The overall goal of this project is to improve our knowledge concerning the optimal treatment for severely depressed inpatients. To do so, we propose to test a strategy of matching patient problems to type of psychosocial treatment. More specifically, we hypothesize that patients who receive psychosocial treatments matched their type of impairments will respond better than patients who receive treatment mismatched to their type of impairment. To test this hypothesis, we propose to subdivide a sample of depressed inpatients into four groups based on their levels of cognitive distortion and family impairment: 1) high cognitive-distortion - high family impairment; 2) high cognitive distortion - low family impairment; 3) low cognitive distortion - high family impairment; and 4) low cognitive distortion - low family impairment. All patients will receive certain common treatment elements, including hospital milieu, psychopharmacology and clinical management sessions. In addition, patients in each of the four subgroups will be randomly assigned to either a """"""""matched"""""""" or """"""""mismatched"""""""" treatment program. Patients in the """"""""matched"""""""" program will receive cognitive-behavioral treatment and/or family treatment matched to the pattern in their deficits, so that patients with impairments in cognitive or family functioning will receive treatments in this area. Patients in the """"""""mismatched"""""""" program will receive an identical amount and type of the same treatments but mismatched to their pattern of deficits, so that patients with impairments in cognitive or family functioning will not receive treatments in these areas. All treatments will begin in the hospital and will continue on an outpatient basis in active treatment for 24 weeks and on a maintenance basis for an additional 12 months.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH044778-04
Application #
2246207
Study Section
Treatment Development and Assessment Research Review Committee (TDA)
Project Start
1990-04-01
Project End
1996-03-31
Budget Start
1993-04-01
Budget End
1995-03-31
Support Year
4
Fiscal Year
1993
Total Cost
Indirect Cost
Name
Butler Hospital (Providence, RI)
Department
Type
DUNS #
069847804
City
Providence
State
RI
Country
United States
Zip Code
02906
Weinstock, Lauren M; Wenze, Susan J; Munroe, Mary K et al. (2013) Concordance between patient and family reports of family functioning in bipolar I disorder and major depressive disorder. J Nerv Ment Dis 201:377-83
Brown, Lily A; Gaudiano, Brandon A; Miller, Ivan W (2010) The impact of panic-agoraphobic comorbidity on suicidality in hospitalized patients with major depression. Depress Anxiety 27:310-5
Gibb, Brandon E; Andover, Margaret S; Miller, Ivan W (2009) Depressive characteristics of adult psychiatric inpatients with a history of multiple versus one or no suicide attempts. Depress Anxiety 26:568-74
Gaudiano, Brandon A; Andover, Margaret S; Miller, Ivan W (2008) The emergence of suicidal ideation during the post-hospital treatment of depressed patients. Suicide Life Threat Behav 38:539-51
Gaudiano, Brandon A; Miller, Ivan W (2007) Dysfunctional cognitions in hospitalized patients with psychotic versus nonpsychotic major depression. Compr Psychiatry 48:357-65
Weinstock, Lauren M; Keitner, Gabor I; Ryan, Christine E et al. (2006) Family functioning and mood disorders: a comparison between patients with major depressive disorder and bipolar I disorder. J Consult Clin Psychol 74:1192-202
Miller, Ivan W; Keitner, Gabor I; Ryan, Christine E et al. (2005) Treatment matching in the posthospital care of depressed patients. Am J Psychiatry 162:2131-8
Beevers, Christopher G; Keitner, Gabor I; Ryan, Christine E et al. (2003) Cognitive predictors of symptom return following depression treatment. J Abnorm Psychol 112:488-96
McDermut, W; Miller, I W; Solomon, D et al. (2001) Family functioning and suicidality in depressed adults. Compr Psychiatry 42:96-104
Miller, I W; Norman, W H; Keitner, G I (1999) Combined treatment for patients with double depression. Psychother Psychosom 68:180-5

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