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)