Psychiatr Prax 2012; 39(06): 280-285
DOI: 10.1055/s-0032-1305097
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Geschlechtsunterschiede in der multimodalen Therapie depressiver Störungen mit komorbider Schmerzsymptomatik

Gender Differences in Response to CBT-Orientated Multimodal Treatment in Depressed Patients with Chronic Pain
Christoph Pieh
1   Abteilung für Psychosomatische Medizin, Universitätsklinikum Regensburg
,
Jürgen Altmeppen
2   Klinik für Anästhesiologie, Klinikum Weiden
,
Susanne Neumeier
2   Klinik für Anästhesiologie, Klinikum Weiden
,
Thomas Loew
1   Abteilung für Psychosomatische Medizin, Universitätsklinikum Regensburg
,
Michael Angerer
4   Klinik für Neurologie, Klinikum Weiden
,
Claas Lahmann
1   Abteilung für Psychosomatische Medizin, Universitätsklinikum Regensburg
3   Klinik für Psychosomatische Medizin und Psychotherapie, Technische Universität München
› Author Affiliations
Further Information

Publication History

Publication Date:
27 August 2012 (online)

Zusammenfassung

Anliegen: Die vorliegende Studie analysierte den Einfluss des Geschlechts auf das Ergebnis einer multimodalen psychosomatischen Behandlung depressiver Patienteninnen und Patienten mit komorbider Schmerzstörung.

Methode: 154 Patientinnen und 144 Patienten durchliefen ein 5-wöchiges standardisiertes Therapieprogramm. Die depressive Symptomatik wurde anhand der Allgemeinen Depressionsskala vor und nach der Behandlung erfasst.

Ergebnisse: Die depressive Symptomatik verbessert sich bei Frauen (ES 0,96) mehr als bei Männern (ES 0,65), sowohl in der Gesamtstichprobe (t = 2,757; p = 0,006), als auch in der Teilstichprobe ohne antidepressive Medikation (t = 2,325; p = 0,021).

Schlussfolgerung: Frauen mit Depressionen und Schmerzen profitieren mehr von einer multimodalen Behandlung als Männer.

Abstract

Objective: Although gender differences are increasingly the focus of current research, gender aspects in the response to pharmacological and non-pharmacological treatment of depression still remain unclear. The aim of this study was to analyze the impact of gender on the outcome of a CBT-orientated multimodal treatment in depressed outpatients with chronic pain.

Methods: A total of 298 patients (154 women) underwent a standardized five-week CBT-orientated multimodal treatment. Depressive symptoms were measured at the beginning and end of the treatment with the German version of the Center for Epidemiological Studies Depression Scale (CES-D).

Results: The improvement of depressive symptoms showed an effect size (ES) of 0.81 in the total sample. However, women improved considerably more (ES 0.96) than did men (ES 0.65) and these gender differences are seen in the complete sample (t = 2.757, df = 296, p = 0.006) as well as in the group without received antidepressants (t = 2.325, df = 151, p = 0.021).

Conclusion: Women with a depressive disorder and chronic pain benefit significantly more from a CBT-orientated multimodal treatment and exhibit a considerably greater reduction of depressive symptoms than do men. These distinctions are not due to differences in received antidepressant medication, psychiatric comorbidities or educational background.

