Association of comorbid personality disorders with clinical characteristics and outcome in a randomized controlled trial comparing two psychotherapies for early-onset persistent depressive disorder

Nele Erkens; Elisabeth Schramm; Levente Kriston; Martin Hautzinger; Martin Härter; Ulrich Schweiger; Jan Philipp Klein

doi:10.1016/j.jad.2017.12.091

Association of comorbid personality disorders with clinical characteristics and outcome in a randomized controlled trial comparing two psychotherapies for early-onset persistent depressive disorder

J Affect Disord. 2018 Mar 15:229:262-268. doi: 10.1016/j.jad.2017.12.091. Epub 2018 Jan 4.

Authors

Nele Erkens¹, Elisabeth Schramm², Levente Kriston³, Martin Hautzinger⁴, Martin Härter³, Ulrich Schweiger⁵, Jan Philipp Klein⁵

Affiliations

¹ Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany. Electronic address: nele.erkens@uksh.de.
² Department of Psychiatry, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
³ Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
⁴ Department of Clinical Psychology and Psychotherapy, University of Tübingen, Tübingen, Germany.
⁵ Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany.

PMID: 29329058
DOI: 10.1016/j.jad.2017.12.091

Abstract

Background: Persistent depressive disorder (PDD) is associated with high rates of comorbid personality disorders (PD). The association of comorbid PD and clinical characteristics has not been systematically studied in PDD. Results regarding effects on treatment outcome are heterogeneous.

Methods: We analyzed the association of comorbid personality disorders with clinical characteristics and outcome in a randomized controlled trial comparing the disorder-specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) with nonspecific supportive psychotherapy (SP) in patients with early-onset PDD. The main outcome measure was the Hamilton Rating Scale for Depression (HRSD-24). Further baseline measures were comorbid axis-I diagnoses (SCID-I), quality of life (QLDS), global functioning (GAF), interpersonal problems (IIP-64) and childhood maltreatment (CTQ).

Results: Out of the 268 patients, 103 (38.4%) met criteria for at least one PD. PD was associated with higher rates of axis I comorbidities (mainly anxiety disorders) and interpersonal problems (patients with PD were more vindictive, more self-sacrificing, less assertive and more inhibited socially than patients without PD). There was no significant main effect of PD on treatment outcome and no significant interaction between PD and treatment group.

Limitations: The main limitation was the exclusion of patients with certain personality disorders (antisocial, schizotypal, and borderline personality disorders). Furthermore, the study was underpowered to find interaction effects of small size.

Conclusion: Persistently depressed patients with and without comorbid PD primarily seemed to differ in the rate of axis I comorbidity and the severity of interpersonal problems. Treatment outcomes appear to be not significantly affected by the presence of PD.

Trial registration: ClinicalTrials.gov NCT00970437.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Analysis of Variance
Anxiety Disorders / psychology
Borderline Personality Disorder
Comorbidity
Depressive Disorder / psychology
Depressive Disorder / therapy*
Female
Humans
Male
Middle Aged
Personality
Personality Disorders / epidemiology
Personality Disorders / psychology*
Psychiatric Status Rating Scales
Psychotherapy / methods*
Quality of Life

Associated data

ClinicalTrials.gov/NCT00970437