Psychosocial Characteristics and Non-pharmacological Intervention of Patients With Treatment-resistant Depression
Condition: Treatment-resistant Depression
MeSH terms: Depression; Depressive Disorder; Depressive Disorder, Treatment-Resistant
Study type: Interventional

Summary: 
      Pharmacotherapy and psychotherapy, effective management strategies for treatment-resistant
      depression are limited and yet to be developed. However, nursing interventions focusing on
      adherence enhancement, symptom reduction, and stress management may be strategic for a better
      disease management. This study aimed to define the rarely-studied concept of TRD under the
      cultural context of Taiwan and to identify new feasible and complementary treatment model
      from nursing perspectives. The project had established important basis on the descriptions of
      psychosocial features and need assessment of people with TRD over psychiatrist's validation.
      The findings also built up a cultural-specific non-pharmacological intervention module for
      effective TRD management in Taiwan. The nursing model of TRD management will further promote
      the development of integrative depression care in the future and complement current
      modalities, while providing important evidence-based information for future research and
      services.
    

Detailed description: 
      The three-year pioneering project began with observing the psychosocial characteristics and
      demographic profile of a group of TRD cohort, followed by validating the cultural meanings
      and recovery constructs of TRD through professional and lay focus groups in the first year.
      In the second to third year, we examined the effectiveness of a 8-week, nurse-led
      psychosocial intervention with group approach in a randomized control trial (RCT) compared to
      the controls receiving usual care with three follow-ups. Detailed psychiatric assessment and
      study interviews have been performed at baseline, 3, 6, and 9 months after the intervention
      by a senior psychiatrist and a research assistant using standardized operation
      forms.Structured measurements have been utilized to collect primary outcome variables of
      psychological distress, suicide risk and resilience as well as secondary outcome measures of
      quality of life, community reintegration level, perceived satisfaction, and main clinical
      variables (e.g., treatment adherence, service use such as ER/OPD attendance or
      hospitalization days). The control group receives usual care of pharmacological therapy
      provided by the psychiatrists in the Psychiatric Department of the study hospital in northern
      Taiwan.
    

Intervention name(s): Nurse-led cognitive-behavioral-based group intervention
Intervention type(s): Behavioral
Intervention description(s): The intervention focused on the following topics of symptom awareness(i.e. provision of literacy in depression and stress), stress management, lifestyle restructuring and emotional self-care. These topics have been integrated as four major domains for discussions in the eight-weekly sessions. Each session starts with open discussion for participants' daily concerns to activate group dynamics, followed by second part of domain-oriented discussions, and then the third part of session review and homework reminder.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: Psychosocial model,nursing intervention