 
  • Literatur

  • 1 Ohayon MM, Stingl JC. Prevalence and comorbidity of chronic pain in the German general population. J Psychiatr Res 2012; 46: 444-450
  • 2 Bair MJ, Robinson RL, Katon W et al. Depression and pain comorbidity: a literature review. Arch Intern Med 2003; 163: 2433-2445
  • 3 Simon GE, Von Korff M, Piccinelli M et al. An international study of the relation between somatic symptoms and depression. N Engl J Med 1999; 341: 1329-1335
  • 4 Kroenke K, Jackson JL, Chamberlin J. Depressive and anxiety disorders in patients presenting with physical complaints: clinical predictors and outcome. Am J Med 1997; 103: 339-347
  • 5 Robinson MJ, Edwards SE, Iyengar S et al. Depression and pain. Front Biosci 2009; 14: 5031-5051
  • 6 Piccinelli M, Wilkinson G. Gender differences in depression. Critical review. Br J Psychiatry 2000; 177: 486-492
  • 7 Weissman MM, Bland R, Joyce PR et al. Sex differences in rates of depression: cross-national perspectives. J Affect Disord 1993; 29: 77-84
  • 8 Kessler RC, McGonagle KA, Swartz M et al. Sex and depression in the National Comorbidity Survey. I: Lifetime prevalence, chronicity and recurrence. J Affect Disord 1993; 29: 85-96
  • 9 Perugi G, Musetti L, Simonini E et al. Gender-mediated clinical features of depressive illness. The importance of temperamental differences. Br J Psychiatry 1990; 157: 835-841
  • 10 Fillingim RB, King CD, Ribeiro-Dasilva MC et al. Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain 2009; 10: 447-485
  • 11 Unruh AM. Gender variations in clinical pain experience. Pain 1996; 65: 123-167
  • 12 Racine M, Tousignant-Laflamme Y, Kloda LA et al. A systematic literature review of 10 years of research on sex/gender and pain perception – Part 2: Do biopsychosocial factors alter pain sensitivity differently in women and men?. Pain 2012; 153: 619-635
  • 13 Parker G, Blanch B, Crawford J. Does gender influence response to differing psychotherapies by those with unipolar depression?. J Affect Disord 2011; 130: 17-20
  • 14 Gorman JM. Gender differences in depression and response to psychotropic medication. Gend Med 2006; 3: 93-109
  • 15 Bigos KL, Pollock BG, Stankevich BA et al. Sex differences in the pharmacokinetics and pharmacodynamics of antidepressants: an updated review. Gend Med 2009; 6: 522-543
  • 16 Hautzinger M, Bailer M. Allgemeine Depressions-Skala. Manual. Göttingen: Beltz Test GmbH; 1993
  • 17 Markush RE, Favero RV. Epidemiologic assessment of stressful life events, depressed mood, and psychophysiological symptoms: A preliminary report. In: Dohrenwend BS, Dohrenwend BP, eds. Stressful Life Events: Their Nature and Effects. New York: John Wiley and Sons; 1973
  • 18 Ferraz MB, Quaresma MR, Aquino LR et al. Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. J Rheumatol 1990; 17: 1022-1024
  • 19 Joos E, Peretz A, Beguin S et al. Reliability and reproducibility of visual analogue scale and numeric rating scale for therapeutic evaluation of pain in rheumatic patients. J Rheumatol 1991; 18: 1269-1270
  • 20 Dillmann U, Nilges P, Saile H et al. Assessing disability in chronic pain patients. Schmerz 1994; 8: 100-110
  • 21 Spek V, Nyklícek I, Cuijpers P et al. Predictors of outcome of group and internet-based cognitive behavior therapy. J Affect Disord 2008; 105: 137-145
  • 22 Thase ME, Reynolds 3rd CF, Frank E et al. Do depressed men and women respond similarly to cognitive behavior therapy?. Am J Psychiatry 1994; 151: 500-505
  • 23 Jarrett RB, Eaves GG, Grannemann BD et al. Clinical, cognitive, and demographic predictors of response to cognitive therapy for depression: a preliminary report. Psychiatry Res 1991; 37: 245-260
  • 24 Sotsky SM, Glass DR, Shea MT et al. Patient predictors of response to psychotherapy and pharmacotherapy: findings in the NIMH Treatment of Depression Collaborative Research Program. Am J Psychiatry 1991; 148: 997-1008
  • 25 Zlotnick C, Shea MT, Pilkonis PA et al. Gender, type of treatment, dysfunctional attitudes, social support, life events, and depressive symptoms over naturalistic follow-up. Am J Psychiatry 1996; 153: 1021-1027
  • 26 Peterson AL, Halstead TS. Group cognitive behavior therapy for depression in a community setting: a clinical replication series. Behav Ther 1998; 29: 3-18
  • 27 McEvoy PM, Nathan P. Effectiveness of cognitive behavior therapy for diagnostically heterogeneous groups: a benchmarking study. J Consult Clin Psychol 2007; 75: 344-350
  • 28 Bockting CL, Spinhoven P, Koeter MW et al. Differential predictors of response to preventive cognitive therapy in recurrent depression: a 2-year prospective study. Psychother Psychosom 2006; 75: 229-236