Effectiveness of inpatient versus outpatient complex treatment programs in depressive disorders: a quasi-experimental study under naturalistic conditions

Stefanie Gerhards,Steffi Koch-Stoecker,Martin Driessen,Hedda Ribbert,Philipp Schulz,Silvia Jander,Frank Neuner

doi:10.1186/s12888-019-2371-5

Stefanie Gerhards, Steffi Koch-Stoecker + Show 5 more

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https://doi.org/10.1186/s12888-019-2371-5

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Abstract

BackgroundDue to long waiting periods for outpatient psychotherapy and the high resource requirements of inpatient treatment, there is a need for alternative treatment programs for patients with depressive disorders. Thus, we investigated the effectiveness of the “Bielefeld Outpatient Intensive Treatment Program of Depression” (BID) in comparison with a typical inpatient treatment program by using a prospective quasi-experimental observational study. We assumed (i) that both complex programs are effective in pre-post analyses after 6 weeks and (ii) that inpatient treatment is more effective compared with the outpatient program.MethodsFour hundred patients with depressive psychopathology – a majority with depressive episodes (ICD-10 F3X) - took part in the BID and 193 in the inpatient program. Different self- (i.e., BDI) and expert measures (i.e., MADRS) of psychopathology at baseline (t1) and 6 weeks later (t2) were applied to examine treatment effects.ResultsTreatment effects were high in separate analyses of both groups with Cohen’s d ranging from 1.10 to 1.76., while ANOVA comparative analyses did not reveal any significant differences between both treatment settings nor did a set of independent covariates analyzed here. Response rates of BDI (p = .002) and MADRS (p = .001) were higher in the outpatient group. Results indicate BID not to be inferior compared to an inpatient program, although diverging pathways to treatment, higher rates of clinical recurrent depressive disorders and severe episodes as well as lower rates of employment and partnership in the inpatient treatment group have to be considered.ConclusionOutpatient intensive treatment programs may represent a solution for patients needing more than a treatment session once per week but less than a complex inpatient or day clinic program.

Highlights

Due to long waiting periods for outpatient psychotherapy and the high resource requirements of inpatient treatment, there is a need for alternative treatment programs for patients with depressive disorders
A moderate number of such models were designed in the mental health field, but only few were realized for more than two to 3 years [12, 13], Gunn and Diggens [14] in an overview reported that multi-professional approaches with structured treatment plans and planned post-intervention care do lead to increased inter-professional communication but may have a positive impact on treatment outcomes in depression
It represents a 2 × 2 factorial design with two times of assessments as well as considering independent demographic and clinical variables as covariates. Patients pathways into these two programs were somewhat different due to the fact, that the Bielefeld Outpatient Intensive Treatment Program of Depression (BID) represents an integrated care program for patients with a specific health insurance (BKK; see above as well as Fig. 1): While in both programs patients could be transferred by private practices, consultation centers or the hospital’s outpatient services directly, participants of the inpatient program could be transferred from a hospital crisis intervention unit when primarily admitted as a case of emergency

Summary

Introduction

Due to long waiting periods for outpatient psychotherapy and the high resource requirements of inpatient treatment, there is a need for alternative treatment programs for patients with depressive disorders. There are alternatives to purely outpatient psychotherapeutic or inpatient forms of treatment for Driessen et al BMC Psychiatry (2019) 19:380 depressive disorders such as complex integrated outpatient care models [10]. These treatment models consist e.g. of cognitive-behavioral therapy sessions, if indicated psychopharmacologic treatment and social interventions by social workers, sport exercises, as well as regular monitoring of the treatment progress. Aims of such integrated care models are increasing quality and cost-efficiency of treatment [11]. Up to now and to the best of our knowledge, there is almost no evidence on the effectiveness of integrated care models in comparison to inpatient treatments (e.g. [15]), more research in this field is needed

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