title: Clinical correlates of difficult-to-treat depression: Exploring an integrated day-care model of treatment.
abstract: OBJECTIVE
  This study aimed to test the effectiveness of an individualized, integrated, day-care treatment programme for the acute phase of "difficult-to-treat depression" (DTD) in a sample of bipolar and unipolar subjects with a complex co-morbidity pattern.
  
  
  METHODS
  A total of 291 patients meeting criteria for DTD were consecutively recruited. All participants underwent a 12-week day-care intervention including individual psychological support and group psycho-education. Subjects were assessed for depressive symptom severity by the 21-item Hamilton Depression Rating Scale (HDRS) at the baseline (T0) and after 4 (T1) and 12 (T2) weeks of treatment. A repeated measures general linear model was performed to test for interactive effects among variables.
  
  
  RESULTS
  An overall significant improvement was detected in the majority of cases (F = 138.6, p < 0.0001). Responders reported lower rates of personality disorders and higher baseline depressive severity. An interaction between bipolarity and co-morbidity was associated with a poorer outcome (F = 5.9, p = 0.0034). Family involvement was the only significant predictor for symptom improvement (F = 7.9, adjusted p = 0.0025).
  
  
  CONCLUSIONS
  Our intervention proved to be effective in the treatment of complex and severe forms of depression. Our results on the role of family support require further investigation to better define suitable targets for tailored therapeutic approaches.
authors.affiliation: a Giovanni Camardese, Institute of Psychiatry and Psychology, Catholic University of the Sacred Heart , Rome , Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Camardese
authors.affiliation: b Marianna Mazza, Institute of Psychiatry and Psychology, Catholic University of the Sacred Heart , Rome , Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Mazza
authors.affiliation: c Leonardo Zaninotto, Institute of Psychiatry and Psychology, Catholic University of the Sacred Heart , Rome , and Department of Biomedical and Neuro-Motor Sciences , University of Bologna , Bologna , Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Zaninotto
authors.affiliation: d Beniamino Leone, Institute of Psychiatry and Psychology, Catholic University of the Sacred Heart , Rome , Italy.
authors.forename: Beniamino
authors.initials: B
authors.lastname: Leone
authors.affiliation: e Giuseppe Marano, Institute of Neurology, Catholic University of the Sacred Heart , Rome , Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marano
authors.affiliation: f Riccardo Serrani, Institute of Neurology, Catholic University of the Sacred Heart , Rome , Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Serrani
authors.affiliation: g Marco Di Nicola, Institute of Psychiatry and Psychology, Catholic University of the Sacred Heart , Rome , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Di Nicola
authors.affiliation: h Pietro Bria, Institute of Psychiatry and Psychology, Catholic University of the Sacred Heart , Rome , Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Bria
authors.affiliation: i Luigi Janiri, Institute of Psychiatry and Psychology, Catholic University of the Sacred Heart , Rome , Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Janiri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003631:Day Care, Medical / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003866:Depressive Disorder / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D015397:Program Evaluation; D011569:Psychiatric Status Rating Scales
keywords: Bipolar; Day-care; Depression; Psycho-education