Research report
Progress monitoring and feedback in psychiatric care reduces depressive symptoms

https://doi.org/10.1016/j.jad.2010.05.003Get rights and content

Abstract

Background

To date, the monitoring of patient progress using standardized assessments has been neglected in hospital-based psychiatric care. Findings in outpatient psychotherapy have demonstrated clinically significant benefits for providing feedback to the sizeable minority of patients who were otherwise unlikely to experience positive outcome (Lambert, 2007). However, a similar system for presenting feedback on patient progress has not yet been assessed for group therapy within psychiatric inpatient settings. The current study aimed to develop and evaluate the effectiveness of a feedback system suitable for use in psychiatric services.

Methods

In a nonrandomized trial, 1308 consecutive inpatients and day patients, whose diagnoses were primarily depressive and anxiety disorders, completed the World Health Organization's Wellbeing Index (WHO-5) routinely during a ten-day cognitive behavioral therapy group. The first cohort (n = 461) received treatment as usual. The second cohort (n = 439) completed monitoring measures without feedback, and for patients in the third cohort (n = 408), feedback on progress was provided to both clinicians and patients midway through the treatment period.

Results

Feedback was effective in reducing depressive symptoms (F(1,649) = 6.29, p < .05) for those patients at risk of poor outcome, but not effective in improving wellbeing (F(1,569) = 1.14, p > .05).

Limitations

The current findings may be generalized to patient samples that exhibit largely depressive disorders, however rigorous follow-up is warranted.

Conclusions

Similar to outpatient settings, feedback appears to be beneficial for improving symptom outcomes but further time may be required for wellbeing to be affected.

Section snippets

Research setting and participants

Participants were recruited from a 98 bed, private psychiatric hospital in Australia. Eligible participants were English speaking inpatients (60%) or day patients (40%) who were participating in the hospital's two week cognitive behavioral therapy program. The sample comprised of 1308 consecutive patients who participated in the trial; 408 who received feedback on their WHO-5 scores, 439 completed the WHO-5 routinely but did not receive feedback on scores until completion of the group, and a

Equivalence of groups

As patients were not randomized to groups, it was necessary to create equivalent cohorts. To reduce the skew of the data, a square root of WHO-5 scores at each day was taken. This score was used for all further WHO-5 analyses. Quality control charts revealed three therapy groups with outlying mean scores at Day 9 of therapy (i.e. three standard deviations beyond the mean). Upon qualitative inspection, two of those three groups were decided to be too small to be considered a therapy group (one

Discussion

The current study aimed to assess the effectiveness of monitoring patient progress and providing feedback about wellbeing in a group inpatient and day patient psychiatric setting. It was proposed that those patients who received feedback on their response to treatment would exhibit significant improvements in symptom relief and wellbeing, when compared to those who did not receive feedback. The study found, unexpectedly, that providing feedback on wellbeing did not significantly improve

Role of funding source

The current study was supported by a grant from the Medicare Private Safety and Clinical Improvement Incentive Pool. Medicare had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Conflict of interest

The authors declare that they have no conflicts of interest.

Acknowledgment

Assistance and ongoing support from Moira Munro is greatly appreciated.

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