|Year : 2019 | Volume
| Issue : 4 | Page : 219-221
Interpersonal therapy group for middle-aged depressive patients: A pilot study
Chan-Hen Tsai M.D 1, Chiung-Wen Chang M.S 1, Hui-Ying Lee B.A 1, Shih-Ming Li Ph.D 2
1 Department of Psychiatry, En Chu Kong Hospital, New Taipei City, Taiwan
2 Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
|Date of Submission||04-Aug-2019|
|Date of Decision||03-Sep-2019|
|Date of Acceptance||04-Sep-2019|
|Date of Web Publication||23-Dec-2019|
No. 1, University Road, Tainan 701
Source of Support: None, Conflict of Interest: None
Objective: In this pilot study, we intended to evaluate the efficacy of the interpersonal therapy group (IPT-G) in middle-aged adult patients with major depressive disorder. Methods: Patients with the diagnosis of major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, who were aged between 40 and 65 years, were recruited to participate in receiving IPT-G while all participants kept all existing antidepressants. The participants were assessed using the Beck Depression Inventory-II (BDI-II) for depression at baseline and immediately after the final treatment session. Results: Totally, 10 patients from an outpatient clinic of a community hospital participated in this 14 weekly 90-min sessions IPT-G while they all kept taking their prescribed antidepressants. Five of them completed the whole course of sessions. The BDI-II scores (means ± standard deviation) of five participants were significantly decreased between sessions 1 and 14 (30.6 ± 19.9 vs. 17.4 ± 15.9) using the Wilcoxon signed-rank test (Z = −2.031, p < 0.05). According to the in-depth interview data of two participants, social and practice dimensions were the main factors responsible for changes in the group. Conclusion: In this pilot study, we demonstrated that antidepressant-medicated middle-aged patients can benefit from IPT-G. But this pilot study result needs to be duplicated with a larger number of study participants to strengthen the study finding.
Keywords: BDI-II, group psychotherapy, major depression disorder, rôle transition
|How to cite this article:|
Tsai CH, Chang CW, Lee HY, Li SM. Interpersonal therapy group for middle-aged depressive patients: A pilot study. Taiwan J Psychiatry 2019;33:219-21
|How to cite this URL:|
Tsai CH, Chang CW, Lee HY, Li SM. Interpersonal therapy group for middle-aged depressive patients: A pilot study. Taiwan J Psychiatry [serial online] 2019 [cited 2020 Jan 25];33:219-21. Available from: http://www.e-tjp.org/text.asp?2019/33/4/219/273859
| Introduction|| |
Depression in adult patients causes a considerable socioeconomic burden; the associated average annual expenditure is about US$ 116.6 million (1.2% of the total national expenses) in Taiwan . Interpersonal therapy (IPT) is one of the first-line treatment options for major depressive disorder in evidence-based practice ,, and the interpersonal therapy group (IPT-G) has been found to be effective and cost-effective for patients with major depressive disorder . In Taiwan, IPT-G is used in clinical practice and schools  and can be conducted for specific populations. Midlife depression has unique manifestation and multifactorial etiology . In this study, we administered short-term IPT-G to middle-aged adult patients in Taiwan and evaluated its efficacy.
| Methods|| |
The study participants who were aged between 40 and 65 years were diagnosed with major depressive disorder made by a psychiatrist according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Those participants received existing antidepressant treatment without recent dosage adjustment before and during group treatment program.
The study participants were assessed using the Beck Depression Inventory-II (BDI-II) for depression at baseline and immediately after the final treatment session. After the treatment program, a clinical psychologist conducted an in-depth 60–90 min interview on two participants to obtain information regarding their experiences in IPT-G. This study was approved by the institutional review board of En Chu Kong Hospital (protocol number = ECKIRB 1061002, approval date = March 7, 2018), with the requirements of obtaining informed consent from the study participants.
