ABSTRACT
BACKGROUND AND METHOD: This naturalistic study was undertaken in routine settings and compared the clinical effectiveness, costs, treatment preference, attrition and patient satisfaction of Group and Individual CBT. RESULTS: No significant differences were found in depressive and distress symptoms between group and individual CBT at post-treatment and follow-up. Individual CBT was 1.5 times more expensive to provide than Group CBT and the wider costs of other supports were similar between study arms suggesting a cost-effectiveness advantage for Group CBT. Patients preferred individual treatment at baseline but, despite this, there were no between-group differences in attrition or satisfaction. CONCLUSION: A larger RCT study is needed, but running CBT groups for depression could be considered more frequently by clinicians.
Subject(s)
Cognitive Behavioral Therapy/economics , Depressive Disorder/economics , Depressive Disorder/therapy , Patient Acceptance of Health Care/psychology , Psychotherapy, Group/economics , Adult , Cost-Benefit Analysis , Depressive Disorder/psychology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Satisfaction , Treatment Outcome , United Kingdom , Young AdultABSTRACT
BACKGROUND: Depression and anxiety are common in Parkinson's disease (PD) and although clinically important remain poorly understood and managed. To date, research has tended to treat depression and anxiety as distinct phenomena. There is growing evidence for heterogeneity in PD in the motor and cognitive domains, with implications for pathophysiology and outcome. Similar heterogeneity may exist in the domain of depression and anxiety. OBJECTIVE: To identify the main anxiety and depression related subtype(s) in PD and their associated demographic and clinical features. METHODS: A sample of 513 patients with PD received a detailed assessment of depression and anxiety related symptomatology. Latent Class Analysis (LCA) was used to identify putative depression and anxiety related subtypes. Results LCA identified four classes, two interpretable as 'anxiety related': one anxiety alone (22.0%) and the other anxiety coexisting with prominent depressive symptoms (8.6%). A third subtype (9%) showed a prominent depressive profile only without significant anxiety. The final class (60.4%) showed a low probability of prominent affective symptoms. The validity of the four classes was supported by distinct patterns of association with important demographic and clinical variables. CONCLUSION: Depression in PD may manifest in two clinical phenotypes, one 'anxious-depressed' and the other 'depressed'. However, a further large proportion of patients can have relatively isolated anxiety. Further study of these putative phenotypes may identify important differences in pathophysiology and other aetiologically important factors and focus research on developing more targeted and effective treatment.
