Journal Article

Effectiveness of telephone-based aftercare case management for adult patients with unipolar depression compared to usual care: A randomized controlled trial

Bailer, Harald, Melchior, Hanne, Härter, Martin, Zahn, Sabine, Kriston, Levente, Christalle, Eva, Götzmann, Lutz, Kivelitz, Laura, Schulz, Holger, Watzke, Birgit

2017

Overview

Patients with depression often have limited access to outpatient psychotherapy following inpatient treatment. The objective of the study was to evaluate the long-term effectiveness of a telephone-based aftercare case management (ACM) intervention for patients with depression. We performed a prospective randomized controlled trial in four psychotherapeutic inpatient care units with N = 199 patients with major depression or dysthymia (F32.x, F33.x, F34.1, according to the ICD-10). The ACM consisted of six phone contacts at two-week intervals performed by trained and certified psychotherapists. The control group received usual care (UC). The primary outcome was depressive symptom severity (BDI-II) at 9-month follow-up, and secondary outcomes were health-related quality of life (SF-8, EQ-5D), self-efficacy (SWE), and the proportion of patients initiating outpatient psychotherapy. Mixed model analyses were conducted to compare improvements between treatment groups. Regarding the primary outcome of symptom severity, the groups did not significantly differ after 3 months (p = .132; ES = -0.23) or at the 9-month follow-up (p = .284; ES = -0.20). No significant differences in health-related quality of life or self-efficacy were found between groups. Patients receiving ACM were more likely to be in outpatient psychotherapy after 3 months (OR: 3.00[1.12-8.07]; p = .029) and 9 months (OR: 4.78 [1.55-14.74]; p = .006) than those receiving UC. Although telephone-based ACM did not significantly improve symptom severity, it seems to be a valuable approach for overcoming treatment barriers to the clinical pathways of patients with depression regarding their access to outpatient psychotherapy.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Access control / Adult / Aftercare / Care and treatment / Case Management / Clinical trials / Continuity of care / Depression (Mood disorder) / Depressive Disorder - therapy / Female / Health aspects / Humans / Male / Medicine and Health Sciences / Mental depression / Mental disorders / Middle Aged / Patients / Primary care / Prospective Studies / Psychological aspects / Psychology / Psychotherapy / Quality of life / Randomization / Research and Analysis Methods / Risk factors / Studies / Telephone / Treatment Outcome / Young adults