Predicting symptoms in major depression after inpatient treatment: The role of alexithymia

Abstract

Introduction Alexithymia has been considered to have a negative influence on the course of symptoms in various psychiatric disorders. Only few studies examined in depressed patients whether alexithymia predicts the outcome of therapeutic interventions or the course of symptoms in naturalistic settings. Aims In the present prospective study, it was investigated whether alexithymia is associated with depressive symptoms after a multimodal inpatient treatment. Methods Forty-five inpatients suffering from acute major depression were examined in the initial phase of treatment and then again after seven weeks. Patients took part in a multimodal treatment program comprising psychodynamic-interactional oriented individual and group therapy. The majority of patients were taking antidepressants during study participation. To assess alexithymia and depressive symptoms, the 20-item Toronto Alexithymia Scale (TAS-20), the Beck Depression Inventory II (BDI-II) and the Hamilton Depression Scale (HAMD) were administered at baseline and follow-up. Results High scores in the Externally Oriented Thinking (EOT) facet of alexithymia at baseline predicted high severity of depressive symptoms at follow-up (for self-reported as well as observer-rated scores). This relationship was not confounded by initial depressive symptoms. Conclusions Inpatients suffering from major depression with a more pronounced external cognitive style might benefit less from multimodal inpatient treatment. Patients high on EOT could avoid reflecting on negative emotions. Psychological interventions might modify or account for alexithymic characteristics to improve the course of depressive symptoms in these patients.