Predictor Of Outcome In Depression Research Articles

The Role of Human Support on Engagement in an Online Depression Prevention Program for Youth

Background: Depression is a significant public health problem for adolescents. The goal of this study was to evaluate the moderating role of human support in an online depression prevention program on both depression outcomes and overall engagement with the intervention. CATCH-IT is an Internet-based depression prevention program that has been shown to reduce symptoms for adolescents who report elevated depression symptom scores, compared to a health education (HE) control group. Participants in the CATCH-IT arm received human support (e.g., motivational interviewing, completed contacts). This study analyzes the moderating role of human support on depressive outcomes and engagement, and examines if engagement predicts depression outcomes. Methods: This secondary analysis consists of a randomized controlled trial for adolescents assigned to the CATCH-IT group. Mixed effects modeling, general linear models, and an exploratory multiple linear regression were used to explore the moderating relationship of human support between intervention and overall engagement. Study variables included depression outcomes (e.g., Center for Epidemiological Studies Depression Scale (CESD)), engagement components (e.g., modules completed, time on the site, and characters typed) and human support (e.g., motivational interviews and completed contacts.) Results: Results showed no significant relationship between contacts, motivational interviews, and depression scores. However, motivational interviews increased engagement with the intervention, such that those who received more motivational interviews completed significantly more modules, spent more time on the site, and typed more characters (p < 0.05). The number of contacts increased engagement with the intervention, and those who received more contacts spent more time on the site and typed more characters (p < 0.05). Exploratory multiple linear regression modeling demonstrated that male, African American/Black, and Hispanic/Latinx users were less engaged compared to other users. Lastly, engagement was not a significant predictor of depression outcomes (p > 0.05). Conclusions: The efficacy of CATCH-IT is not better explained by the degree to which participants received doses of human support from providers during the use of this online intervention. This may reveal the high potential of effective online interventions without the blended integration of human support for adolescents. To increase engagement of adolescents with an online depression prevention program, human support may be more efficient when utilizing MI rather than technical support.

Clinical judgement, case complexity and symptom scores as predictors of outcome in depression: an exploratory analysis

BackgroundClinical guidelines for depression in adults recommend the use of outcome measures and stepped care models in routine care. Such measures are based on symptom severity, but response to treatment is likely to also be influenced by personal and contextual factors. This observational study of a routine clinical sample sought to examine the extent to which “symptom severity measures” and “complexity measures” assess different aspects of patient experience, and how they might relate to clinical outcomes, including disengagement from treatment.MethodsSubjects with symptoms of depression (with or without comorbid anxiety) were recruited from people referred to an established Primary Care Mental Health Team using a stepped care model. Each participant completed three baseline symptom measures (the Personal Health Questionnaire (PHQ), Generalised Anxiety Disorder questionnaire (GAD) and Clinical Outcomes in Routine Evaluation (CORE-10)), and two assessments of “case complexity” (the Minnesota-Edinburgh Complexity Assessment Measure (MECAM) and a local complexity assessment). Clinician perception of likely completion of treatment and patient recovery was also assessed. Outcome measures were drop out and clinical improvement on the PHQ.Results298 subjects were recruited to the study, of whom 258 had a sufficient dataset available for analysis. Data showed that the three measures of symptom severity used in this study (PHQ, GAD and CORE-10) seemed to be measuring distinct characteristics from those associated with the measures of case complexity (MECAM, previous and current problem count). Higher symptom severity scores were correlated with improved outcomes at the end of treatment, but there was no association between outcome and complexity measures. Clinicians could predict participant drop-out from care with some accuracy, but had no ability to predict outcome from treatment.ConclusionsThese results highlight the extent to which drop-out complicates recovery from depression with or without anxiety in real-world settings, and the need to consider other factors beyond symptom severity in planning care. The findings are discussed in relation to a growing body of literature investigating prognostic indicators in the context of models of collaborative care for depression.

