Typical disease courses of patients with unipolar depressive disorder after in-patient treatments-results of a cluster analysis of the INDDEP project

Theresa Martinek; Marc Jarczok; Edit Rottler; Armin Hartmann; Almut Zeeck; Heinz Weiß; Jörn von Wietersheim

doi:10.3389/fpsyt.2023.1081474

Typical disease courses of patients with unipolar depressive disorder after in-patient treatments-results of a cluster analysis of the INDDEP project

Front Psychiatry. 2023 Apr 6:14:1081474. doi: 10.3389/fpsyt.2023.1081474. eCollection 2023.

Authors

Theresa Martinek¹, Marc Jarczok¹, Edit Rottler¹, Armin Hartmann², Almut Zeeck², Heinz Weiß³, Jörn von Wietersheim¹

Affiliations

¹ Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany.
² Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital, Freiburg, Germany.
³ Department of Psychosomatic Medicine and Psychotherapy, Robert-Bosch-Krankenhaus, Stuttgart, Germany.

Abstract

Introduction: Previously established categories for the classification of disease courses of unipolar depressive disorder (relapse, remission, recovery, recurrence) are helpful, but insufficient in describing the naturalistic disease courses over time. The intention of the present study was to identify frequent disease courses of depression by means of a cluster analysis.

Methods: For the longitudinal cluster analysis, 555 datasets of patients who participated in the INDDEP (INpatient and Day clinic treatment of DEPression) study, were used. The present study uses data of patients with at least moderate depressive symptoms (major depression) over a follow-up period of 1 year after their in-patient or day-care treatments using the LIFE (Longitudinal Interval Follow-Up Evaluation)-interview. Eight German psychosomatic hospitals participated in this naturalistic observational study.

Results: Considering only the Calinski-Harabatz index, a 2-cluster solution gives the best statistical results. In combination with other indices and clinical interpretations, the 5-cluster solution seems to be the most interesting. The cluster sizes are large enough and numerically balanced. The KML-cluster analyses revealed five well interpretable disease course clusters over the follow-up period: "sustained treatment response" (N = 202, 36.4% of the patients), "recurrence" (N = 80, 14.4%), "persisting relapse" (N = 115, 20.7%), "temporary relapse" (N = 95, 17.1%), and remission (N = 63, 11.4%).

Conclusion: The disease courses of many patients diagnosed with a unipolar depression do not match with the historically developed categories such as relapse, remission, and recovery. Given this context, the introduction of disease course trajectories seems helpful. These findings may promote the implementation of new therapy options, adapted to the disease courses.

Keywords: cluster analysis; follow up examination; in-patient treatment; major depression (MD); treatment response groups.

Grants and funding

This INDDEP study was funded by a grant from the Heidehof Stiftung GmbH Stuttgart (No. 59055.02.1-4). The Heidehof Stiftung had no influence neither on the study design, the collection, analysis, and interpretation of the data, nor in writing or submitting this manuscript.