Is duration of psychological treatment for depression related to return into treatment?

A M Boerema,A Van Straten,L Voorrips,A Hellenthal,P Cuijpers,A T F Beekman

doi:10.1007/s00127-016-1267-7

Abstract

PurposeThere 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.MethodsThis 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.ResultsThe 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.ConclusionsThe 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.

Highlights

In the past decades, psychotherapy for depression shifted from long-term psycho-analytic approaches to more brief therapies like cognitive behavioral therapy [1]
The majority of patients did not return into mental health care (86 %)
The results suggest that a longer duration of treatment may prevent return into mental health care in some groups

Summary

Introduction

Psychotherapy for depression shifted from long-term psycho-analytic approaches to more brief therapies like cognitive behavioral therapy [1]. At present there is an increasing pressure on mental health-care providers to provide even shorter therapies, while retaining high quality and cost-effectiveness [1]. These treatments typically focus on increasing patients’ self-management skills and may be offered face-to-face, by telephone or online. There is evidence that such brief therapies are effective [2,3,4,5,6,7].

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