State- and trait-like therapeutic alliance in interpersonal psychotherapy groups.

Effect of couple-based interpersonal psychotherapy on postpartum depressive symptoms: A randomised controlled trial.

Postpartum depression and anxiety are under-addressed public health problems with numerous treatment access barriers, including insufficiently available mental health specialist providers. To examine the effectiveness of nurse-delivered telephone interpersonal psychotherapy (IPT) for postpartum depression. Trial registration ISRCTN88987377. Postpartum women (n = 241) with major depression (on the Structured Clinical Interview for DSM-IV (SCID-I)) from 36 Canadian public health regions in rural and urban settings were randomly assigned to 12 weekly 60 min nurse-delivered telephone-IPT sessions or standard locally available care. The primary outcome was the proportion of women clinically depressed at 12 weeks post-randomisation, with masked intention-to-treat analysis. Secondary outcomes examined included comorbid anxiety, self-reported attachment and partner relationship quality. At 12 weeks, 10.6% of women in the IPT group (11/104) and 35% in the control group (35/100) remained depressed (OR = 0.22, 95% CI 0.10-0.46), with the IPT group 4.5 times less likely to be clinically depressed (SCID); 21.2% in the IPT group and 51% in the control group had an Edinburgh Postnatal Depression Scale (EPDS) score >12 (OR = 0.26, 95% CI 0.14-0.48), and attachment avoidance decreased more in the IPT group than in the control group (P = 0.02). Significant differences favoured the IPT group for comorbid anxiety and partner relationship quality at all time points, with no differences in health service or antidepressant use. None of the IPT responders relapsed by 36 weeks. Between-group SCID differences were sustained at 24 weeks, but not at 36 weeks. Nurse-delivered telephone IPT is an effective treatment for diverse urban and rural women with postpartum depression and anxiety that can improve treatment access disparities.

This study is a randomised controlled trial comparing outcomes from an 8-week Interpersonal Psychotherapy group (IPT-G) for postnatal depression with 'treatment as usual' (TAU), conducted in a routine community setting in the Australian Capital Territory (ACT). Eligible women were recruited and randomly assigned to either IPT-G or TAU conditions. This study compared outcomes on such variables as depressive symptoms, marital adjustment, social support and mother-infant bond at baseline, mid-treatment, end-of-treatment and 3 months follow-up. Participants were also independently assessed using the Hamilton Depression Rating Scale (HAM-D). 50 women completed baseline assessments and were included in the analysis. Comparisons of treatment conditions showed that by end of treatment both the TAU and IPT-G groups significantly improved in terms of mean depression scores, however, the IPT-G women improved significantly more and had continued improvements at 3 months post therapy. Furthermore, women who received IPT-G displayed significant improvement in terms of marital functioning and perceptions of the mother-infant relationship compared to TAU participants. These findings highlight the potential benefits of an interpersonally based treatment, which not only improves outcomes for the mother but also potentially for the couple and the infant when compared to usual care.

Moderators of Treatment Effectiveness for War-Affected Youth With Depression in Northern Uganda

In a previously reported, multi-site, randomized controlled trial in women with postpartum depression (PPD), telephone-based, nurse-delivered, interpersonal psychotherapy (IPT) compared with standard postpartum care showed a reduction of 24% in the incidence of PPD (Dennis et al, British Journal of Psychiatry, 2020). The economic implications of this therapy have not been explored. We aimed to determine the cost-effectiveness of telephone-based, nurse-delivered IPT compared with standard postpartum care, using resource utilization data collected alongside the clinical study. We conducted a prospectively planned economic evaluation using patient-level data from the IPT trial, which enrolled 241 mothers with PPD. We considered costs from a societal perspective, measuring direct medical costs from study logs and secondary sources, as well as evaluating costs borne by the mother and family (including both medical and non-medical expenditures) and wage losses through questionnaires. We used a time horizon of 12 weeks post-randomization, corresponding to the endpoint of the clinical trial. Costs are reported in (2022) Canadian dollars. Patients in the IPT group had more phone calls with public health nurses external to those provided by the study protocol (IPT 73% versus control 55%, p = 0.007) and fewer visits to psychiatrists (9% versus 22%, p = 0.008). However, there were no statistically significant differences in any of the cost categories or total societal expenditures (IPT group $6,653, control group $5,336, p = 0.234). When costs and effects were combined, the societal expenditure was $5,397 for each additional patient without PPD. Telephone-based, nurse-delivered IPT, as employed in this trial, showed no statistically significant differences in costs compared with standard care but resulted in improved clinical outcomes. Although associated with moderate uncertainty, the resulting incremental cost-effectiveness was well within the acceptable range for medical interventions in this population, and telephone-based, nurse-delivered IPT should be considered for patients with PPD. · Telephone-based, nurse-delivered IPT is effective in treating PPD.. · We performed an economic evaluation alongside a randomized controlled trial of IPT, using patient-level data and considering costs from a societal perspective.. · Patients in the IPT group had more phone calls with public health nurses and fewer visits to psychiatrists, with overall similar costs between the two groups.. · The societal expenditure was $5,397 for each additional patient without PPD, which is well within the acceptable range for medical interventions in this population.. · Telephone-based, nurse-delivered IPT should be considered for cost-effective care of patients with PPD..

