title: Is duration of psychological treatment for depression related to return into treatment?
abstract: There is increasing pressure on mental health providers to reduce the duration of treatments, while retaining level of quality and effectiveness. The risk is that the population is underserved and therefore needs new treatment episodes. The primary aim of this study was to investigate whether duration of treatment and return into mental health care were related.
  
  
  
  This study examined Dutch patients with an initial treatment episode in 2009 or 2010 in specialized mental health settings for depressive disorder (N = 85,754). Follow-up data about treatment episodes were available up until 2013. The data set included demographic (age, gender), and clinical factors (comorbidity with other DSM-IV Axis; scores on the 'Global Assessment of Functioning'). Cox regression analyses were used to assess whether duration of treatment and relapse into mental health care were related.
  
  
  
  The majority of patients did not return into mental health care (86 %). Patients with a shorter duration of treatment (5-250 min; 251-500 min and 751-1000 min) were slightly more likely to return (reference group: >1000 min) (HR 1.19 95 % CI 1.13-1.26; HR 1.11 95 % CI 1.06-1.17; HR 1.18 95 % CI 1.11-1.25), adjusted for demographic and clinical variables.
  
  
  
  The results suggest that a longer duration of treatment may prevent return into mental health care in some groups. However, because of the design of the study, no causal inference can be drawn. Further research, preferably in a RCT, is needed to determine whether the trend towards lower intensity treatments is associated with repeated mental health care use.
authors.affiliation: Department of Clinical Neuro and Developmental Psychology, Section Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands. a.m.boerema@vu.nl.|EMGO+ Institute for Health Care and Research, VU University Medical Centre, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. a.m.boerema@vu.nl.
authors.forename: A M
authors.initials: AM
authors.lastname: Boerema
authors.affiliation: Department of Clinical Neuro and Developmental Psychology, Section Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.|EMGO+ Institute for Health Care and Research, VU University Medical Centre, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Cuijpers
authors.affiliation: EMGO+ Institute for Health Care and Research, VU University Medical Centre, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.|Department of Psychiatry, VU University Medical Centre, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
authors.forename: A T F
authors.initials: AT
authors.lastname: Beekman
authors.affiliation: Statistics Netherlands (CBS), Henri Faasdreef 312, 2492 JP, The Hague, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Hellenthal
authors.affiliation: Statistics Netherlands (CBS), Henri Faasdreef 312, 2492 JP, The Hague, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Voorrips
authors.affiliation: Department of Clinical Neuro and Developmental Psychology, Section Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.|EMGO+ Institute for Health Care and Research, VU University Medical Centre, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: van Straten
mesh_terms: D000328:Adult; D003863:Depression / Q000523:psychology / Q000628:therapy*; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D011613:Psychotherapy / Q000379:methods*; D012008:Recurrence; D013997:Time Factors
keywords: Brief therapy; Duration of treatment; Psychotherapy; Return into treatment