Feasibility of generic, short, and easy-to-use assessment of psychological distress during psychotherapy : Longitudinal measurement invariance of CORE-10 and -OM

Objective: While the CORE-10 inventory for Clinical Outcome Routine Evaluation has shown good psychometric properties in cross-sectional assessment, the feasibility of generic, short, and easy-to-use longitudinal assessment of a broadband construct such as the targeted "general psychological distress" remains to be psychometrically demonstrated. Therefore, we investigated longitudinal measurement invariance (LMI) of CORE-10. For comprehensiveness, we also analyzed its parent inventory, CORE-OM. Method: We investigated the LMI of pre- and post-therapy CORE-10 and -OM assessments in a naturalistic treatment register of 1715 patients' short psychotherapies, testing whether the construct of "psychological distress" remained the same across the treatments. Results: We observed good psychometric properties and no violations of LMI for CORE-10 in chi-squared equivalence tests, nor in effect-size-based evaluations. Only the highly sensitive chi-squared difference tests detected LMI violations but these had little practical influence. The CORE-OM data did not fit well with factorial models but this was cross-sectional rather than a genuinely longitudinal (LMI-related) issue. Conclusions: CORE-10 appeared a structurally valid measure of general psychological distress and suitable for longitudinal assessment, whereas the CORE-OM had a less clear factorial structure. Regarding psychometrics, these findings support the use of CORE-10 in longitudinal assessment during psychotherapy and do not support CORE-OM.Peer reviewe

Associations between specific depressive symptoms and psychosocial functioning in psychotherapy

Background: Psychotherapy for depression aims to reduce symptoms and to improve psychosocial functioning. We examined whether some symptoms are more important than others in the association between depression and functioning over the course of psychotherapy treatment.Methods: We studied associations between specific symptoms of depression (PHQ-9) and change in social and occupational functioning (SOFAS), both with structural equation models (considering liabilities of depression and each specific symptom) and with logistic regression models (considering the risk for individual patients). The study sample consisted of adult patients (n symbolscript 771) from the Finnish Psychotherapy Quality Registry (FPQR) who completed psychotherapy treatment between September 2018 and September 2021.Results: Based on our results of logistic regression analyses and SEM models, the baseline measures of depression symptoms were not associated with changes in functioning. Changes in depressed mood or hopelessness, problems with sleep, feeling tired, and feeling little interest or pleasure were associated with improved func-tioning during psychotherapy. The strongest evidence for symptom-specific effects was found for the symptom of depressed mood or hopelessness. Limitations: Due to our naturalistic study design containing only two measurement points, we were unable to study the causal relationship between symptoms and functioning. Conclusions: Changes in certain symptoms during psychotherapy may affect functioning independently of un-derlying depression. Knowledge about the dynamics between symptoms and functioning could be used in treatment planning or implementation. Depressed mood or hopelessness appears to have a role in the dynamic relationship between depression and functioning.Peer reviewe

Associations between symptoms and functioning and between total depression and functioning in psychotherapy

Tavoitteet. Masennuksen mittaaminen perustuu usein oireiden summapisteiden laskemiseen, jolloin hoidon vaikutta-vuutta arvioidaan summapisteissä tapahtuneen muutoksen perusteella. Summapisteiden laskemisen seurauksena oirei-ta koskevaa tietoa kuitenkin menetetään. Masennusoireiden lievittymisestä huolimatta esiintyvät toimintakyvyn puu-tokset ovat yleisiä, minkä vuoksi hoidon vaikuttavuuden arvioinnissa tulisi mitata myös toimintakykyä. Tämän tut-kimuksen tavoitteena on selvittää, ennustavatko yksittäiset masennusoireet toimintakyvyssä havaittua muutosta ko-konaismasennuksesta riippumatta. Lisäksi haluttiin tutkia, voidaanko yksittäisten oiremuutosten perusteella erotella henkilöitä, joilla toimintakyvyssä on tapahtunut kliinisesti merkittävää kohenemista niistä henkilöistä joilla muutos on ollut vähäisempää. Menetelmät. Tutkimuksen aineisto (n= 214) on peräisin HUS psykiatrian laaturekisteristä, jossa aineistonkeruu on integroitu osaksi psykoterapiaprosessia. Oiremuutosten ja masennuksen summapisteissä tapahtuneiden muutosten vaikutuksia toimintakykyyn tutkittiin lineaaristen regressiomallien ja MIMIC-rakenneyhtälömallien avulla. Toiminta-kyvyn muutosten kliinistä merkitsevyyttä ennustettiin logistisilla regressioanalyyseilla. Tulokset ja johtopäätökset. Oiremuutosten ja toimintakyvyn välistä yhteyttä kuvaavissa regressiomalleissa ikä, su-kupuoli, diagnoosi, tai psykoterapiasuuntaus eivät olleet merkitseviä ennustajia. Oiremuutosten yhteys toimintaky-vyssä havaittuun muutokseen ei riippunut siitä, oliko henkilölle diagnosoitu masennus, vai jokin muu mielentervey-denhäiriö. Masennusoireista vain tyytymättömyys itseen tai kokemus epäonnistumisesta oli yhteydessä toimintaky-vyn muutokseen (beta= -0.25, p-arvo= .003), kun samanaikaisesti huomioitiin kokonaismasennuksessa tapahtunut muutos. Tulosten perusteella hoidon kohdentaminen potilaan itseä kohtaan koetun tyytymättömyyden tai epäonnis-tumisen kokemuksiin voi parantaa hoidon jälkeistä toimintakykyä ja lyhytpsykoterapian vaikuttavuutta.Aim. Measuring depression is often based on calculating sum scores of symptoms in which case the effectiveness of treatment is evaluated on the basis of the change in the sum scores. However, as a result of calculating the sum scores, data about symptoms is lost. Despite the mitigation of depression symptoms, functional deficiencies are common and therefore psychosocial functioning should also be measured when evaluating the effectiveness of treatment. The aim of this study is to determine whether individual depressive symptoms, regardless of diagnosis, predict the observed change in psychoso-cial function, while simultaneously considering the effect of total depression scores. In addition, it was sought to deter-mine whether individual changes in symptoms predict a change in psychosocial function when comparing subjects with a clinically significant improvement in psychosocial function with those with less change. Methodology. The data of the study (n = 214) comes from the psychotherapy quality-control register of HUS Psychiatry, where data collection is integrated into the psychotherapy process. The effects of changes in symptoms and depression sum scores on psychosocial functioning were studied using linear regression models and MIMIC-models. The clinical significance of changes in psychosocial functioning was predicted by logistic regression analyzes. Results and Conclusions. In regression models describing the association between symptom changes and psychosocial functioning, age, gender, diagnosis, or psychotherapy were not significant predictors. The connection of symptomatic changes with the observed change in psychosocial functioning did not depend on whether the person was diagnosed with depression or some other mental disorder. Of the depressive symptoms, only self-dissatisfaction or experiences of failure was associated with a change in psychosocial function (beta = -0.25, p-value = .003), while simultaneously taking into account the change in overall depression. Based on the results, self-dissatisfaction can predict a change in psychosocial function regardless of overall depression, which is why self-reported dissatisfaction appears to be an important symptom predictive of the effectiveness of short-term psychotherapy in general psychiatric patients