Do patients\u2019 resilience and subjective illness representation predict the outcome of a routine inpatient treatment program of major depressive disorder?

Laura Marschollek,Udo Bonnet

doi:10.1007/s00406-021-01285-5

Abstract

Adopting a personalized medicine approach beyond genetic/epigenetic profiling within psychiatric diagnostic and treatment is challenging. For the first time, we studied the influence of two patient resources (resilience and illness representation) on the success of an inpatient treatment of major depressive disorder (MDD). Using a 5-week observational real-world-study, the treatment- success was measured by the difference between the subjective depression- severity (according to the German short form of Beck’s Depression-Inventory) at baseline (i.e., days four to six post-admission) and study- endpoint. In the intention-to-treat sample (n = 60, 47.3 ± 12.8 years old; 58% females), the patients’ illness representation [measured by the “Krankheitskonzeptskala” (KK)] did not predict their treatment- success. The KK-dimension ‘trust-in-doctors’ was associated with resilience but not with the treatment-success. Albeit, the patients’ resilience (determined by Resilience- Scale, 11-item-version (RS-11)) negatively predicted their positive treatment- success (b = − 0.09, p = 0.017, f2 = 0.11). This influence of resilience on treatment- success was completely mediated by the baseline-depression- severity. This means, patients with low resilience reported high baseline-depression- levels which predicted a significant positive treatment- success. And, patients with high resilience reported low baseline-depression-levels which predicted no relevant or even negative inpatient treatment-success. The latter “high-resilience”- group (n = 27) was especially interesting. Remarkably, these patients appeared to have experienced within the first four-to-six inpatient treatment-days an “early sudden gain” against their considerable MDD- burden that initially had led to their admission. Thus, a stronger resilience might serve as a proxy of the development of an early MDD-relief as well as of lower baseline-depression- levels. Further studies are warranted to support the value of a patient’s resilience to predict his treatment response and inpatient treatment duration.

Highlights

As well as in other Western countries, the major depressive disorder (MDD) belongs to the three most prevalent mental disorders in Germany [1, 2]
We attempted to investigate whether two typical personal resources, i.e., the patient’s resilience [7,8,9] as well as illness representation [10, 11], could have an impact on the outcome of his inpatient MDD- treatment
Within the limitations of this study, we corroborate the reputation of resilience as a protective factor for MDD resilience was found to be a negative predictor for inpatient treatment-success of MDD

Summary

Introduction

As well as in other Western countries, the major depressive disorder (MDD) belongs to the three most prevalent mental disorders in Germany [1, 2]. 50% and 15% are in outpatient and inpatient/day patient settings, respectively [3]. Lower treatment motivation/ expectation and lower patient satisfaction with psychiatric treatment as well as the number of comorbidities have been found to negatively predict the outcome of an inpatient MDD- treatment [4,5,6]. Studies inquiring patients’ resources as a potential catalyst for treatment effectiveness are very scarce. We attempted to investigate whether two typical personal resources, i.e., the patient’s resilience [7,8,9] as well as illness representation [10, 11], could have an impact on the outcome (treatment success) of his inpatient MDD- treatment. Why we have chosen these two personal resources?

Methods

Results

Discussion

Conclusion