Quality of marital relationship and depression: results of a 10-year prospective follow-up study.

BACKGROUND: Although the long-term course of depression has been intensively examined, there are only few studies on the long-term development of depressed patients' spousal relationships. The aim of the study was to assess the quality and stability of depressed patients' spousal relationships in the long-term course of depression and to identify predictors of relationship outcome. METHODS: In the study, 50 inpatients with Major Depression were followed-up one, two and ten years after discharge from hospital and compared to a healthy control group matched by age and sex. Marital satisfaction was measured by the Terman item. Expressed Emotion (EE) was assessed with the Five-Minute Speech Sample (FMSS) and the Perceived Criticism Index (PC). RESULTS: In the follow-up period of ten years, 26 patients (56.5%) had a recurrence. Ten years after discharge from hospital 8 couples were separated, 11 were unhappy and 26 couples were happy with their spousal relationship. The quality of marital relationship decreased over the follow-up period. In comparison to a healthy control group, patients showed a significantly worse quality of marital relationship at follow-up. Besides age and course of depression, the spousal EE status was a prognostic factor for the quality of the relationship after 10 years. CONCLUSIONS: The results confirm the decrease of marital satisfaction over time in the long-term course of depression. Identified interpersonal predictors of the quality of spousal relationship in major depression could be used as indication criteria for couple therapy.

Expressed emotion, perceived criticism and 10-year outcome of depression.

Outcome studies of patients suffering from depression indicate a high relapse rate and a tendency towards chronicity. A family atmosphere characterised by expressed emotion (EE) and perceived criticism (PC) was reported to be a robust predictor of outcome in affective disorders. The aim of the study was to analyze the association between EE, PC and long-term outcome of depression. Fifty inpatients with major depression were followed up 1, 2 and 10 years after discharge from the hospital. After 10 years, 26 patients (56.5%) had at least one recurrence. Spousal EE, assessed with the Five-Minute Speech Sample (FMSS), and the Perceived Criticism Index (PCI) were not significant prognostic factors for depression outcome. The significance of EE and PC for the long-term course of depression has to be questioned. The findings indicate a need to examine factors that may partly mediate the effect of EE and PC on the outcome of depression.

Knowledge about affective disorders and outcome of depression.

BACKGROUND: For affective disorders, imparting information about the illness has become standard treatment. Despite the great clinical relevance of knowledge about depression, few empirical studies on this subject have been carried out. The aim of the study was to identify the prognostic value of knowledge about affective disorders for the two year outcome of depression. METHODS: 62 first-hospitalised patients with major depression were recruited and tested with the Knowledge about Depression and Mania Inventory (KDMI). The patients were followed-up after 1 and 2 years. RESULTS: In the 2-year follow-up period, 28 patients (45.2%) had a recurrent or chronic course of depression. Patients with stable remission had significantly more knowledge about affective disorders compared to patients with recurrence or chronic depression. Knowledge about treatment was prognostically relevant whereas knowledge about symptoms and knowledge about coping were not. CONCLUSIONS: The results show that knowledge about affective disorders and especially knowledge about treatment is a predictor for the outcome of depression. This indicates the necessity of multidimensional assessment of knowledge about disorder. Future studies should examine the mechanisms underlying the prognostic effect in order to improve treatment of depression.

[Efficacy of psychodynamic short-term psychotherapy for children and adolescents with behavioral disorders]. / Zur Wirksamkeit psychodynamischer Kurzzeit- psychotherapie bei Kindern und Jugendlichen mit Verhaltensstörungen.

Behavioral disorders represent one of the most frequent mental disorders in children and adolescents. Even though psychodynamic psychotherapies are often used to treat behavioral disorders, to date, its efficacy has rarely been empirically evaluated. The aim of the study therefore was to evaluate psychodynamic short-term psychotherapy (PSTP) for children and adolescents with behavioral disorders. By means of a waiting-list controlled study, 26 children and adolescents fulfilling diagnosis of behavioral disorders were examined. The treatment group received 25 sessions of psychodynamic psychotherapy. Primary criterion of outcome was the Impairment-Score for Children and Adolescents (IS-CA). Furthermore, the Child Behavior Checklist (CBCL) and the Psychic and Social-Communicative Findings Sheet for Children and Adolescents (PSCFS-CA) were administered at the beginning and end of the treatment. The statistical as well as the clinical significance of changes during treatment were analysed. It could be shown, that the treatment group improved significantly more in the Impairment-Score for children and adolescents (IS-CA) compared to the waiting group. The effect size of the IS-CA total score was 0,6. 31% of the children in the treatment group improved clinically significantly or according to the criterion of Reliable Change, whereas that was the case only for 8 % of the subject in the waiting list condition. A significant advantage was found for the therapy group in the PSCFS-CA. Effect sizes were between 0.8 and 1.4. In the CBCL significant improvement could be shown for the treatment and control group however only with small effects. These results substantiate that psychodynamic short-term psychotherapy (PSTP) is an effective intervention for children and adolescents with behavioral disorders. However, the findings also show that some of the children and adolescents are in need of a more intensive or long-term treatment.