found that single treatment using MED or CBT performed equally well as the combined CBT-antidepressant treatment in controlling the remission. The study provided important knowledge to inform the mental health care planning in China.
authors.affiliation: Beijing Anding Hospital, Capital Medical University, Beijing, China.
authors.forename: Si
authors.initials: S
authors.lastname: Zu
authors.forename: Yu-Tao
authors.initials: YT
authors.lastname: Xiang
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.forename: Ling
authors.initials: L
authors.lastname: Zhang
authors.forename: Gang
authors.initials: G
authors.lastname: Wang
authors.forename: Xin
authors.initials: X
authors.lastname: Ma
authors.forename: Amy M
authors.initials: AM
authors.lastname: Kilbourne
authors.forename: Gabor S
authors.initials: GS
authors.lastname: Ungvari
authors.forename: Helen F K
authors.initials: HF
authors.lastname: Chiu
authors.forename: Kelly Y C
authors.initials: KY
authors.lastname: Lai
authors.forename: Samuel Y S
authors.initials: SY
authors.lastname: Wong
authors.forename: Doris S F
authors.initials: DS
authors.lastname: Yu
authors.forename: Zhan-Jiang
authors.initials: ZJ
authors.lastname: Li
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D044466:Asian People; D002681:China; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D012917:Social Adjustment
chemical_list: D000928:Antidepressive Agents
keywords: China; Cognitive-behavioral therapy; Major depressive disorders; Outpatients