title: Efficacy of short-term psychodynamic psychotherapy (STPP) with depressed breast cancer patients: results of a randomized controlled multicenter trial.
abstract: BACKGROUND
  There is a lack of trials of psychodynamic treatments of depression in breast cancer patients. The purpose of this trial was to determine the efficacy of short-term psychodynamic psychotherapy (STPP) in non-metastatic breast cancer patients diagnosed with depression, one of the most frequent mental comorbidities of breast cancer.
  
  
  METHODS
  In a multicenter prospective trial, 157 breast cancer patients with comorbid depression were randomized to either individual STPP (intervention group, N=78) or 'treatment as usual' (control group, TAU, N=79). As our primary outcome measure, we hypothesized a higher rate of remission defined as no diagnosis of depression (Structured Clinical Interview for DSM-IV) and reduction in depression score by at least 2 points (Hospital Anxiety and Depression Scale, HADS-D) in STPP versus TAU at treatment termination. Secondary outcomes mainly refer to quality of life (QoL).
  
  
  RESULTS
  In the intention to treat (ITT) analysis, 44% of the STPP group achieved highly significantly more remission than TAU (23%). STPP treatment (OR=7.64; P<0.001) was the strongest predictor for remission post-treatment; time was also significant (OR=0.96; P<0.05). A high effect favoring STPP (d=0.82) was observed for the HADS-D score post-treatment (secondary outcome). Regarding further secondary outcomes (QoL), analyses of covariance yielded main effects for group (favoring STPP with an effect size of at least d=0.5) for global QoL, role, emotional and social functioning, pain, treatment side-effects, breast symptoms and upset by hair loss.
  
  
  CONCLUSIONS
  STPP is an effective treatment of a broad range of depressive conditions in breast cancer patients improving depression and functional QoL. Findings are limited by the drop-out rate (∼1/3) and delayed post-treatment assessments. Future trials may consider stepped-care approaches, tailored to patients' needs and requirements in the acute treatment phase.
authors.affiliation: Department for Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz.
authors.forename: M E
authors.initials: ME
authors.lastname: Beutel
authors.forename: G
authors.initials: G
authors.lastname: Weißflog
authors.forename: K
authors.initials: K
authors.lastname: Leuteritz
authors.forename: J
authors.initials: J
authors.lastname: Wiltink
authors.forename: A
authors.initials: A
authors.lastname: Haselbacher
authors.forename: C
authors.initials: C
authors.lastname: Ruckes
authors.forename: S
authors.initials: S
authors.lastname: Kuhnt
authors.forename: Y
authors.initials: Y
authors.lastname: Barthel
authors.forename: B H
authors.initials: BH
authors.lastname: Imruck
authors.forename: R
authors.initials: R
authors.lastname: Zwerenz
authors.forename: E
authors.initials: E
authors.lastname: Brähler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology* / Q000628:therapy; D003863:Depression / Q000628:therapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D064889:Psychotherapy, Psychodynamic; D011788:Quality of Life; D016896:Treatment Outcome; D055815:Young Adult
keywords: Short-term Psychodynamic Psychotherapy (STPP); breast cancer; depression; efficacy; quality of life (QoL)