OJPsych  Vol.4 No.3 , July 2014
The Cost-Effectiveness of Short-Term Psychodynamic Psychotherapy and Solution-Focused Therapy in the Treatment of Depressive and Anxiety Disorders during a Three-Year Follow-Up
ABSTRACT

Background: Various psychotherapies are used extensively in treating different mental disorders, but still relatively little is known about the long-term health and cost effects of different therapies. The aim of this study is to compare the cost-effectiveness of short-term psychodynamic psychotherapy (SPP) and solution-focused therapy (SFT) in the treatment of depressive and anxiety disorders during a three-year follow-up. Methods: A total of 198 outpatients suffering from mood or anxiety disorder were randomized to SPP or SFT. Symptoms were assessed using the Beck Depression Inventory, the Hamilton Depression Rating Scale, the Symptom Check List Anxiety Scale, the Hamilton Anxiety Rating Scale, and the Symptom Check List Global Severity Index. Both direct and indirect costs due to mental health problems were measured. Results: The symptoms of depression and anxiety were reduced statistically significantly according to all 5 psychiatric outcome measures during the first 7 months, after which only minor changes were observed. The differences between the two groups were small and not statistically significant. The direct costs were about equal in both groups but the indirect costs were somewhat higher in the SPP group, although not statistically significantly. The costs of auxiliary treatments were much higher than the cost of SPP or SFT. Conclusions: With regard to cost-effectiveness, there is little difference between SPP and SFT.


Cite this paper
Maljanen, T. , Härkänen, T. , Virtala, E. , Lindfors, O. , Tillman, P. and Knekt, P. (2014) The Cost-Effectiveness of Short-Term Psychodynamic Psychotherapy and Solution-Focused Therapy in the Treatment of Depressive and Anxiety Disorders during a Three-Year Follow-Up. Open Journal of Psychiatry, 4, 238-250. doi: 10.4236/ojpsych.2014.43030.
References
[1]   Cuijpers, P., van Straten, A., Andersson, G. and van Oppen, P. (2008) Psychotherapy for Depression in Adults: A Meta-Analysis of Comparative Outcome Studies. Journal of Consulting and Clinical Psychology, 76, 909-922. http://dx.doi.org/10.1037/a0013075

[2]   Cape, J., Whittington, C., Buszewicz, M., Wallace, P. and Underwood, L. (2010) Brief Psychological Therapies for Anxiety and Depression in Primary Care: Meta-Analysis and Meta-Regression. BMC Medicine, 8, 38. http://dx.doi.org/10.1186/1741-7015-8-38

[3]   Knekt, P., Lindfors, O., Renlund, C., Sares-Jaske, L., Laaksonen, M.A. and Virtala, E. (2011) Use of Auxiliary Psychiatric Treatment during a 5-Year Follow-Up among Patients Receiving Short- or Long-Term Psychotherapy. Journal of Affective Disorders, 135, 221-230.
http://dx.doi.org/10.1016/j.jad.2011.07.024

[4]   Abbass, A.A., Hancock, J.T., Henderson, J. and Kisely, S.R. (2006) Short-Term Psychodynamic Psychotherapies for Common Mental Disorders. Cochrane Database of Systematic Reviews, Issue 4.

[5]   Bosmans, J., Schreuders, B., van Marwijk, H., Smit, J., van Oppen, P. and van Tulder, M. (2012) Cost-Effectiveness of Problem-Solving Treatment in Comparison with Usual Care for Primary Care Patients with Mental Health Problems: ARandomized Trial. BMC Family Practice, 13, 98.
http://dx.doi.org/10.1186/1471-2296-13-98

[6]   Knekt, P., Lindfors, O., Harkanen, T., Valikoski, M., Virtala, E., Laaksonen, M.A., Marttunen, M., Kaipainen, M., Renlund, C. and the Helsinki Psychotherapy Study Group (2008) Randomized Trial on the Effectiveness of Long- and Short-Term Psychodynamic Psychotherapy and Solution-Focused Therapy on Psychiatric Symptoms during a 3-Year Follow-Up. Psychological Medicine, 38, 689-703. http://dx.doi.org/10.1017/S003329170700164X

