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Subgroup analyses of a concise care trial of depressive and/or anxiety disorders

Denise Meuldijk, Erik J Giltay, Ingrid V E Carlier, Irene M van Vliet, Albert M van Hemert, Frans G Zitman


Rationale, aims and objectives: Concise forms of psychotherapy and psychopharmacotherapy have shown clinical effectiveness. Identifying the factors that predict who is most likely to benefit from such treatment may help to deliver the most adequate and person-centered care. 

Methods: Secondary care outpatients aged 18-65 years with mild to moderate DSM-IV depressive and/or anxiety disorders, participated in a pragmatic randomized controlled equivalence trial comparing a concise format of cognitive behavioural  and/or pharmacotherapy (i.e., concise care) to standard care. A range of putative factors associated with treatment outcome - socio-demographic characteristics and clinical characteristics - were assessed at baseline. Subgroup analyses were conducted analyzing the effects of interaction terms on changes over time in the Brief Symptom Inventory (BSI) scores as the outcome measure.

Results: A total of 182 participants were included and randomized to concise care (n = 93) and to standard care (n = 89). Participants were on average 36.5 (SD 12.3) years old and 61% were women. Patients suffering from any ‘anxiety (without depressive) disorder’ benefited significantly less from concise care than standard care (P = 0.012).

Conclusions: The benefit of a concise form of psychotherapy and pharmacotherapy was independent from demographic and clinical characteristics. Only patients with anxiety (without depressive) disorders benefit less from concise treatment.


Concise care, depressive and anxiety disorders, person-centered healthcare, predictors of outcome, randomized controlled equivalence trial, routine clinical practice, Routine Outcome Monitoring (ROM)

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Knekt, P. & Lindfors, O. (2004). A randomized trial of the effect of four forms of psychotherapy on depressive and anxiety disorders. Design, methods, and results on the effectiveness of short-term psychodynamic psychotherapy and solution-focused therapy during a one-year follow-up. Studies in social security and health. The Social Insurance Institution, Helsinki.

Knekt, P., Lindfors, O., Härkänen, T., Välikoski, M., Laaksonen, M.A., Marttunen, M., Kaipainen, M., Renlund, C. & Helsinki Psychotherapy Study Group. (2008). Randomized trial on the effectiveness of long-and short-term psychodynamic psychotherapy and solution-focused therapy on psychiatric symptoms during a 3-year follow-up. Psychological Medicine 38 (5) 689-703.

van Straten, A., Tiemens, B., Hakkaart, L., Nolen, W.A. & Donker, M.C. (2006). Stepped care vs. matched care for mood and anxiety disorders: a randomized trial in routine practice. Acta Psychiatrica Scandinavica 113 (6) 468-476.

Driessen, E., Van, H.L., Don, F.J., Peen, J., Kool, S., Westra, D., Hendriksen, M., Schoevers, R.A., Cuijpers, P., Twisk, J.W. & Dekker, J.J. (2013). The efficacy of cognitive-behavioral therapy and psychodynamic therapy in the outpatient treatment of major depression: a randomized clinical trial. American Journal of Psychiatry 170 (9) 1041-1050.

Meuldijk, D., Carlier, I.V., van Vliet, I.M., van Veen, T., Wolterbeek, R., van Hemert, A.M. & Zitman, F.G. (2016). The clinical effectiveness of concise cognitive behavioral therapy with or without pharmacotherapy for depressive and anxiety disorders; a pragmatic randomized controlled equivalence trial in clinical practice. Contemporary Clinical Trials 47, 131-138.

Frank, E., Rucci, P., Katon, W., Barrett, J., Williams, J.W. Jnr., Oxman, T., Sullivan, M. & Cornell, J. (2002). Correlates of remission in primary care patients treated for minor depression. General Hospital Psychiatry 24 (1) 12-19.

Joutsenniemi, K., Laaksonen, M.A., Knekt, P., Haaramo, P. & Lindfors, O. (2012). Prediction of the outcome of short- and long-term psychotherapy based on socio-demographic factors. Journal of Affective Disorders 141 (2-3) 331-342.

van Noorden, M.S., Van Fenema, E.M., van der Wee, N.J., van Rood, Y.R., Carlier, I.V., Zitman, F.G. & Giltay, E.J. (2012). Predicting outcomes of mood, anxiety and somatoform disorders: the Leiden routine outcome monitoring study. Journal of Affective Disorders 142 (1-3) 122-131.