Mineralocorticoid Receptor Agonist as a Predictor of Treatment Outcome in Depression with and without Early Life Stress

Mineralocorticoid Receptor Agonist as a Predictor of Treatment Outcome in Depression with and without Early Life Stress

Predictors of Adherence and Outcome in Internet-Based Cognitive Behavior Therapy Delivered in a Telephone Counseling Setting

This study investigated predictors of adherence and outcome in a sample of callers to a national crisis telephone counseling service who were randomized to receive a 6-week, online, self-administered psychoeducation and cognitive behavioral therapy (CBT) intervention. Age, sex, relationship status, employment status, level of education, baseline depression symptom severity, and motivation to undertake the intervention were examined as predictors of adherence to the intervention in participants assigned to receive the online intervention (n = 83). Predictors of depression outcome were assessed using mixed models repeated measures ANOVA, comparing the two web-CBT intervention groups to the tracking and control groups (n = 155). Lower baseline depression severity was significantly associated with greater adherence to the intervention. A significant interaction was found between measurement occasion and motivation to undertake the intervention. At 6 month follow-up, participants with low and moderate levels of motivation had lower depressive symptoms than those with high levels of motivation. At 12 month follow-up, those with moderate levels of motivation had lower depressive symptoms than those with high motivation. The findings suggest that lower pre-intervention depression symptoms may positively influence adherence to online treatment for depression, while low and moderate levels of motivation appear to be optimal for treatment outcome. The factors that relate to adherence and outcome need to be understood to prevent dropout and maximize treatment effectiveness in online interventions.

Treatment Outcome in Psychiatric Inpatients: The Discriminative Value of Self-Esteem

Self-esteem has been identified as an important clinical variable within various psychological and psychiatric conditions. Surprisingly, its prognostic and discriminative value in predicting treatment outcome has been understudied. The current study aims to assess, in an acute psychiatric setting, the comparative role of self-esteem in predicting treatment outcome in depression, anxiety, and global symptom severity, while controlling for socio-demographic variables, pre-treatment symptom severity, and personality pathology. Treatment outcome was assessed with pre- and post-treatment measures. A heterogeneous convenience sample of 63 psychiatric inpatients completed upon admission and discharge self-report measures of depression, anxiety, global symptom severity, and self-esteem. A significant one-way repeated-measures multivariate analysis of variance (MANOVA) followed up by analyses of variance (ANOVAs) revealed significant reductions in depression (eta2 = .72), anxiety (eta2 = .55), and overall psychological distress (eta2 = .60). Multiple regression analyses suggested that self-esteem was a significant predictor of short-term outcome in depression but not for anxiety or overall severity of psychiatric symptoms. The regression model predicting depression outcome explained 32% of the variance with only pre-treatment self-esteem contributing significantly to the prediction. The current study lends support to the importance of self-esteem as a pre-treatment patient variable predictive of psychiatric inpatient treatment outcome in relation with depressive symptomatology. Generalization to patient groups with specific diagnoses is limited due to the heterogeneous nature of the population sampled and the treatments provided. Implications for clinical practice and future research are discussed.

Major depression and its correlates in primary care settings in six countries

Few published studies address depression outcomes in primary care from a cross-cultural perspective. To define baseline factors associated with 9-month clinical outcomes across six countries. Adults meeting criteria for current major depression were recruited from primary care clinics in Australia, Brazil, Israel, Spain, Russia and the USA; 968 patients were assessed at the 9-month follow-up. Predictors of complete remission were examined using logistic regression with a hierarchical model. Rates of complete remission in the six sites ranged from 25% to 48%. Logistic regression using pooled data showed that education, key life events and the Quality of Life Depression Scale score at baseline were the final predictors of complete remission, adjusting for centres, socio-demographic data, severity of depression, comorbidity and general quality of life. Variationin predictors across sites was not statistically significant. The two major findings of this study were the low proportion of people achieving complete remission at follow-up across the six sites, and that some baseline characteristics (education, Quality of Life Depression Scale score and key life events) are modest predictors of outcome in depression.

Predictors of 1-year outcome in depression.

