A high physical symptom count reduces the effectiveness of treatment for depression, independently of chronic medical conditions

K.M. Huijbregts, F.J. de Jong, H.W.J. van Marwijk, A.T.F. Beekman, H.J. Adèr, C.M. van der Feltz-Cornelis

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Aim
To assess to what extent a high physical symptom count influences the effect of treatment for major depressive disorder (MDD), and whether or not actual comorbid medical conditions explain this relationship.
Method
Secondary data-analysis on a cluster-randomized trial in primary care, comparing the effectiveness of collaborative care with care as usual (CAU). MDD was measured using the PHQ-9. The Physical Symptoms Questionnaire (PSQ) was filled out at baseline by 115 patients (77.2% of those who entered the trial). Multilevel logistic regression models were used to test whether a high physical symptom count predicted lack of response to treatment, adding interaction terms to test differential effects on collaborative care versus CAU.
Results
A high physical symptom count negatively influenced the effect of both collaborative care and care as usual (no interaction). Specifically, a high physical symptom count predicted lack of response in both conditions at 3 (odds ratio = 6.8), 6 (OR = 4.1), and 9 months follow-up (OR = 6.4). This was not explained by chronic physical illness.
Conclusion
In this RCT, patients with MDD accompanied by a high physical symptom count benefited less from treatment for MDD in primary care, regardless of the type of treatment (either collaborative care or CAU). This was not explained by the presence of comorbid medical conditions. Further research is needed to improve treatment for MDD accompanied by a high physical symptom count, although collaborative care for depression is still more effective than CAU for this group of patients. Trial registration: Dutch trial register ISRCTN15266438.
Keywords: Depression, Collaborative care, Primary care, Concomitant physical symptoms, Somatization
Original languageEnglish
Pages (from-to)179-185
JournalJournal of Psychosomatic Research
Volume74
Issue number3
DOIs
Publication statusPublished - 2013

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Major Depressive Disorder
Depression
Logistic Models
Odds Ratio

Cite this

Huijbregts, K.M. ; de Jong, F.J. ; van Marwijk, H.W.J. ; Beekman, A.T.F. ; Adèr, H.J. ; van der Feltz-Cornelis, C.M. / A high physical symptom count reduces the effectiveness of treatment for depression, independently of chronic medical conditions. In: Journal of Psychosomatic Research. 2013 ; Vol. 74, No. 3. pp. 179-185.
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title = "A high physical symptom count reduces the effectiveness of treatment for depression, independently of chronic medical conditions",
abstract = "AimTo assess to what extent a high physical symptom count influences the effect of treatment for major depressive disorder (MDD), and whether or not actual comorbid medical conditions explain this relationship.MethodSecondary data-analysis on a cluster-randomized trial in primary care, comparing the effectiveness of collaborative care with care as usual (CAU). MDD was measured using the PHQ-9. The Physical Symptoms Questionnaire (PSQ) was filled out at baseline by 115 patients (77.2{\%} of those who entered the trial). Multilevel logistic regression models were used to test whether a high physical symptom count predicted lack of response to treatment, adding interaction terms to test differential effects on collaborative care versus CAU.ResultsA high physical symptom count negatively influenced the effect of both collaborative care and care as usual (no interaction). Specifically, a high physical symptom count predicted lack of response in both conditions at 3 (odds ratio = 6.8), 6 (OR = 4.1), and 9 months follow-up (OR = 6.4). This was not explained by chronic physical illness.ConclusionIn this RCT, patients with MDD accompanied by a high physical symptom count benefited less from treatment for MDD in primary care, regardless of the type of treatment (either collaborative care or CAU). This was not explained by the presence of comorbid medical conditions. Further research is needed to improve treatment for MDD accompanied by a high physical symptom count, although collaborative care for depression is still more effective than CAU for this group of patients. Trial registration: Dutch trial register ISRCTN15266438.Keywords: Depression, Collaborative care, Primary care, Concomitant physical symptoms, Somatization",
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A high physical symptom count reduces the effectiveness of treatment for depression, independently of chronic medical conditions. / Huijbregts, K.M.; de Jong, F.J.; van Marwijk, H.W.J.; Beekman, A.T.F.; Adèr, H.J.; van der Feltz-Cornelis, C.M.