Nilsen, T.S., Eisemann, M. & Kvernmo, S. (2013). Predictors and moderators of outcome in child and adolescent anxiety and depression: a systematic review of psychological treatment studies. European Child & Adolescent Psychiatry 22 (2) 69-87.

Meyers, B.S., Sirey, J.A., Bruce, M., Hamilton, M., Raue, P., Friedman, S.J., Rickey, C., Kakuma, T., Carroll, M.K., Kiosses, D. & Alexopoulos, G. (2002). Predictors of early recovery from major depression among persons admitted to community-based clinics: an observational study. Archives of General Psychiatry 59 (8) 729-735.

Weinberger, M.I., Sirey, J.A., Bruce, M.L., Heo, M., Papademetriou, E. & Meyers, B.S. (2008). Predictors of major depression six months after admission for outpatient treatment. Psychiatric Services 59 (10) 1211-1215.

Yonkers, K.A., Dyck, I.R., Warshaw, M. & Keller, M.B. (2000). Factors predicting the clinical course of generalised anxiety disorder. British Journal of Psychiatry 176, 544-549.

Schat, A., van Noorden, M.S., Noom, M.J., Giltay, E.J., van der Wee, N.J., Vermeiren, R.R. & Zitman, F.G. (2013). Predictors of outcome in outpatients with anxiety disorders: the Leiden routine outcome monitoring study. Journal of Psychiatric Research 47 (12) 1876-1885.

Penninx, B.W., Nolen, W.A., Lamers, F., Zitman, F.G., Smit, J.H., Spinhoven, P., Cuijpers, P., de Jong, P.J., van Marwijk, H.W., van der Meer, K., Verhaak, P., Laurant, M.G., de Graaf, R., Hoogendijk, W.J., van der Wee, N., Ormel, J., van Dyck, R. & Beekman, A.T. (2011). Two-year course of depressive and anxiety disorders: results from the Netherlands Study of Depression and Anxiety (NESDA). Journal of Affective Disorders 133 (1-2) 76-85.

Brent, D.A., Kolko, D.J., Birmaher, B., Baugher, M., Bridge, J., Roth, C. & Holder, D. (1998). Predictors of treatment efficacy in a clinical trial of three psychosocial treatments for adolescent depression. Journal of the American Academy of Child and Adolescent Psychiatry 37 (9) 906-914.

Bruce, S.E., Yonkers, K.A., Otto, M.W., Eisen, J.L., Weisberg, R.B., Pagano, M., Shea, M.T. & Keller, M.B. (2005). Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. American Journal of Psychiatry 162 (6) 1179-1187.

Ormel, J., Oldehinkel, T., Brilman, E. & van den Brink, W. (1993). Outcome of depression and anxiety in primary care. A three-wave 3 1/2-year study of psychopathology and disability. Archives of General Psychiatry 50 (10) 759-766.

Hofmann, S.G., Asnaani, A., Vonk, I.J., Sawyer, A.T. & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy and Research 36 (5) 427-440.

Spek, V., Cuijpers, P., Nyklicek, I., Riper, H., Keyzer, J. & Pop, V. (2007). Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychological Medicine 37 (3) 319-328.

Butler, A.C., Chapman, J.E., Forman, E.M. & Beck, A.T. (2006). The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clinical Psychology Review 26 (1) 17-31.

Meuldijk, D., Carlier, I.V., van Vliet, I.M., van den Akker-Marle, M.E. & Zitman, F.G. (2012). A randomized controlled trial of the efficacy and cost-effectiveness of a brief intensified cognitive behavioral therapy and/or pharmacotherapy for mood and anxiety disorders: design and methods. Contemporary Clinical Trials 33 (5) 983-992.

Meuldijk, D., Carlier, I.V., van Vliet, I.M., van Hemert, A.M., Zitman, F.G. & van den Akker-van Marle, M.E. (2015). Economic Evaluation of Concise Cognitive Behavioural Therapy and/or Pharmacotherapy for Depressive and Anxiety Disorders. Journal of Mental Health Policy and Economics 18 (4) 175-183.

