Effectiveness of Psychoeducation for Patients with Unipolar Depression

• ¹ King's College London School of Medicine, Psychological Medicine, United Kingdom
• ² University of São Paulo, Neurosciences and Behaviour, Brazil

INTRODUCTION: Major depressive disorder is a chronic, long-term disease with a high recurrence rate (Kessler et al., 2003). This disease often leads to functional disability, causing significant social-occupational impairment for the patient and their relatives (Jaeger et al., 2006). Around 50% of the individuals suffering from a first depressive episode, will experience a second one due to several modifiable and non-modifiable contributing factors including medication adherence (Burcusa and Iacono, 2007). Thus, prevention strategies which could decrease the chances of further recurrences could be extremely helpful alongside the usual pharmacological treatment (Cuijpers et al., 2008). Several psychosocial interventions have shown efficacy in accomplishing this aim (Linde et al., 2015). However, the effectiveness of group psychoeducation has still been poorly explored for unipolar depression (Tursi et al 2013) despite its substantial evidence in other chronic mental disorders sharing several characteristics, such as bipolar and schizophrenic disorders (Colom et al., 2009; Pekkala and Merinder, 2002; Batista et al 2011). OBJECTIVES: This study aims to evaluate the potential effectiveness of psychoeducation in patients with unipolar depressive disorder exploring a comprehensive group of key outcome measures. METHODS: The study was conducted at the outpatient clinic of Hospital das Clínicas, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Brazil. After offering the participation in the study to a consecutive sample of patients with the primary diagnosis of a depressive episode under pharmacologic treatment, those willing to participate were screened for inclusion criteria, an HAM-D21 ≥ 17 were considered as the cut-off in this study. If inclusion criteria were fulfilled, subjects were assigned into two groups according to a partially randomized sampling method: a psychoeducation group (PE) who received a psychoeducational intervention, and treatment as usual group (TAU) who had psychiatric and medical care but did not receive psychoeducation intervention. The Psychoeducational Program consisted of 8 weekly meetings, lasting 90 minutes each with the participation of 5 patients in average. The psychoeducational groups were closed, with semi-structured sessions and pre-defined themes that address the following topics: clinical information about the disorder, etiological aspects, pharmacological and psychotherapeutic treatments, detection of early signs of relapse, the possibility of family collaboration with the treatment and social reintegration of the patient. The HAM-D was used to evaluate the severity of depressive symptoms. The following instruments were also applied: MADRS, BDI, BAI, BSI, BHS. To assess the adherence to treatment, we used the EAM and the QCF and to evaluate functioning patients; a FAST scale was employed. All instruments were applied at the initial and final stages of intervention. Data was analysed using chi-square and t- tests to compare sociodemographic characteristics and ANOVA analyses to evaluate the differences in mean scores of each measure between groups. RESULTS: Twenty-eight patients with major depressive were included in the study and 14 were assigned to each group. Considering both groups, the samples were homogeneous regarding sociodemographic and clinical characteristics. A significant difference in the decrease of the HAM-D symptoms was observed in favour of the PE group (F= 77,71; d.f.= 1; p<0,001). Regarding treatment adherence, the results indicated a tendency of PE patients to adhere more to pharmacological treatment than TAU (EAM: p=0.08). The results of psychosocial functioning assessment also suggest that the domains of autonomy (p <0.02) and interpersonal relationships (p = 0.05) had a more significant change in the PE group. Both in PE and TAU groups, the following symptoms decreased over 8 weeks: Depression (HAM-D: p <0.001; MADRS: p <0.001; BDI: p<0.001), anxiety (BAI: p<0.05), hopeless (BHS: p<0.001) and suicidal ideation (BSI: p<0.005). They also showed an improvement in overall psychosocial functioning (FAST: p<0.001) and domains of Autonomy (p=0.002), Work (p<0.05), Cognition (p<0.001), Finance (p=0.006), Interpersonal Relations (p<0.001) and Leisure (p<0.05). CONCLUSION: The data suggest that both approaches result in improvements for patients after 8 weeks. However, our results indicate that psychoeducation was more effective in reducing depressive symptoms, autonomy, interpersonal relationships and a tendency to increase the adherence to pharmacological treatment.