Lotte Kring

DEPRE-ST: The Patient Perspective – A Mixed Methods Study of Treatment Success with Psychotherapy in Patients with Chronic and Treatment-Resistant Depression

Project description

Aim:
Using a mixed methods approach, this PhD project will examine patients’ expectations of and experiences with psychotherapeutic treatment for chronic treatment-resistant depression (CTRD). The project will compare patients’ perspectives both with those of relatives and therapists, and with outcomes at the symptom and functional levels, in order to gain knowledge about whether the way treatment success is assessed within Psychiatry in the Region of Southern Denmark and the Capital Region of Denmark aligns with patients’ needs.

Background

Studies show that evidence-based treatment of CTRD leads to recovery in approximately one third of patients. To date, the assessment of treatment effects has primarily focused on symptom measures based on diagnostic categories. In addition, the methodology of randomized controlled trials emphasizes a quantifiable primary outcome, which subsequently becomes the basis for treatment guidelines and quality monitoring. However, it is unclear whether a primary focus on symptoms as a measure of treatment effect is as valuable to patients as it is to the treatment system. It is therefore necessary to involve patients themselves and their relatives to gain greater insight into their expectations of what constitutes successful treatment.

So far, only limited research exists in this area, and existing studies show that symptom reduction is often not the only or the most important treatment goal for patients. Furthermore, there are significant differences in perspectives on treatment success between patients and clinicians.

Methods

The PhD project is based on an ongoing research project (DEPRE-ST) conducted across four psychiatric departments in the Region of Southern Denmark and the Capital Region of Denmark. DEPRE-ST is a randomized controlled trial (RCT) investigating treatment of CTRD using the psychotherapeutic approach schema therapy (ST) compared with Treatment As Usual (TAU).
(For more information about the RCT: https://www.psykiatri-regionh.dk/cndr/forskning/forskningsprojekter/DEPRE-ST-/Sider/default.aspx).
Participants for the present project are recruited from this population.

The project applies a mixed methods approach, with primary use of qualitative methods (in-depth interviews and participant observation). Twenty patients are recruited to participate in semi-structured interviews before and after their treatment course in the RCT. Ten of these patients are recruited as key informants, meaning that their close relatives also participate in interviews, and that the PhD student visits the patient and relative in their home and follows them in everyday situations (participant observation) to gain increased knowledge about relevant factors in their personal recovery.

A total of 20 individual pre-treatment interviews with patients and 10 individual pre-treatment interviews with relatives are conducted. In addition, 10 individual post-treatment interviews with patients and 10 joint post-treatment interviews with patients and relatives are conducted. Furthermore, 20 interviews with the patients’ primary therapist are conducted at treatment initiation. In total, 60 qualitative interviews are conducted, all of which are audio-recorded and subsequently transcribed. The qualitative data are analyzed using thematic analysis and general principles of ethnographic analysis.

The project will also compare the qualitative patient interviews with quantitative measures using PSYCHLOPS. PSYCHLOPS is a brief questionnaire in which patients themselves define and report 1–2 problems that trouble them the most and rate the severity of these problems on a 6-point Likert scale. PSYCHLOPS is administered in the parent study at treatment start and end. The post-treatment measure will thus indicate the effect of the treatment course in relation to the patient’s individual, self-defined treatment goals. It is expected that PSYCHLOPS constitutes a more precise and individualized quantitative measure of treatment success than standard outcome measures.

Perspective

Studies show that patients experience psychotherapy as part of a broader process of achieving a better life, highlighting the necessity of examining patients’ expectations of treatment from a wider perspective. For example, research within personal recovery shows that themes such as empowerment, agency, meaning in life, and positive social relationships are particularly significant. This line of research also emphasizes the importance of relatives, as they constitute a substantial part of patients’ everyday lives. When relatives are involved, they can function as support for patients during their treatment process and personal recovery. Studies show that patients and relatives often have different expectations regarding outcomes, and this project will therefore investigate and compare patients’ and relatives’ expectations of treatment from a recovery perspective.

Start date and expected end date: 01.08.2023 – 03.03.2027

Principal supervisor: Stine Bjerrum Møller, Associate Professor

Co-supervisors: Assistant Professor Yasuhiro Kotera, School of Health Sciences, University of Nottingham

Research group: The Danish Center of Psychotraumatology

Collaborating partners: Psychiatry in the Region of Southern Denmark and the Capital Region of Denmark

Keywords: Patient perspective, CTRD, treatment outcome, personal recovery, fieldwork.