Outcomes of combined treatment: A person-centered study of patients receiving medication and psychotherapy for depression
In the United States, nearly half of the 14.8 million individuals suffering a major depressive episode receive combined medication and psychotherapy treatment. However, research has yet to use rigorous empirical methods to examine differential patient outcomes in different combined treatment delivery models. The primary objective of the current study was to identify predictors of patient satisfaction and adherence in combined treatment based on interactions between treatment models, patient characteristics, and therapeutic relationship for patients in split treatment, when two clinicians administer treatments, and integrated treatment, when one clinician administers both. This study utilized a cross-sectional mixed methods design. One-hundred and twenty adults with major depressive disorder currently receiving combined treatment were recruited on Amazon.com's Mechanical Turk and at Fordham University. The mean age of participants was 29.8 years (SD = 8.0). Mean months receiving medication was 38.2 (SD = 45.1) and psychotherapy was 35.4 (SD = 41.5). The study sample was mostly white (79.2%), comprised of 50 males (41.7%) and 70 females (58.3%), and a range of educational levels from high school to graduate school; approximately three quarters of participants were employed. The overarching hypothesis of this study was not supported except in the case of treatment preference strength relating to satisfaction. The hypothesis that working alliance would significantly predict outcomes was supported for medication adherence and satisfaction, but not for psychotherapy adherence. Additionally, symptom severity was significantly related to satisfaction and medication adherence, and personality predicted psychotherapy adherence. The qualitative findings suggested that patients experience treatment cohesion as the working together of treatments and clinicians to address their needs, thereby contributing to increased satisfaction and subjective efficacy. It appears from this study's results that matching patients to a particular combined treatment model based on one's preference strength for a particular treatment modality, and therapeutic alliance with one's providers may help increase adherence and satisfaction; in this way, the current study also affirms the person-centered movement's call for matching nondiagnostic patient variables to treatments. Future research is needed to support practice recommendations to clinicians providing combined treatment.
Baruch, Rachel Levine, "Outcomes of combined treatment: A person-centered study of patients receiving medication and psychotherapy for depression" (2015). ETD Collection for Fordham University. AAI3728390.