Nonresponse und Misserfolge in der stationären Psychotherapie
Nonresponse and failure of inpatient psychotherapy
by Ann-Kathrin Albers
Date of Examination:2021-11-18
Date of issue:2021-11-08
Advisor:Prof. Dr. Carsten Spitzer
Referee:Prof. Dr. Carsten Spitzer
Referee:Prof. Dr. Knut Schnell
Referee:Prof. Dr. Thomas Meyer
Persistent Address:
http://dx.doi.org/10.53846/goediss-8932
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Abstract
English
Research concerning failure of inpatient psychotherapy in Germany is rare and affected by methodological problems. Consequently, there is a lack of results of multimodal studies assessing the frequency of nonresponse and deterioration and variables which influence the latter two. Therefore, this dissertation analyses how often nonresponse and deterioration occur. It investigates if there are gender differences in therapy failure or differences between patients with and without personality disorders or between those with Cluster B and Cluster C personality disorders. Thus, data from routine diagnostics of Asklepios Fachklinikum Tiefenbrunn were analysed retrospectively. A total of 3862 (59.6 %) of 6481 patients who received inpatient psychodynamically oriented treatment at Asklepios Fachklinikum Tiefenbrunn between 01/01/2005 and 31/12/2014 were included in this study. Inclusion criteria were a treatment for at least six weeks, a minimum age of 18 years and a documented global severity index score of SCL-90-R at admission and discharge. For indirect assessment of distress and interpersonal problems, patients filled out the Symptom Checklist SCL-90-R and the Inventory of Interpersonal Problems IIP. Therapists rated the severity of the patients´ disease by using the impairment severity score. In addition, direct assessment of change was employed from patient and therapist perspectives. Depending on the method of measurement between 1.1 and 7.5 % of inpatients deteriorated and 10.1 to 50.0 % of inpatients were nonresponders. There was no distinct difference in frequency of nonresponse and deterioration between men and women, only the SCL-90-R showed more therapy failure for men. Moreover, the results from indirect assessment for patients with and without personality disorders did not differ regarding the occurrence of failure. Based on direct assessment, patients with personality disorders rated their symptoms more often as unaffected or worse than before therapy. Therapy results for patients with Cluster B or C personality disorders did not vary significantly regardless of the assessment method. According to the test results women became more seriously ill than men. Furthermore, patients with personality disorders were more strongly affected than patients without personality disorders. Patients with Cluster B personality disorders showed higher global severity index scores than patients with Cluster C personality disorders only when the SCL-90-R was used. Overall, this dissertation reveals that failure in inpatient psychotherapy is common. In consideration of all test results neither gender nor existence of personality disorders with differentiation between Cluster B and Cluster C personality disorders was identified as a risk of failure. This is in accordance with other studies. In contrast to most previous studies a larger sample size was chosen resulting in a higher representativity. Both multimodal assessment and individual case analysis helped to gain information compared to former studies, which were limited to effect sizes or a single survey method. Exceeding previous studies, therapy failure was analysed with regards to interpersonal aspects and personality disorders. However, predicting therapy results in the future is not feasible because therapy effects were measured at the time of discharge and not in a follow-up survey. Consequently, further research is required. Due to missing evidence of a relevant influence of the examined parameters on therapy failure, it is still necessary to multimodally determine contributing factors in prospective naturalistic studies.
Keywords: inpatient psychotherapy; nonresponse; deterioration; gender differences; personality disorders; measurement of change; interpersonal problems