Longitudinal Clusters of Long-Term Trajectories in Patients with Early-Onset Chronic Depression: 2 Years of Naturalistic Follow-Up after Extensive Psychological Treatment

Moritz Elsaesser; Bernd Feige; Levente Kriston; Lea Schumacher; Jasmin Peifer; Martin Hautzinger; Martin Härter; Elisabeth Schramm

doi:10.1159/000535005

Longitudinal Clusters of Long-Term Trajectories in Patients with Early-Onset Chronic Depression: 2 Years of Naturalistic Follow-Up after Extensive Psychological Treatment

Psychother Psychosom. 2024;93(1):65-74. doi: 10.1159/000535005. Epub 2023 Dec 28.

Authors

Moritz Elsaesser¹, Bernd Feige¹, Levente Kriston², Lea Schumacher², Jasmin Peifer¹, Martin Hautzinger³, Martin Härter², Elisabeth Schramm¹

Affiliations

¹ Department of Psychiatry and Psychotherapy, Medical Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany.
² Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
³ Department of Psychology, Eberhard Karls University of Tübingen, Tübingen, Germany.

PMID: 38154457
DOI: 10.1159/000535005

Abstract

Introduction: In clinical trials, mostly group-level treatment effects of repeated cross-sectional measures are analyzed. However, substantial heterogeneity regarding individual symptom profiles and the variability of treatment effects are often neglected, especially over the long-term course. To provide effective personalized treatments, investigations of these characteristics are urgently needed.

Methods: Depression severity ratings over 104 weeks of follow-up after year-long treatment with the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) or Supportive Psychotherapy (SP) were analyzed. Longitudinal cluster analysis and multinomial logistic regression analysis were conducted to investigate intraindividual trajectories from one of the largest psychotherapy trials in early-onset chronic depression.

Results: Two-year post-study-treatment trajectories of N = 188 patients with early-onset chronic depression were grouped into four prototypical clusters. Overall, 16.0% of patients remitted (cluster 1) and most of them did not receive any treatment during the 2-year follow-up. However, 84.0% of patients continued to experience subthreshold (37.2% cluster 2) or major depressive symptoms (46.8% clusters 3-4) and spent on average more than half of the follow-up in pharmacological and psychological treatment. Hierarchical regression analysis indicated that previous study treatment with CBASP or SP did not significantly predict cluster allocation, while baseline variables accounted for a large proportion of explained variance (R2 N = 0.64).

Conclusion: While some patients experienced stable remission over 2 years of follow-up, the majority of patients experienced subthreshold or major depressive symptoms regardless of former study treatment with CBASP or SP. This calls for a long-term perspective implementing staging and innovative treatment approaches such as the sequential model or modular psychotherapy.

Keywords: Chronic depression; Cluster analysis; Cognitive Behavioral Analysis System of Psychotherapy; Follow-up; Longitudinal trajectories.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Chronic Disease
Cross-Sectional Studies
Depression* / psychology
Depression* / therapy
Depressive Disorder, Major* / diagnosis
Follow-Up Studies
Humans
Psychotherapy
Treatment Outcome