Given the number of adolescents who present with mental health issues, it is important to explore the best treatment options for this population. Group psychotherapy has been described in the literature as the ideal choice for adolescents who engage in mental health treatment. It is considered a “natural” fit, as adolescents are focused on their peer group during this developmental period. There has been an abundance of research examining behavioral oriented group psychotherapy with adolescents suggesting positive clinical benefits and outcomes. However, process oriented group psychotherapy research with adolescents has been lacking. In particular, the “voice” and perspectives of adolescents who attend group psychotherapy is significantly sparse. The aim of this research study was to address this gap in the literature by interviewing adolescents about their experiences of participating in an interpersonal psychotherapy group. A qualitative descriptive method was the design of choice for this study. Semi-structured, open-ended interviews were conducted with eight adolescents who attended an interpersonal psychotherapy group for a period of three months. The data was analyzed using qualitative inductive manifest content analysis. All eight participants described their experiences and the meaning of their experiences. Surprisingly, all eight participants also described and focused on the group process rather than the content. A number of therapeutic factors including universality, cohesion, interpersonal learning, altruism and instillation of hope emerged from the data which are consistent with Yalom’s theoretical framework. The participants described a number of benefits resulting from their participation and made recommendations for future group therapists related to the physical space, group composition and characteristics and style of the group leader. Implications for knowledge development, research, education and clinical practice, were discussed. Recommendations included future qualitative studies with a broader representation of adolescents participating in heterogeneous and homogenous psychotherapy groups. Increasing psychiatric nurses’ awareness of the benefits of interpersonal psychotherapy groups is warranted along with training opportunities for group leaders in interpersonal psychotherapy.

The Collaborative Care Model (CoCM), in which social workers, primary care physicians, and a consulting psychiatrist work as a team, is an established approach to the treatment of common mental health conditions in primary care settings. Following implementation of a CoCM depression care program at our hospital-based academic primary care practice, we observed a low rate of retention with the use of problem solving therapy/behavioral activation (PST/BA). Our aim in this study was to evaluate the effectiveness of interpersonal psychotherapy (IPT), an evidence-based, flexible strategy that focuses on the relationship between depression and interpersonal challenges, compared to PST/BA. In 2015, most patients enrolled in our CoCM received PST/BA. In 2016, most patients received IPT. Patients who were enrolled and discharged from our CoCM depression care program in the years 2015 and 2016 and received either PST/BA or IPT, were included. Our primary measure was the difference in change in PHQ-9 score between the PST/BA and the IPT groups. Secondary outcomes included the difference in the change in GAD-7 score and measures of glycemic and blood pressure control between the two groups. Two hundred thirty four patients were included in our analysis. One hundred sixty five received PST/BA and 69 received IPT. There was no difference between groups in baseline demographics or measures of depression, anxiety, presence of hypertension, or presence of prediabetes/diabetes. Our primary analysis demonstrated a greater decrease in PHQ-9 score in patients receiving IPT (9.93) compared to those receiving PST/BA (5.41) (p< 0.0001). The proportion of patients achieving a clinical response (PHQ-9 < 10) was also greater in the IPT group (71%) compared to the PST/BA group (44%). In a CoCM depression care program, IPT was a more effective strategy in improving depression symptoms as measured by PHQ-9 scores than PST/BA.

IntroductionPostpartum depression (PPD) is a prevalent and debilitating disease that may affect medication adherence and thus maternal health and vertical transmission among women with HIV. We assessed the feasibility of a trial of interpersonal psychotherapy (IPT) versus antidepressant medication (ADM) to treat PPD and/or anxiety among postpartum women with HIV in Lusaka, Zambia.MethodsBetween 29 October 2019 and 8 September 2020, we pre‐screened women 6–8 weeks after delivery with the Edinburgh Postnatal Depression Scale (EPDS) and diagnosed PPD or anxiety with the Mini International Neuropsychiatric Interview. Consenting participants were randomized 1:1 to up to 11 sessions of IPT or daily self‐administered sertraline and followed for 24 weeks. We assessed EPDS score, Clinical Global Impression‐Severity of Illness (CGI‐S) and medication side effects at each visit and measured maternal HIV viral load at baseline and final study visit. Retention, visit adherence, change in EPDS, CGI‐S and log viral load were compared between groups with t‐tests and Wilcoxon signed rank tests; we report mean differences, relative risks and 95% confidence intervals. A participant satisfaction survey assessed trial acceptability.Results78/80 (98%) participants were retained at the final study visit. In the context of the COVID‐19 pandemic, visit adherence was greater among women allocated to ADM (9.9 visits, SD 2.2) versus IPT (8.9 visits, SD 2.4; p = 0.06). EPDS scores decreased from baseline to final visit overall, though mean change was greater in the IPT group (−13.8 points, SD 4.7) compared to the ADM group (−11.4 points, SD 5.5; p = 0.04). Both groups showed similar changes in mean log viral load from baseline to final study visit (mean difference −0.43, 95% CI −0.32, 1.18; p = 0.48). In the IPT group, viral load decreased significantly from baseline (0.9 log copies/ml, SD 1.7) to final visit (0.2 log copies/ml, SD 0.9; p = 0.01).ConclusionsThis pilot study demonstrates that a trial of two forms of PPD treatment is feasible and acceptable among women with HIV in Zambia. IPT and ADM both improved measures of depression severity; however, a full‐scale trial is required to determine whether treatment of PPD and anxiety improves maternal–infant HIV outcomes.