We compared several different methods for assessing depression 'recovery' over a 1-year review interval, to determine the utility of the contrasting approaches. Second, we assessed baseline predictors of 1-year outcome and recovery status. Third, we examined the extent to which predictors showed consistency across the variable definitions of outcome and recovery. Twelve-month outcome was assessed in a sample of 182 subjects who at baseline assessment met DSM criteria for a major depressive episode. The contrasting methods involved a defined percentage reduction in Beck Depression Inventory self-rating scores, formalised change point definitions, no longer meeting DSM-IV major depression criteria, and clinical global improvement (CGI) ratings. Sixty-one per cent reached formalised change point criteria for full remission or recovery when trajectories across the 12-month interval were examined. Other measures quantified recovery rates ranging from 43% to 70%. Those with a psychotic or melancholic depression were more likely to have achieved recovery status in some analyses. Non-recovery at 12 months was predicted most consistently by higher baseline levels of anxiety and depression; high trait anxiety and a lifetime anxiety disorder; disordered personality function; and having reported exposure to acute and enduring stressors at baseline assessment. While the CGI was the superior system in terms of number of significant discriminating predictors of outcome, the change point definitional approach provides much greater information across the follow-up interval, arguing for their complementary utility. As several currently identified baseline predictors of outcome (i.e. anxiety, disordered personality function) also predicted onset of depression, their relevance as both depression-inducing and depression-propagating variables is suggested.

Family history as a predictor of poor long-term outcome in depression.

We investigated whether family history had prognostic significance in depression in a study which addressed some of the methodological shortcomings of previous studies. We collected family history data on a consecutive series of 89 patients admitted with RDC major depression, blind to the outcome of the proband. This comprised 116, 283 and 120 first-degree relatives examined with the SADS-L, FH-RDC and case note data, respectively. The outcome of 74 of these probands (83%), previously categorised into four operationally defined groups, was then examined. A positive family history of severe psychiatric illness (i.e. a relative with a history of either a psychosis, hospitalised depression or suicide) was associated with poor outcome in the proband. This association persisted after controlling for variable family size, age structure and gender. As family history was correlated with neither Kendell's neurotic/psychotic index nor the proband's neuroticism score, an individual with high scores an all three would have a greatly increased chance of having a poor outcome. A family history of severe psychiatric illness in a first-degree relative may be useful as one of the vulnerability factors for predicting poor long-term outcome in depression.

The DST as a predictor of outcome in depression

The DST as a predictor of outcome in depression

The DST as a predictor of outcome in depression: a meta-analysis.

The authors undertook a review of the literature on the dexamethasone suppression test (DST) as a predictor of course and outcome in major depression, to illustrate clinical and pathophysiological implications of studying the relation between biological measures and course of illness in psychiatry. In computerized searches and cross-references, 144 articles were found that related DST results to prediction of treatment response or outcome. Meta-analysis was performed on pooled data from all of the studies and separately on data from selected studies that had used stricter methodology. 1) Baseline DST status did not predict response to antidepressant treatment or outcome after hospital discharge. 2) Non-suppression of cortisol on the baseline DST predicted poorer response to placebo. 3) Persistent nonsuppression of cortisol on the DST after treatment was associated with high risk of early relapse and poor outcome after discharge. Baseline DST results may be devoid of prognostic value, but posttreatment nonsuppression of cortisol on the DST is strongly associated with poor outcome. Persistent nonsuppression may reflect a partially treated index episode or identify sicker patients who are unresponsive to treatment. The findings reiterate the importance of studying biological measures in relation to multiple validators of psychiatric illness beyond cross-sectional diagnosis.

Interepisode consistency of dexamethasone suppression test results in affective disorders.

Twenty-two patients with recurrent affective disorders received 1-mg dexamethasone suppression tests (DSTs) during multiple hospitalizations. Interepisode consistency of DST results was found in 82% of the subjects, which supports the use of this test as a predictor of relapse.

Neuroticism as a predictor of outcome in depression.

Low levels of neuroticism have variably been associated with a better outcome of depressive disorders but the interpretation of this phenomenon is clouded by the knowledge that severity of depression may itself confound ratings of neuroticism. To clarify any relationship between neuroticism and outcome, the authors assessed the predictability of neuroticism (as assessed by questionnaire, psychiatrist rating, and subject self-report) in separate groups of psychiatric patients and symptomatic volunteers with nonmelancholic depression. Depressives' judgments of their own neuroticism correlated with neuroticism scores on the Eysenck Personality Inventory (EPI), but neither of these measures predicted improvement at 6 nor 20 weeks. Judgments of neuroticism made by psychiatrists, which did not correlate with EPI neuroticism scores, did predict improvement. The study suggests that differences in defining neuroticism contribute to its variable association with outcome and further suggests the relevance of clinically assessing neuroticism as a personality variable.