Psychosomatic inpatient treatment: Real-world effectiveness, response rates and the helping alliance

Abstract

ObjectiveWhile inpatient mental health treatments in real-world settings have shown to be generally effective with moderate to large pre-post effects, little is known about rates of response in inpatients. MethodsInpatients routinely treated at a university hospital for psychosomatics and psychotherapy in Germany were assessed before and after receiving a psychodynamically oriented multimodal treatment. As primary outcome response rates based on the Symptom Checklist-90-Revised (SCL-90-R) were used. As secondary outcomes, pre-post effect sizes on measures of symptoms and stress (SCL-90-R, Hospital anxiety and depression scale, Perceived stress questionnaire) as well as interpersonal problems (IIP) were determined. Additionally, the relationship of the helping alliance to outcome was examined. ResultsA total of 709 patients with various primary diagnoses and high mental (72.4%) and physical (61%) comorbidity, receiving on average 7.9 weeks of treatment, were included. The response rate based on the SCL-90-R global severity index was 62.9% at posttreatment and 60.4% at short-term follow up. Pre-post effect sizes on symptom and stress measures were large (Cohen's d ≥ 1.0) while change regarding interpersonal problems was small (d = 0.34). For patients responding to treatment a significantly better helping alliance was found, corresponding to a large effect (d = 0.84). ConclusionsA majority of patients benefitted considerably from a psychosomatic inpatient treatment in terms of response and pre-post effects. Response was significantly related to the quality of the therapeutic alliance. Monitoring and improving alliance may enhance treatment outcome.