BackgroundPsychotherapeutic treatment is underused in primary care, where even short-term psychotherapy can be perceived as too lengthy and labour-intensive. We tested here for the first time the preliminary efficacy of seven sessions of interpersonal counselling (IPC) by comparison with sixteen sessions of interpersonal psychotherapy (IPT) in regular clinical settings. MethodsPatients seeking treatment for the first time who met the DSM-IV criteria for major depressive disorder (MDD, mild/moderate) were randomized to either IPC (n=20) or IPT (n=20). The efficacy of the treatments was assessed using the 34-item Clinical Outcomes in Routine Evaluation (CORE-OM) scale and the Beck Depression Inventory (BDI) scale. Results90% of the patients completed all the treatment sessions. IPC delivered by psychiatric nurses in primary care proved equally as effective as IPT delivered by psychotherapists/psychologists in secondary care. The pre-treatment to 12-month follow-up within-group effect sizes were large: 1.52 (CORE-OM) and 1.41 (BDI) in the IPC group and 1.58 (CORE-OM) and 1.40 (BDI) in the IPT group. At the 12-month follow-up 59% of the patients in the IPC group and 63% in the IPT group were classified as recovered on the CORE-OM scale, with corresponding remission rates of 61% for both groups on the BDI scale. LimitationsThe small sample size limited the power to detect differences between the groups and the naturalistic settings may have confounded the results. ConclusionsThis clinical trial suggests that IPC is an appropriate and even sufficient first-phase intervention for handling previously untreated mild to moderate depression in primary health care.

Interpersonal psychotherapy (IPT) has been proposed for prevention of excess weight gain among adolescents with loss-of-control (LOC) eating. Mixed findings from a trial testing this conjecture warrant elucidation of potential outcome predictors. The therapeutic alliance (adolescent-facilitator emotional bond and task collaboration) may be important for IPT but has received little attention in weight-related interventions. This study evaluated associations of adolescent-reported therapeutic alliance during IPT with weight- and eating-related outcomes. Secondary analyses of a randomized controlled trial were conducted to compare group IPT to health education (HE) for preventing excess weight gain among 113 girls (ages 12-17) with body mass index (BMI) at the 75th to 97th percentile and LOC eating. BMI and LOC eating were measured at baseline, 12 weeks (postintervention), and 1 year. Multilevel modeling was used to test associations between change in therapeutic alliance (from session 1 to session 12) and changes in weight- and eating-related outcomes (from postintervention to 1 year). Analyses were controlled for therapeutic alliance after session 1 and for baseline and postintervention outcome values; group assignment (IPT vs. HE) was a moderator. Increases in emotional bond were associated with decreased weight and with greater decreases in number of LOC eating episodes at 1 year in the IPT group (p<0.05) and with weight gain in the HE group (p<0.05). Greater task collaboration was related to greater weight gain at 1-year follow-up, regardless of group assignment (p<0.05). The association of therapeutic alliance during IPT with weight and LOC eating outcomes among adolescent girls merits further investigation.

Peer support and interpersonal psychotherapy groups experienced decreased prenatal depression, anxiety and cortisol

This chapter covers an interpersonal psychotherapy group (IPT-G) in Senegal. It explains that depression is the most common psychiatric disorder in sub-Saharan Africa (SSA) and is highly prevalent among people living with HIV on antiretroviral therapy (ART). Thus, IPT adaptation centered on treatment modality, protocol, language, and training, while context and population informed the choice of modality and protocol. Challenges to IPT-G implementation were primarily organizational in nature and nonspecific to the intervention itself. The chapter examines the IPT-G feasibility and acceptability study that laid the groundwork for future work in Senegal before mentioning its possible future of upscaling service delivery and systemic screening at health facilities to help with case identification.

P-4-21 - Serotonergic dysregulation in dysthymia

Sertraline and/or interpersonal psychotherapy for patients with dysthymic disorder in primary care: 6-month comparison with longitudinal 2-year follow-up of effectiveness and costs

P-4-20 - Predictors of outcome for long-term treatment