Our IPT-G had 14 weekly 90-min sessions. Each session included 10 min of warm-up, 70 min of leader-guided group therapy, and 10 min of closure. One male licensed psychiatrist and one female clinical psychologist with a three-year IPT experience were the group therapist and cotherapist. They took turns to be therapist or cotherapist for each session. One registered psychiatric nurse was responsible for coordinating the group and conducting telephone follow-ups. A senior licensed clinical psychologist with a 10-year IPT-G experience observed and supervised the group. During the sessions, the therapists used multimedia tools, such as posters, computer slide shows, and brochures, to explain interpersonal topics and skills. The participants first practiced those new interpersonal skills in the group and then applied them in actual life between sessions as “interpersonal homework.” The psychiatric nurse did weekly telephone follow-ups between sessions to determine participant moods and make further appointments.
IPT-G has been described to cause therapeutic change through three stages of treatment ,. The initial stage involves evaluation, promotion of social skill, and group cohesion establishment. The middle stage is focused on resolving interpersonal problems classified into four IPT issues, namely grief, interpersonal disputes, rôle transition, and interpersonal deficits. In middle-aged adult patients, the middle stage is focused on the issue of rôle transition. The final stage involves discussion of termination and the learned skill set as well as introduction for resource related to their depression.
| Results|| |
Fourteen sessions of IPT-G were conducted in a community program in northern Taiwan. Ten study participants were referred from psychiatrists at an outpatient clinic of a community general hospital, and five participants completed all the sessions [Table 1].
Overall, 50% of the participants completed all the sessions, whereas 80% completed more than six sessions. The BDI-II scores (means ± standard deviation) of five participants were decreased significantly between sessions 1 and 14 (30.6 ± 19.9 vs. 17.4 ± 15.9) with the Wilcoxon signed-rank test (Z = −2.031, p< 0.05). According to the in-depth interview data of two participants, social and practice dimensions were the main factors responsible for changes in the group.
In the group, social support from other members was the main factor that attracted other members to join the group. But social strain kept the members from joining the group. Social support from other members in the group enabled positive changes in the members, whereas social strain increased members' distress.
“The social support from the group was the main reason that attracted me to join the group. I will introduce others to join the group... By contrast, the conflicts in the group discouraged me from joining the group” (male participant).
“Sometimes, members in the group had some conflicts, and the next time, I was afraid to join the group” (female participant).
The skills learned by the participants in the group were useful in their daily lives. In this group, interpersonal homework was provided with a handout for positive interpersonal skills and positive activities to regulate the participants' negative emotions. In the practice dimension, the participants showing greater engagement in homework in daily life received more benefits from the sessions. “The activities learned from the group enhance one's wellbeing in daily life” (male participant; female participant).
| Discussion|| |
Five participants completed IPT-G, and their BDI-II scores were decreased significantly between sessions 1 and 14 according with the Wilcoxon signed-rank test (p< 0.05). This result suggests that IPT-G had a therapeutic effect on depression in the middle-aged participants. In the midlife period, people reevaluate their vocational accomplishments and rethink their family life; in the group, the middle-aged participants faced problems with rôle transition. In the middle stage of IPT-G, the rôle transition problems were treated as the key agenda in the group.
Lipsitz and Markowitz  found that IPT has four mechanisms of change, namely enhancing social support, reducing interpersonal stress, facilitating emotional processing, and improving social skills. The first and second therapeutic mechanisms are related to the social dimension, whereas the other mechanisms are associated with the practice dimension in this study. When applying IPT-G, social support and engaging in homework are the main factors that lead to BDI-II score improvement. In the middle-aged population, rôle transition is a crucial problem, and IPT-G provides a means to solve this problem and ensure a smooth transition from young age to old age. The small number of participants was the key limitation of this study. In the future, a randomized control group experimental design can be used for additional empirical analysis.
| Financial Support and Sponsorship|| |
The study was financially supported by En Chu Kong Hospital.
| Conflicts of Interest|| |
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