Abstract
Most patients with depressive disorders are managed in primary care and community settings. Primary care patients appear to prefer psychosocial interventions to drug therapy. Amongst many possible psychosocial interventions, four are discussed in this paper: non-directive counselling, cognitive behavioural therapy, problem solving treatment and group-psychoeducation. For each one, the rationale, thera peutic basis and training needs are described. Then the evidence for their efficacy and cost effectiveness is assessed.
The review concludes that all of these interventions may be recommended for the short term treatment of mild to moderate depressive disorders in primary care and community settings, although the evidence for non-directive counselling is not as strong as for the other interventions. Further research is needed to assess their usefulness for other types of common mental disorders, and in reducing rates of relapse and recurrence. Problem solving treatment may provide the best combination of patient acceptability, ease of training and application, and demonstrable efficacy.
Abstract
Die meisten Patienten mit depressiven Störungen werden im Rahmen der Primärversorgung und in Gemeindesettings behandelt. Patienten in der Primärversorgung scheinen psychosoziale Behandlungsmethoden einer Therapie mit Medikamenten vorzuziehen. Von vielen möglichen Interventionen sollen im Rahmen desfolgenden Beitrags vier Möglichkeiten diskutiert werden: nicht-direktive Beratung, kognitivbehaviourale Therapie, Training der Problemlösefähigkeit und Psychoedukation in einer Gruppe. Fürjede dieser Behandlungsmöglichkeiten sollen die theoretischen Grundlagen, die therapeutische Basis und die erforderliche Schulungfür Anwender beschrieben werden. Im Anschluss werden die Wirksamkeit und Kosten-Effektivität der jeweiligen Therapieformen besprochen.
Es wird geschlussfolgert, dass alle vier Interventionsformen zur Kurzzeitbehandlung leichter bis mittlerer Depressionen in der Primärversorgung und im Gemeindesetting empfohlen werden können, obwohl die Evidenzfür nicht-direktive Beratung nicht so stark ist, wiefür die anderen Behandlungsarten.
Weitere Forschung ist unabdingbar um die Eignung der vorgestellten Interventionen auch für andere psychische Erkrankungen prüfen zu können sowie nachzuweisen, wie sie zur Reduktion von Rückfällen unddem Wiederauftreten der Erkrankungen beitragen. Das Training der Problemlosefahigkeit scheint eine Behandlungsform zu sein, die für die Patienten annehmbar ist, einfach in Schulung/Training und Anwendung und zugleich eine nachweisbare Wirksamkeit aufweist.
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Dowrick, C. Psychosocial interventions for depression in community settings. Z. f. Gesundheitswiss. 9, 197–204 (2001). https://doi.org/10.1007/BF02956494
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DOI: https://doi.org/10.1007/BF02956494
Keywords
- mental health
- depression
- psychosocial intervention
- psychological therapy
- counselling
- cognitive therapy
- problem solving
- group psycho-education
- community
- primary care