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The effect of comorbid personality disorder on depression outcome after short-term psychotherapy in a randomised clinical trial

BACKGROUND: Time-limited psychotherapy for depression is effective. However, comorbid personality disorders affect therapy outcomes negatively. Studies of follow-up effects and results relating to the influence of comorbid personality disorder and treatment modality are scarce. AIMS: To determine th...

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Autores principales: Koppers, David, Kool, Marit, Van, Henricus, Driessen, Ellen, Peen, Jaap, Dekker, Jack
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6646965/
https://www.ncbi.nlm.nih.gov/pubmed/31530296
http://dx.doi.org/10.1192/bjo.2019.47
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author Koppers, David
Kool, Marit
Van, Henricus
Driessen, Ellen
Peen, Jaap
Dekker, Jack
author_facet Koppers, David
Kool, Marit
Van, Henricus
Driessen, Ellen
Peen, Jaap
Dekker, Jack
author_sort Koppers, David
collection PubMed
description BACKGROUND: Time-limited psychotherapy for depression is effective. However, comorbid personality disorders affect therapy outcomes negatively. Studies of follow-up effects and results relating to the influence of comorbid personality disorder and treatment modality are scarce. AIMS: To determine the influence of comorbid personality disorder and treatment modality on outcomes after cognitive–behavioural therapy (CBT) or short-term psychodynamic supportive psychotherapy (SPSP) for depression. METHOD: This study draws on data from a previously published randomised clinical trial contrasting SPSP and CBT for depression (both 16 sessions). We compared the effectiveness of these psychotherapies for patients with and without personality disorder (n = 196). The primary measure was depression outcome; the secondary measurements were interpersonal functioning and quality of life. Collected data were analysed using multilevel analysis. Trial registration: ISRCTN31263312 (http://www.controlled-trials.com). RESULTS: Although participants with and without comorbid personality disorder improved at treatment termination (d = 1.04, 95% CI 0.77–1.31 and d = 1.36, 95% CI 0.97–1.76, respectively) and at follow-up (d = 1.15, 95% CI 0.87–1.43 and d = 2.12, 95% CI 1.65–2.59 respectively), personality disorder had a negative effect on depression outcome at both measurement points (P < 0.05). A similar negative effect on interpersonal functioning was no longer apparent at follow-up. Comorbid personality disorder had no influence on social functioning or quality of life outcomes, irrespective of treatment modality. CONCLUSIONS: CBT and SPSP contribute to the improvement of depressive symptoms and interpersonal problems in depressed patients with and without comorbid personality disorder. Both treatments are an effective first step in a stepped care approach, but – given remaining levels of depression in patients with personality disorder – they are probably inadequate for large numbers of patients with this comorbidity. DECLARATION OF INTEREST: None.
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spelling pubmed-66469652019-08-05 The effect of comorbid personality disorder on depression outcome after short-term psychotherapy in a randomised clinical trial Koppers, David Kool, Marit Van, Henricus Driessen, Ellen Peen, Jaap Dekker, Jack BJPsych Open Papers BACKGROUND: Time-limited psychotherapy for depression is effective. However, comorbid personality disorders affect therapy outcomes negatively. Studies of follow-up effects and results relating to the influence of comorbid personality disorder and treatment modality are scarce. AIMS: To determine the influence of comorbid personality disorder and treatment modality on outcomes after cognitive–behavioural therapy (CBT) or short-term psychodynamic supportive psychotherapy (SPSP) for depression. METHOD: This study draws on data from a previously published randomised clinical trial contrasting SPSP and CBT for depression (both 16 sessions). We compared the effectiveness of these psychotherapies for patients with and without personality disorder (n = 196). The primary measure was depression outcome; the secondary measurements were interpersonal functioning and quality of life. Collected data were analysed using multilevel analysis. Trial registration: ISRCTN31263312 (http://www.controlled-trials.com). RESULTS: Although participants with and without comorbid personality disorder improved at treatment termination (d = 1.04, 95% CI 0.77–1.31 and d = 1.36, 95% CI 0.97–1.76, respectively) and at follow-up (d = 1.15, 95% CI 0.87–1.43 and d = 2.12, 95% CI 1.65–2.59 respectively), personality disorder had a negative effect on depression outcome at both measurement points (P < 0.05). A similar negative effect on interpersonal functioning was no longer apparent at follow-up. Comorbid personality disorder had no influence on social functioning or quality of life outcomes, irrespective of treatment modality. CONCLUSIONS: CBT and SPSP contribute to the improvement of depressive symptoms and interpersonal problems in depressed patients with and without comorbid personality disorder. Both treatments are an effective first step in a stepped care approach, but – given remaining levels of depression in patients with personality disorder – they are probably inadequate for large numbers of patients with this comorbidity. DECLARATION OF INTEREST: None. Cambridge University Press 2019-07-16 /pmc/articles/PMC6646965/ /pubmed/31530296 http://dx.doi.org/10.1192/bjo.2019.47 Text en © The Royal College of Psychiatrists 2019 http://creativecommons.org/licenses/by-nc-sa/4.0/ This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike licence (http://creativecommons.org/licenses/by-nc-sa/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the same Creative Commons licence is included and the original work is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use
spellingShingle Papers
Koppers, David
Kool, Marit
Van, Henricus
Driessen, Ellen
Peen, Jaap
Dekker, Jack
The effect of comorbid personality disorder on depression outcome after short-term psychotherapy in a randomised clinical trial
title The effect of comorbid personality disorder on depression outcome after short-term psychotherapy in a randomised clinical trial
title_full The effect of comorbid personality disorder on depression outcome after short-term psychotherapy in a randomised clinical trial
title_fullStr The effect of comorbid personality disorder on depression outcome after short-term psychotherapy in a randomised clinical trial
title_full_unstemmed The effect of comorbid personality disorder on depression outcome after short-term psychotherapy in a randomised clinical trial
title_short The effect of comorbid personality disorder on depression outcome after short-term psychotherapy in a randomised clinical trial
title_sort effect of comorbid personality disorder on depression outcome after short-term psychotherapy in a randomised clinical trial
topic Papers
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6646965/
https://www.ncbi.nlm.nih.gov/pubmed/31530296
http://dx.doi.org/10.1192/bjo.2019.47
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