In: Journal of Psychosomatic Research, Vol. 74, No. 3, 2013, p. 179-185.

Research output: Contribution to journalArticleScientificpeer-review

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T1 - A high physical symptom count reduces the effectiveness of treatment for depression, independently of chronic medical conditions

AU - Huijbregts, K.M.

AU - de Jong, F.J.

AU - van Marwijk, H.W.J.

AU - Beekman, A.T.F.

AU - Adèr, H.J.

AU - van der Feltz-Cornelis, C.M.

PY - 2013

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N2 - AimTo assess to what extent a high physical symptom count influences the effect of treatment for major depressive disorder (MDD), and whether or not actual comorbid medical conditions explain this relationship.MethodSecondary data-analysis on a cluster-randomized trial in primary care, comparing the effectiveness of collaborative care with care as usual (CAU). MDD was measured using the PHQ-9. The Physical Symptoms Questionnaire (PSQ) was filled out at baseline by 115 patients (77.2% of those who entered the trial). Multilevel logistic regression models were used to test whether a high physical symptom count predicted lack of response to treatment, adding interaction terms to test differential effects on collaborative care versus CAU.ResultsA high physical symptom count negatively influenced the effect of both collaborative care and care as usual (no interaction). Specifically, a high physical symptom count predicted lack of response in both conditions at 3 (odds ratio = 6.8), 6 (OR = 4.1), and 9 months follow-up (OR = 6.4). This was not explained by chronic physical illness.ConclusionIn this RCT, patients with MDD accompanied by a high physical symptom count benefited less from treatment for MDD in primary care, regardless of the type of treatment (either collaborative care or CAU). This was not explained by the presence of comorbid medical conditions. Further research is needed to improve treatment for MDD accompanied by a high physical symptom count, although collaborative care for depression is still more effective than CAU for this group of patients. Trial registration: Dutch trial register ISRCTN15266438.Keywords: Depression, Collaborative care, Primary care, Concomitant physical symptoms, Somatization

AB - AimTo assess to what extent a high physical symptom count influences the effect of treatment for major depressive disorder (MDD), and whether or not actual comorbid medical conditions explain this relationship.MethodSecondary data-analysis on a cluster-randomized trial in primary care, comparing the effectiveness of collaborative care with care as usual (CAU). MDD was measured using the PHQ-9. The Physical Symptoms Questionnaire (PSQ) was filled out at baseline by 115 patients (77.2% of those who entered the trial). Multilevel logistic regression models were used to test whether a high physical symptom count predicted lack of response to treatment, adding interaction terms to test differential effects on collaborative care versus CAU.ResultsA high physical symptom count negatively influenced the effect of both collaborative care and care as usual (no interaction). Specifically, a high physical symptom count predicted lack of response in both conditions at 3 (odds ratio = 6.8), 6 (OR = 4.1), and 9 months follow-up (OR = 6.4). This was not explained by chronic physical illness.ConclusionIn this RCT, patients with MDD accompanied by a high physical symptom count benefited less from treatment for MDD in primary care, regardless of the type of treatment (either collaborative care or CAU). This was not explained by the presence of comorbid medical conditions. Further research is needed to improve treatment for MDD accompanied by a high physical symptom count, although collaborative care for depression is still more effective than CAU for this group of patients. Trial registration: Dutch trial register ISRCTN15266438.Keywords: Depression, Collaborative care, Primary care, Concomitant physical symptoms, Somatization

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JO - Journal of Psychosomatic Research

JF - Journal of Psychosomatic Research

SN - 0022-3999

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