15
Subprojekt 2.3 inal Presentation, 6/10/03 Prevention of Chronification in Patients with Depression and Somatoform Disorders Winfried Rief Philipps University, Marburg
Subprojekt 2.3
Final Presentation,06/10/03
Prevention of Chronification in Patients with Depression and Somatoform Disorders
Winfried Rief
Philipps University, Marburg
Study centers
E. Rauh
A. Nanke
W. Rief
N. Baltruschat
S. Pausch
E. Geissner
M. Fichter
Subprojekt 2.3
Final Presentation,06/10/03
The aims of the study were:
Analysis of predictors of outcome in patients with unexplained physical symptoms (SFD) and comorbid depression inPrimary Care
Development of a brief intervention which is feasible withPrimary Care needs
Evaluation of this intervention Development of Primary Care networks
Subprojekt 2.3
Final Presentation,06/10/03
Design
Aquisition of 200 patients in GP offices
4 weeks later: 2nd assessment
6 months later: 3rd assessment
Initial assessmentRandomization
Standard Medical CareN = 100
Brief InterventionN = 100
Subprojekt 2.3
Final Presentation,06/10/03
Start 4 weeks later
6 months later
Prien Intervention 70 57 56
Control 17 12 10
Marburg Intervention 74 61 60
Control 66 62 56
Total 227 192 (85%)
182(80%)
Completers
Subprojekt 2.3
Final Presentation,06/10/03
Sample Characteristics
• 77,7 % female; Mean age: 48 years
• no. of doctor visits (last 6 months): 16
• no. of doctor visits without psychiatrists/psychotherapists (last 6 months): 14
• BDI 16.0
• no. of somatoform symptoms (Interview): 11
• Time since onset of unexplained physical symptoms (first symptoms): 10 years
Consumer Satisfaction:Patient ratings of intervention (n = 106) - „confirmed mostly/ completely“ -
97,20%
95,20%
92,50%
90,00%
96,30%
0% 20% 40% 60% 80% 100%
new copingstrategies
coping promising
felt understood bytherapist
recommend to afriend
should be offeredmore often
Hypochondriasis WI (all data; interaction p<0.01)
0
1
2
3
4
5
6
7
8
Intervention Control
INDEX
6 months later
Somatization SCL (all data; interaction p<0.02)
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
0,9
Intervention Control
INDEX
6 months later
General Psychopathology SCL (all data; interaction p<0.05)
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
0,9
Intervention Control
INDEX
6 months later
Somatization SCL (only Marburg data; interaction p<0.02)
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
0,8
Intervention Control
INDEX
6 months later
Doctor Visits (non-psychiatrists; only Marburg data; p<0.09)
0
2
4
6
8
10
12
14
16
Intervention Control
6 months before
6 months after
Subprojekt 2.3
Final Presentation,06/10/03
Prediction of Improvement• Linear regression analysis (difference scores;
T1-T3, criterium: SOMS)• Somatization SOMS (T1); β = 0.70; p<.001• Depression BDI (T1); β = -.42; p<.001• Hypochondriasis WI (T1); β = -.25; p<.006• (Psychological illness attributions; β = .15; p<.10)
Subprojekt 2.3
Final Presentation,06/10/03
Next Steps• Analysis of specific aspects of health care use (c.f.,
detailed interview on investigations, treatments, pharmaceutics etc.)
• Short-term versus long-term effects (Preliminary analyses: Improvements develop slowly)
• Responders versus non-responders; development of indication rules
• Cross-sectional analyses (e.g., >100 blood samples for genetic and other tests)
• Problem: Sample with persisting symptoms; high user; severely disabled
Subprojekt 2.3
Final Presentation,06/10/03
Conclusions• Significant improvements of participants of the one-
session intervention• This intervention could become an important tool to
improve the ineffective health care use of these patients• For a broader, long-lasting effect, it would be necessary
to-> train GPs in the use of our minimal intervention-> define ways for compensation of GPs doing this
intervention (e.g., „Modellprojekt“ of the health care insurances)
