Transcript Resultaten SCEPTRE

Effectiveness of different forms of
psychotherapy for patients with
cluster C personality disorder
Anna Bartak
Marieke D. Spreeuwenberg, Helene Andrea, Jan J.V. Busschbach,
Roel Verheul, Theo Stijnen, Paul M.G. Emmelkamp
Study on Cost-Effectiveness of Personality Disorder Treatment
(SCEPTRE)
Xth International ISSPD Congress, The Hague, September 2007
Background
• Few effectiveness studies cluster C
• Focus on theoretical orientations
– Mostly no differences found
• Few comparisons of “dosage”
– Ethical problems with randomisation
 SCEPTRE: Dosage comparison using a quasiexperimental design
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Sample
• N = 361
• Mean age = 33.5 (SD=9.5)
• 70.1 % women
• 29.9 % men
•
•
•
•
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67.3 % pure cluster C
23.3 % cluster C & cluster B
3.9 % cluster C & cluster A
5.5 % cluster C & cluster A & B
Treatment
• Psychotherapy
• Different “dosage” groups:
– Outpatient up to 6 months
– Outpatient more than 6 months
– Day hospital up to 6 months
– Day hospital more than 6 months
– Inpatient up to 6 months
– Inpatient more than 6 months
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(not incl.)
(n=63)
(n=83)
(n=66)
(n=75)
(n=74)
Outcome measures
1. GSI (SCL-90)
–
Psychological symptom distress
2. OQ-45
–
–
Social role functioning
Interpersonal functioning
3. EQ-5D
–
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Quality of Life
Times of measurement
• Variable
• Effect modelling for outcome at 12 months
after baseline
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Raw change in symptom distress
Unpublished – Do not quote
GSI
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3,5
3
2,5
2
1,5
1
0,5
Baseline
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12 months after baseline
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0
Raw change in social functioning
Unpublished – Do not quote
OQ-45 Social Role
25
20
15
10
5
Baseline
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12 months after baseline
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0
Raw change in interpersonal
functioning
Unpublished – Do not quote
OQ-45 Interpersonal Functioning
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30
25
20
15
10
5
Baseline
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12 months after start baseline
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0
Raw change in quality of life
Unpublished – Do not quote
EuroQoL EQ-5D Quality of Life
1,2
1
0,8
0,6
0,4
0,2
Baseline
10
12 months after baseline
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Recovered?
Raw recovery rates
Unpublished – Do not quote
Percentages recovered, improved, unchanged, deteriorated
Treatment group
Recovered
Improved
Unchanged
Deteriorated
Long outpatient Short day hospital Long day hospital Short inpatient Long inpatient
24,0%
21,9%
35,1%
66,7%
40,8%
16,0%
9,6%
21,1%
13,0%
15,8%
56,0%
61,6%
33,3%
18,5%
35,5%
4,0%
6,8%
10,5%
1,9%
7,9%
To compare: in Dutch mental health services, 60% of patients remain
‘unchanged’ after treatment (GAF, data from 2006)
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Unbiased effects of different
treatment dosages
• Comparison of five different dosages
• But: pre-treatment differences of patients
Propensity score (PS)
“the conditional probability of assignment to a
certain treatment group, given the set of
observed pre-treatment characteristics”
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Propensity Score
• Dimensional
Assessment of
Personality Pathology
(DAPP-BQ)
• Motivation
• Quality of Life
(EQ-5D)
• Functioning (OQ-45)
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• Symptom Distress
(GSI)
• Severity Indices of
Personality
Problems (SIPP)
• Diagnosis
(SIDP-IV)
• Age
Comparison
• Difference scores: Diff = Diff 1 – Diff 2
Diff 2
Diff 1
Treatment 1
e
in
l
e
as
B
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Treatment 2
12
m
o
hs
t
n
e
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as
B
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m
o
hs
t
n
Symptom distress
Unpublished – Do not quote
GSI - Difference score
Treatment group
Long outpatient
Short day hospital
Long day hospital
Short inpatient
β
β
β
β
Long outpatient
Short day hospital
-0.03034
Long day hospital
-0.00378
0.02656
Short inpatient
0.3915*
0.4218**
0.3952**
Long inpatient
0.1417
0.172
0.1455
* p < 0.05 ** p < 0.01 *** p < 0.001
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-0.2498
Functioning
Unpublished – Do not quote
OQ Social Role - Difference score
Treatment group
Long outpatient
β
Long outpatient
Short day hospital
Long day hospital
Short inpatient
Long inpatient
-17995
-18675
0.9781
-0.06833
Short day hospital
β
-0.06802
2.7776**
11162
Long day hospital
β
2.8456*
11842
Short inpatient
β
-16614
* p < 0.05 ** p < 0.01 *** p < 0.001
OQ Interpersonal Relations - Difference score
Treatment group
Long outpatient
β
Long outpatient
Short day hospital
Long day hospital
Short inpatient
Long inpatient
* p < 0.05 ** p < 0.01 *** p < 0.001
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-0.6291
-0.6055
24447
0.01114
Short day hospital
β
0.02362
3.0738*
0.6402
Long day hospital
β
3.0502*
0.6166
Short inpatient
β
-24336
Quality of life
Unpublished – Do not quote
EuroQoL EQ-5D - Difference score
Treatment group
Long outpatient
Short day hospital
Long day hospital
Short inpatient
β
β
β
β
Long outpatient
Short day hospital
-0.04931
Long day hospital
-0.01274
0.03657
Short inpatient
0.0879
0.1372**
0.1006
Long inpatient
-0.02031
0.02901
-0.00756
* p < 0.05 ** p < 0.01 *** p < 0.001
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-0.1082*
Conclusion
• Patients with cluster C personality pathology
improve during psychotherapy
• Short inpatient therapy (up to 6 months) shows
the highest improvement at 12 months after
baseline, in terms of symptom distress, social
and interpersonal functioning, and quality of life
[email protected]
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