Associations between specific depressive symptoms and psychosocial functioning in psychotherapy.

BACKGROUND: Psychotherapy for depression aims to reduce symptoms and to improve psychosocial functioning. We examined whether some symptoms are more important than others in the association between depression and functioning over the course of psychotherapy treatment. METHODS: We studied associations between specific symptoms of depression (PHQ-9) and change in social and occupational functioning (SOFAS), both with structural equation models (considering liabilities of depression and each specific symptom) and with logistic regression models (considering the risk for individual patients). The study sample consisted of adult patients (n = 771) from the Finnish Psychotherapy Quality Registry (FPQR) who completed psychotherapy treatment between September 2018 and September 2021. RESULTS: Based on our results of logistic regression analyses and SEM models, the baseline measures of depression symptoms were not associated with changes in functioning. Changes in depressed mood or hopelessness, problems with sleep, feeling tired, and feeling little interest or pleasure were associated with improved functioning during psychotherapy. The strongest evidence for symptom-specific effects was found for the symptom of depressed mood or hopelessness. LIMITATIONS: Due to our naturalistic study design containing only two measurement points, we were unable to study the causal relationship between symptoms and functioning. CONCLUSIONS: Changes in certain symptoms during psychotherapy may affect functioning independently of underlying depression. Knowledge about the dynamics between symptoms and functioning could be used in treatment planning or implementation. Depressed mood or hopelessness appears to have a role in the dynamic relationship between depression and functioning.

Feasibility of generic, short, and easy-to-use assessment of psychological distress during psychotherapy: Longitudinal measurement invariance of CORE-10 and -OM.

Objective: While the CORE-10 inventory for Clinical Outcome Routine Evaluation has shown good psychometric properties in cross-sectional assessment, the feasibility of generic, short, and easy-to-use longitudinal assessment of a broadband construct such as the targeted "general psychological distress" remains to be psychometrically demonstrated. Therefore, we investigated longitudinal measurement invariance (LMI) of CORE-10. For comprehensiveness, we also analyzed its parent inventory, CORE-OM. Method: We investigated the LMI of pre- and post-therapy CORE-10 and -OM assessments in a naturalistic treatment register of 1715 patients' short psychotherapies, testing whether the construct of "psychological distress" remained the same across the treatments. Results: We observed good psychometric properties and no violations of LMI for CORE-10 in chi-squared equivalence tests, nor in effect-size-based evaluations. Only the highly sensitive chi-squared difference tests detected LMI violations but these had little practical influence. The CORE-OM data did not fit well with factorial models but this was cross-sectional rather than a genuinely longitudinal (LMI-related) issue. Conclusions: CORE-10 appeared a structurally valid measure of general psychological distress and suitable for longitudinal assessment, whereas the CORE-OM had a less clear factorial structure. Regarding psychometrics, these findings support the use of CORE-10 in longitudinal assessment during psychotherapy and do not support CORE-OM.