Predictors for successful psychotherapy: Does migration status matter?

Friederike Kobel,Eva Morawa,Yesim Erim,Stephan Doering

doi:10.1371/journal.pone.0257387

Friederike Kobel, Eva Morawa + Show 2 more

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https://doi.org/10.1371/journal.pone.0257387

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Abstract

BackgroundWe investigated, if migration status, and additional sociodemographic and clinical factors, are associated with somatization and depressiveness at admission and with remission after inpatient psychotherapy.MethodsMultiple linear and binary logistic regression analyses were used to identify predictors for severity of somatoform and depressive symptoms at admission of inpatient psychotherapy (T0), and for remission after inpatient psychotherapy (T1). We tested the association between symptoms concerning somatization (PHQ-15: Patient-Health-Questionnaire Somatization Module) and depression (PHQ-9: Patient-Health-Questionnaire Depression Module) and several sociodemographic and clinical factors in 263 patients at admission. For remission after treatment, we additionally included severity of symptoms at admission, number of diagnoses and duration of treatment in the regression models. Remission after treatment was defined as response plus a post value of less than 10 points in the respective questionnaire. Clinical relevance was interpreted using effect sizes (regression coefficients, Odds Ratio (OR)) and Confidence Intervals (CI).FindingsSignificant and clinically relevant predictors for high symptom severity at T0 were lower education (β = -0.13, p = 0.04), pretreatment(s) (β = 0.205, p = 0.002) and migration status (β = 0.139, p = 0.023) for somatization, and potential clinically relevant predictors (|β|>0.1) for depression were living alone (β = -0.116, p = 0.083), pretreatment(s) (β = 0.118, p = 0.071) and migration status (β = 0.113, p = 0.069). At T1 patients with pretreatment(s) (OR = 0.284 [95% CI: 0.144, 0.560], p<0.001) and multiple diagnoses (OR = 0.678 [95% CI: 0.472, 0.973], p = 0.035) were significantly and clinically relevant less likely to show a remission of depressive symptoms. In addition, a potentially clinically meaningful effect of migration status on remission of depressive symptoms (OR = 0.562 [95% CI: 0.264, 1.198], p = 0.136) cannot be ruled out. For somatoform symptoms pretreatment(s) (OR = 0.403, [95% CI: 0.156, 1.041], p = 0.061) and education (OR = 1.603, [95% CI: 0.670, 3.839], p = 0.289) may be regarded as clinically relevant predictors for remission.ConclusionThe results of our study suggest that migration status has a clinically relevant influence on severity of somatoform and depressive symptoms at admission. Clinical relevance of migration status can also be assumed regarding the remission of depression. Migration status and further factors affecting the effectiveness of the treatment should be analyzed in future research among larger samples with sufficient power to replicate these findings.

Highlights

Inpatient psychotherapy is crucial for the treatment of patients who suffer from psychological disorders and yet, investigation on predictors for successful psychotherapy is scarce
The vast majority of studies in inpatient psychosomatic settings has been conducted in Germany [2,3,4,5], since here inpatient psychotherapy is nationwide supplied as a regular health insurance service
Taking previous research on the topic into consideration we aimed to examine whether: 1. belonging to first- or second-generation immigrants is an independent predictor for the severity of depressive and somatoform symptoms at the beginning of inpatient psychotherapy?

Summary

Introduction

Inpatient psychotherapy is crucial for the treatment of patients who suffer from psychological disorders and yet, investigation on predictors for successful psychotherapy is scarce. In Germany inpatient psychotherapy is mostly embedded in a multimodal treatment plan in psychosomatic departments. When an indication is secured, multimodal and multicomponent inpatient psychotherapy is free of charge for all insured patients in Germany. Inpatient psychotherapy is based on depth psychological or behavioral methods and includes, besides individual and group psychotherapy, several other methods such as psychoeducation, medical treatment, family sessions, body- and art therapy. The vast majority of studies in inpatient psychosomatic settings has been conducted in Germany [2,3,4,5], since here inpatient psychotherapy is nationwide supplied as a regular health insurance service. If migration status, and additional sociodemographic and clinical factors, are associated with somatization and depressiveness at admission and with remission after inpatient psychotherapy

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