title: Prognostic and prescriptive predictors of improvement in a naturalistic study on inpatient and day hospital treatment of depression.
abstract: BACKGROUND
  The study aimed to identify prognostic (associated with general outcome) and prescriptive (associated with differential outcome in two different settings) predictors of improvement in a naturalistic multi-center study on inpatient and day hospital treatment in major depressive disorder (MDD).
  
  
  METHODS
  250 inpatients and 250 day hospital patients of eight psychosomatic hospitals were assessed at admission, discharge and a 3-months follow-up. Primary outcome was defined as a reduction of depressive symptomatology from admission to discharge and from discharge to follow-up (QIDS-C, total score). Percent improvement scores at discharge and at follow-up were entered as dependent variables into two General Linear Models with a set of predictor variables and the respective interaction terms with treatment setting. The selection of predictor sets was guided by statistical methods of variable preselection (LASSO).
  
  
  RESULTS
  Three variables were associated with less improvement from admission to discharge: the number of additional axis-I diagnoses, axis-II co-morbidity (SCID) and lower motivation (expert assessment). Social support (F-SozU) predicted symptom course between discharge and 3-month follow-up. Patients with no absent / sick days prior to admission showed a less favorable symptom course after discharge when treated as inpatients.
  
  
  CONCLUSIONS
  Patients with co-morbidity show less improvement during the active treatment phase. Motivation can be considered a prerequisite for symptom reduction, whereas social support seems to be an important factor for the maintenance of treatment gains. The lack in prescriptive predictors found may point to the fact that inpatient and day hospital treatment have comparable effects for most subgroups of patients with MDD.
authors.affiliation: Department for Psychosomatic Medicine and Psychotherapy, University Medical Center, Freiburg, Germany. Electronic address: almut.zeeck@uniklinik-freiburg.de.
authors.forename: Almut
authors.initials: A
authors.lastname: Zeeck
authors.affiliation: Department for Psychosomatic Medicine and Psychotherapy, University Medical Center, Ulm, Germany.
authors.forename: Jörn
authors.initials: J
authors.lastname: von Wietersheim
authors.affiliation: Department for Psychosomatic Medicine and Psychotherapy, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Weiss
authors.affiliation: Department for Psychosomatic Medicine and Psychotherapy, University Medical Center, Freiburg, Germany; Thure-von-Uexküll-Klinik, Glottertal, Germany.
authors.forename: Carl Eduard
authors.initials: CE
authors.lastname: Scheidt
authors.affiliation: Rhein Klinik, Bad Honnef, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Völker
authors.affiliation: Rhein Klinik, Bad Honnef, Germany.
authors.forename: Astrid
authors.initials: A
authors.lastname: Helesic
authors.affiliation: Bürgerhospital, Stuttgart, Germany.
authors.forename: Annegret
authors.initials: A
authors.lastname: Eckhardt-Henn
authors.affiliation: Department for Psychosomatic Medicine and Psychotherapy, University Medical Center, Mainz, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Beutel
authors.affiliation: Department for Psychosomatic Medicine and Psychotherapy, University Medical Center, Freiburg, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Endorf
authors.affiliation: Department for Psychosomatic Medicine and Psychotherapy, University Medical Center, Ulm, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Treiber
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Fürst Stirum-Klinikum, Bruchsal, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Rochlitz
authors.affiliation: Department for Psychosomatic Medicine and Psychotherapy, University Medical Center, Freiburg, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Hartmann
mesh_terms: D000328:Adult; D015897:Comorbidity; D003631:Day Care, Medical; D003863:Depression / Q000628:therapy; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006760:Hospitalization; D006801:Humans; D007297:Inpatients / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009042:Motivation; D011237:Predictive Value of Tests; D011379:Prognosis; D011602:Psychophysiologic Disorders / Q000628:therapy; D018582:Sick Leave; D012944:Social Support; D016896:Treatment Outcome
keywords: Day hospital; Depression; Inpatient; Outcome; Predictors; Psychotherapy; Subgroups