Hopewell, S., Clarke, M., Moher, D., Wager, E., Middleton, P., Altman, D.G., Schulz, K.F. & CONSORT Group. (2008). CONSORT for reporting randomized controlled trials in journal and conference abstracts: explanation and elaboration. PLoS Medicine 5 (1) e20.

Moher, D., Hopewell, S., Schulz, K.F., Montori, V., Gøtzsche, P.C., Devereaux, P.J., Elbourne, M. & Altman, D.G. (2010). CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. British Medical Journal 340, c869.

Campbell, M.K., Elbourne, D.R. & Altman, D.G. (2004). CONSORT statement: extension to cluster randomised trials. British Medical Journal 328 (7441) 702-708.

Zwarenstein, M., Treweek, S., Gagnier, J.J., Altman, D.G., Tunis, S., Haynes, B., Oxman, A.D., Moher, D., CONSORT group & Pragmatic Trials in Healthcare (Pracihc) group. (2008). Improving the reporting of pragmatic trials: an extension of the CONSORT statement. British Medical Journal 337, a2390.

American Psychiatric Association (APA). (1994). Diagnostic and Statistical Manual of Mental Disorders. 4th Edition. Text Revision (DSM-IV-TR). Washington, DC: APA.

Guy, W. (1976). ECDEU Assessment Manual for Psychopharmacology. Rockville, MD: National Institute of Mental Health.

Clark, D.M. & Salkovskis, P.M. (1987). Cognitive Treatment for panic attacks: Therapist's Manual. Department of Psychiatry, University of Oxford.

Beck, J.S. (1995). Cognitive Therapy: basic and beyond. New York: Guilford Press.

Shapiro, F. (1995). Eye Movement Desensitization and Reprocessing (EMDR): Basic Principles, Protocols. New York: Guilford Press.

[http:]. Mental health guidelines (in Dutch) []. 2015.

Davison, G.C. (2000). Stepped care: doing more with less? Journal of Consulting and Clinical Psychology 68 (4) 580-585.

Haaga, D.A. (2000). Introduction to the special section on stepped care models in psychotherapy. Journal of Consulting and Clinical Psychology 68 (4) 547-548.

Donker, T., van Straten, A., Marks, I. & Cuijpers, P. (2009). A brief Web-based screening questionnaire for common mental disorders: development and validation. Jouirnal of Medical Internet Research 11 (3) e19.

Sheehan, D.V., Lecrubier, Y., Sheehan, K.H., Amorim, P., Janavs, J., Weiller, E., Herqueta, T., Baker, R. & Dunbar, G.C. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59 (Supplement 20) 22-33.

Van Vliet, I.M. & de Beurs, E. (2007). The MINI-International Neuropsychiatric Interview. A brief structured diagnostic psychiatric interview for DSM-IV en ICD-10 psychiatric disorders. Tijdschrift Voor Psychiatrie 49 (6) 393-397.

Lecrubier, Y., Sheehan, D.V., Weiller, E., Amorim, P., Bonora, I., Harnett Sheehan, K. & Janvas, J. (1997). The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. European Psychiatry 12 (5) 224-231.

Derogatis, L.R. (1975). The Brief Symptom Inventory. Baltimore, MD: Clinical Psychometric Research.

de Beurs, E., den Hollander-Gijsman, M.E., van Rood, Y.R., van der Wee, N.J., Giltay, E.J., van Noorden, M.S., van der Lem, R., van Fenema, E. & Zitman, F.G. (2011). Routine outcome monitoring in the Netherlands: practical experiences with a web-based strategy for the assessment of treatment outcome in clinical practice. Clinical Psychology & Psychotherapy 18 (1) 1-12.

Derogatis, L.R. & Melisaratos, N. (1983). The Brief Symptom Inventory: an introductory report. Psychological Medicine 13 (3) 595-605.

Cohen, J. (1992). A power primer. Psychological Bulletin 112 (1) 155-159.

Schulte-van Maaren, Y.W., Carlier, I.V., Zitman, F.G., van Hemert, A.M., de Waal, M.W., van Noorden, M.S. & Giltay, E.J. (2012). Reference values for generic instruments used in routine outcome monitoring: the Leiden Routine Outcome Monitoring Study. BMC Psychiatry 12, 203.

