Post-awakening salivary alpha-amylase as modulator of treatment response in patients with burnout and major depression.

Around 50% of patients with major depression do not respond to standard first-line treatments, such as psychotherapy and pharmacotherapy. At the same time, a subgroup exhibits altered functioning of stress-responsive bodily systems, such as the central locus coeruleus/sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. Given that these systems impact arousal and cognition, it is possible that this subgroup contributes to the high rates of non-responders. Our aim was to investigate whether sympathetic and HPA axis activity modulate treatment outcomes in patients with stress-related major depression. A total of N = 74 inpatients (median age: 50, 62% male) with signs of burnout who fulfilled diagnostic criteria for major depression were recruited. Saliva samples were collected at awakening as well as 30 and 45 min later. Alpha-amylase activity and cortisol concentrations were determined before patients underwent evidence-based multimodal treatment. Non-responders were defined as patients exhibiting a <50% decrease in depression on the Beck Depression Inventory. Non-responders had significantly higher post-awakening alpha-amylase activity than responders (p = .025). In addition, alpha-amylase activity increased significantly over the course of treatment (p = .004), irrespective of responder status. Post-awakening cortisol was neither a predictor nor an indicator of treatment response. If future research confirms alpha-amylase activity as a modulator of treatment response, this may indicate a subgroup of patients with major depression which may benefit from augmentative treatments, such as heart rate variability biofeedback and/or cognitive interventions targeting high arousal.

Burnout Subtypes: Psychological Characteristics, Standardized Diagnoses and Symptoms Course to Identify Aftercare Needs.

Background: To better understand individual differences between burnout inpatients and improve individually tailored treatments in a psychiatric hospital, cluster analysis based on a number of self-report measures was used to investigate psychosocial characteristics of 96 participants. Method: Group membership was analyzed regarding associations with standardized measures of psychiatric and personality disorders. Moreover, symptom levels of burnout, depression, and general mental health were used to characterize the groups and to observe differential trajectories at admission, discharge, and follow-up. Results: As in previous research, we identified four subtypes that differed in comorbidity, psychological characteristics and treatment outcome. This calls for tailored interventions for the more vulnerable patients. Conclusion: The replicated and enriched characterization of burnout inpatients can help to optimally meet the differential needs of burnout patients.

Emotional competence predicts outcome of an inpatient treatment program for burnout.

BACKGROUND: Previous research has shown an association between burnout and low emotional competence (EC), defined as the ability to adequately regulate the intensity and expression of emotions. EC might also play a maintaining role in depression. The current paper aimed at studying the effect of improved EC on the course of burnout and depression. METHODS: 113 psychiatric inpatients completed a set of standardized self-report questionnaires at intake, discharge and three months after treatment, assessing EC, burnout, and depression. Multi-level analyses investigated the effect of improved EC on burnout and depression. RESULTS: Improved EC including a better emotion regulation during treatment predicted favourable treatment outcomes regarding burnout and depression symptoms. LIMITATIONS: The present results should be considered in light of some methodological limitations. Most importantly, the patient sample consists of patients of one inpatient ward and is therefore not representative of all burnout patients. CONCLUSIONS: This study supports EC as a putative mechanism of change in the multimodal treatment of inpatients with a stress-related depressive disorder and burnout. Clinical and research consequences of the findings will be discussed.

[Assessing Change of Depressive Symptoms and Severity of Depression in an Inpatient Setting : Performance of the HoNOS (Health of the Nation Outcome Scales)]. / Die Eignung der HoNOS (Health of the Nation Outcome Scales) zur Erfassung des Verlaufs und des Schweregrads depressiver Symptomatik im stationären Setting.

Objectives This study investigates the assessment of change of depressive symptoms and severity of depression with the "Health of the Nation Outcome Scales" (HoNOS) in an inpatient setting. Method Participants were 132 adults diagnosed with depressive disorder (F32: n=102; F33: n=30). Bivariate correlations were used to determine the correlation of the HoNOS with self-reported (BDI) and observer-rated depressive symptoms (HAMD). The predictive validity of the HoNOS was analysed with linear regression models. Results The HoNOS differentiated significantly between patients with moderate versus severe depression at baseline (p<0,05). It correlated with the HAMD change score (r=0,25, p<0,008), but not with the BDI change score (r=0,19, p>0,008).The HoNOS was not a significant predictor of observer-rated depression at discharge (ß=0,03, p>0,05). Conclusion As the HoNOS only partially seems to assess the change and severity of depressive symptoms, it should only be used in combination with depression-specific instruments.

Characterization of patients discharged from inpatient treatment for burnout: use of psychological characteristics to identify aftercare needs.

With increasing severity, burnout corresponds to a state of significant suffering with impaired social functioning, decreased quality of life, and psychosomatic complaints. The present study investigates (a) how former patients of an inpatient clinic for burnout therapy can be grouped on the basis of their psychological characteristics and (b) whether these groups correspond to different levels of residual symptoms (depression and burnout) and general mental health. Cluster analysis of psychological characteristics was used to form groups. Four specific groups could be identified (functionals, dysfunctionals, straightforward pragmatists, unhappy altruists). This grouping, with subsequent characterization according to symptom levels, provides important information indicating possible needs for aftercare and suggests areas for improvement of previous care.