[7]   Knekt, P. and Lindfors, O. (2004) A Randomized Trial of the Effect of Four Forms of Psychotherapy on Depressive and Anxiety Disorders: Design, Methods, and Results on the Effectiveness of Short-Term Psychodynamic Psychotherapy and Solution-Focused Therapy during a One-Year Follow-Up. Social Insurance Institution, Helsinki, 15-112. http://www.ktl.fi/tto/hps/pdf/effectiveness.pdf.

[8]   Maljanen, T., Paltta, P., Harkanen, T., Virtala, E., Lindfors, O., Laaksonen, M.A., Knekt, P. and the Helsinki Psychotherapy Study Group (2012) The Cost-Effectiveness of Short-Term Psychodynamic Psychotherapy and Solution-Focused Therapy in the Treatment of Depressive and Anxiety Disorders during a One-Year Follow-Up. Journal of Mental Health Policy and Economics, 15, 13-23.

[9]   American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. American Psychiatric Association, Washington DC.

[10]   Malan, D.H. (1976) The Frontier of Brief Psychotherapy: An Example of the Convergence of Research and Clinical Practice. Plenum Medical Books, New York. http://dx.doi.org/10.1007/978-1-4684-2220-7

[11]   Sifneos, P.E. (1978) Short-Term Anxiety Provoking Psychotherapy. In: Davanloo, H., Ed., Short-Term Dynamic Psychotherapy, Spectrum, New York, 35-42.

[12]   Johnson, L.D. and Miller, S.D. (1994) Modification of Depression Risk Factors: A Solution-Focused Approach. Psychotherapy: Theory, Research, Practice, Training, 31, 244-253.
http://dx.doi.org/10.1037/h0090220

[13]   deShazer, S., Berg, I.K., Lipchik, E., Nunnally, E., Molnar, A., Gingerich, W. and Weiner-Davies, M. (1986) Brief Therapy: Focused Solution Development. Family Process, 25, 207-221.
http://dx.doi.org/10.1111/j.1545-5300.1986.00207.x

[14]   Beck, A.T., Ward, C.H., Mendelson, M., Mock, J. and Erbaugh, J. (1961) An Inventory for Measuring Depression. Archives of General Psychiatry, 4, 561-571.
http://dx.doi.org/10.1001/archpsyc.1961.01710120031004

[15]   Hamilton, M. (1960) A Rating Scale for Depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56-61. http://dx.doi.org/10.1136/jnnp.23.1.56

[16]   Derogatis, L.R., Lipman, R.S. and Covi, L. (1973) SCL-90: An Outpatient Psychiatric Rating Scale—Preliminary Report. Psychopharmacology Bulletin, 9, 13-28.

[17]   Hamilton, M. (1959) The Assessment of Anxiety States by Rating. British Journal of Medical Psychology, 32, 50-55. http://dx.doi.org/10.1111/j.2044-8341.1959.tb00467.x

[18]   Laaksonen, M.A., Lindfors, O., Knekt, P. and Aalberg, V. (2012) Suitability for Psychotherapy Scale (SPS) and Its Reliability, Validity and Prediction. British Journal of Clinical Psychology, 51, 351-375. http://dx.doi.org/10.1111/j.2044-8260.2012.02033.x

[19]   Harkanen, T., Knekt, P., Virtala, E. and Lindfors, O. (2005) A Case Study in Comparing Therapies Involving Informative Drop-Out, Non-Ignorable Non-Compliance and Repeated Measurements. Statistics in Medicine, 24, 3773-3787. http://dx.doi.org/10.1002/sim.2409

[20]   Rubin, D.B. (1987) Multiple Imputation for Nonresponse in Surveys. John Wiley, New York. http://dx.doi.org/10.1002/9780470316696