Lindfors, O., Knekt, P., Heinonen, E. & Virtala, E. (2014). Self-concept and quality of object relations as predictors of outcome in short- and long-term psychotherapy. Journal of Affective Disorders 152-154, 202-211.

Sotsky, S.M., Glass, D.R., Shea, M.T., et al. Patient predictors of response to psychotherapy and pharmacotherapy: findings in the NIMH Treatment of Depression Collaborative Research Program. American Journal of Psychiatry 148 (8) 997-1008.

Crits-Christoph, P., Gibbons, M.B.C., Losardo, D., Narducci, J., Schamberger, M. & Gallop, R. (2004). Who benefits from brief psychodynamic therapy for generalized anxiety disorder? Canadian Journal of Psychoanalysis 12, 301-324.

Ehlers, A., Clark, D.M., Hackmann, A., McManus, F. & Fennell, M. (2005). Cognitive therapy for post-traumatic stress disorder: development and evaluation. Behaviour Research and Therapy 43 (4) 413-431.

Jakubovski, E., Diniz, J.B., Valerio, C., Fossaluza, V., Belotto-Silva, C., Gorenstein, C., Miquel, E. & Shavitt, R.G. (2013). Clinical predictors of long-term outcome in obsessive-compulsive disorder. Depression and Anxiety 30 (8) 763-772.

Laaksonen, M.A., Knekt, P. & Lindfors, O. (2013). Psychological predictors of the recovery from mood or anxiety disorder in short-term and long-term psychotherapy during a 3-year follow-up. Psychiatry Research 208 (2) 162-173.

Laaksonen, M.A., Sirkia, C., Knekt, P. & Lindfors, O. (2014). Self-reported immature defense style as a predictor of outcome in short-term and long-term psychotherapy. Brain and Behavior 4 (4) 495-503.

Keller, M.B. (2003). The lifelong course of social anxiety disorder: a clinical perspective. Acta Psychiatrica Scandinavica Supplementum (417), 85-94.

Keller, M.B. (2006). Social anxiety disorder clinical course and outcome: review of Harvard/Brown Anxiety Research Project (HARP) findings. Journal of Clinical Psychiatry 67 (Supplement 12) 14-19.

Keller, M.B. & Hanks, D.L. (1993). Course and outcome in panic disorder. Progress in Neuro-Psychopharmacology & Biological Psychiatry 17 (4) 551-570.

Pollack, M.H. & Otto, M.W. (1997). Long-term course and outcome of panic disorder. Journal of Clinical Psychiatry 58 (Supplement 2) 57-60.

Tiemens, B.G., Ormel, J. & Simon, G.E. (1996). Occurrence, recognition, and outcome of psychological disorders in primary care. American Journal of Psychiatry 153 (5) 636-644.

Angst, J. & Vollrath, M. (1991). The natural history of anxiety disorders. Acta Psychiatrica Scandanavica 84 (5) 446-452.

Rhebergen, D., Batelaan, N.M., de Graaf, R., Nolen, W.A., Spijker, J., Beekman, A.T. & Penninx, B.W. (2011). The 7-year course of depression and anxiety in the general population. Acta Psychiatrica Scandinavica 123 (4) 297-306.

Cuijpers, P., Sijbrandij, M., Koole, S.L., Andersson, G., Beekman, A.T. & Reynolds, C.F., III. (2013). The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons. World Psychiatry 12 (2) 137-148.

Lewis, A.J., Dennerstein, M. & Gibbs, P.M. (2008). Short-term psychodynamic psychotherapy: review of recent process and outcome studies. Australian & New Zealand Journal of Psychiatry 42 (6) 445-455.

Abbass, A.A., Kisely, S.R., Town, J.M., Leichsenring, F., Driessen, E., De Maat, S., Gerber, A., Dekker, J., Rabung, S., Rusalovska, S. & Crowe, E. (2014). Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database of Systematic Reviews 7, CD004687.

Bressi, C., Porcellana, M., Marinaccio, P.M., Nocito, E.P. & Magri, L. (2010). Short-term psychodynamic psychotherapy versus treatment as usual for depressive and anxiety disorders: a randomized clinical trial of efficacy. Journal of Nervous and Mental Disease 198 (9) 647-652.

Leichsenring, F., Rabung, S. & Leibing, E. (2004). The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: a meta-analysis. Archives of General Psychiatry 61 (12) 1208-1216.



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