title: Symptom change trajectories during inpatient psychotherapy in routine care and their associations with long-term outcomes.
abstract: This study examined symptom change trajectories during inpatient psychotherapy and the association of these changes with long-term outcomes. In an observational multicenter study, weekly measurements of symptom severity were performed during inpatient treatment and 6 months after discharge. The symptom severity was measured using the 18-item scale of the Hamburg Modules for the Assessment of Psychosocial Health. The sample included 576 inpatients (mean age: 43.9 years; 77.6% female; main diagnoses: depressive (57.2%), adjustment (15.8%), anxiety (7.4%), and eating disorders (7.2%); mean treatment duration: 42.0 days). With empirically and clinically informed growth mixture models four subgroups of symptom change were revealed: gradual response (71%), early response (9%), delayed response (5%), and nonresponse (11%). Particularly low educational level, non-employment and chronic disorders were associated with unfavorable symptom courses (non- and delayed response). Long-term outcomes differed systematically across subgroups (p<0.001; η(2)=0.165). The patients who responded early presented the highest rates of clinically significant improvement (43.9%) from admission to follow-up. Nearly all of these patients (92.7%) showed reliable improvement. Due to the high association of symptom change trajectories with long-term outcomes, results may contribute to interventions that are tailored to the needs of patients and may foster longer lasting therapeutic effectiveness.
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Electronic address: h.melchior@uke.de.
authors.forename: Hanne
authors.initials: H
authors.lastname: Melchior
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Electronic address: schulz@uke.de.
authors.forename: Holger
authors.initials: H
authors.lastname: Schulz
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Electronic address: kriston@uke.de.
authors.forename: Levente
authors.initials: L
authors.lastname: Kriston
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Electronic address: anika.hergert@gmx.de.
authors.forename: Anika
authors.initials: A
authors.lastname: Hergert
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Electronic address: hofreute@uke.de.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Hofreuter-Gätgens
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Electronic address: bergelt@uke.de.
authors.forename: Corinna
authors.initials: C
authors.lastname: Bergelt
authors.affiliation: Department of Applied Human Sciences, University of Applied Sciences Magdeburg-Stendal, Osterburger Str. 25, 39576 Stendal, Germany. Electronic address: matthias.morfeld@hs-magdeburg.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Morfeld
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Electronic address: koch@uke.de.
authors.forename: Uwe
authors.initials: U
authors.lastname: Koch
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany; Department of Psychology - Clinical Psychology and Psychotherapy Research, University of Zürich, Binzmühlestr. 14/16, 8050 Zürich, Switzerland. Electronic address: b.watzke@psychologie.uzh.ch.
authors.forename: Birgit
authors.initials: B
authors.lastname: Watzke
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D008875:Middle Aged; D011613:Psychotherapy / Q000379:methods / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Depression; Follow-up; Growth mixture modeling; Repeated measurement; Symptom change trajectories