[21]   Schafer, J.L. (1999) Multiple Imputation: A Primer. Statistical Methods in Medical Research, 8, 3-15. http://dx.doi.org/10.1191/096228099671525676

[22]   Lee, J. (1981) Covariance Adjustment of Rates Based on the Multiple Logistic Regression Model. Journal of Chronic Diseases, 34, 415-426.http://dx.doi.org/10.1016/0021-9681(81)90040-0

[23]   Graubard, B.I. and Korn, E.L. (1999) Predictive Margins with Survey Data. Biometrics, 55, 652-659. http://dx.doi.org/10.1111/j.0006-341X.1999.00652.x

[24]   Efron, B. (1982) TheJackknife, the Bootstrap and Other Resampling Plans. CBMS-NSF Regional Conference Series in Applied Mathematics, Monograph 38, SIAM.
http://dx.doi.org/10.1137/1.9781611970319

[25]   Drummond, M., Sculpher, M., Torrance, G., O’Brien, B. and Stoddart, G.L. (2005) Methods for the Economic Evaluation of Health Care Programmes. 3rd Edition, Oxford University Press, Oxford.

[26]   Pruessner, J., Kirschbaum, C., Meinlschmid, G. and Hellhammer, D. (2003) Two Formulas for Computation of the Area under the Curve Represent Measures of Total Hormone Concentration versus Time-Dependent Change. Psychoneuroendocrinology, 28, 916-931.
http://dx.doi.org/10.1016/S0306-4530(02)00108-7

[27]   Briggs, A.H. (2001) Handling Uncertainty in Economic Evaluation and Presenting the Results. In: Drummond, M. and McGuire, A., Eds., Economic Evaluation in Health Care. Merging Theory with Practice, Oxford University Press, Oxford, 172-214.

[28]   Manning, W.G., Fryback, D.G. and Weinstein, M.C. (1996) Reflecting Uncertainty in Cost-Effectiveness Analysis. In: Gold, M.R., Siegel, J.E., Russell, L.B. and Weinstein, M.C., Eds., Cost-Effectiveness in Health and Medicine, Oxford University Press, Oxford, 247-275.

[29]   Armitage, P. (2001) Theory and Practice in Medical Statistics. Statistics in Medicine, 20, 2537-2548. http://dx.doi.org/10.1002/sim.727

[30]   SAS Institute Inc. (2008) SAS/STAT® 9.2 User’s Guide. SAS Institute Inc., Cary.

[31]   Gingerich, W.J. and Eisengart, S. (2000) Solution-Focused Brief Therapy: A Review of the Outcome Research. Family Process, 39, 477-498. http://dx.doi.org/10.1111/j.1545-5300.2000.39408.x

[32]   Guthrie, E., Moorey, J., Margison, F., Barker, H., Palmer, S., McGrath, G., Tomenson, B. and Creed, F. (1999) Cost- Effectiveness of Brief Psychodynamic-Interpersonal Therapy in High Utilizers of Psychiatric Services. Archives of General Psychiatry, 56, 519-526.
http://dx.doi.org/10.1001/archpsyc.56.6.519

[33]   Hujanen, T., Peltola, M., Hakkinen, U. and Pekurinen, M. (2008) Men’s and Women’s Health Care Expenditures by Age Groups in 2006 [in Finnish]. Stakesintyopapereita 37/2008, Stakes, Helsinki.

[34]   Simon, G., Ormel, J., VonKorff, M. and Barlow, W. (1995) Health Care Costs Associated with Depressive and Anxiety Disorders in Primary Care. American Journal of Psychiatry, 152, 352-357.

[35]   Konnopka, A., Leichsenring, F., Leibing, E. and Konig, H. (2009) Cost-of-Illness Studies and Cost-Effectiveness Analyses in Anxiety Disorders: A Systematic Review. Journal of Affective Disorders, 114, 14-31. http://dx.doi.org/10.1016/j.jad.2008.07.014

 
 
Top