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- Title
Implications of the Network Theory for the Treatment of Mental Disorders: A Secondary Analysis of a Randomized Clinical Trial.
- Authors
Schumacher, Lea; Klein, Jan Philipp; Elsaesser, Moritz; Härter, Martin; Hautzinger, Martin; Schramm, Elisabeth; Kriston, Levente
- Abstract
Key Points: Question: To what extent do empirical data support specific hypotheses, derived from the network theory of mental disorders, regarding the (interindividual) changeability of symptom dynamics in response to treatment? Findings: In this secondary analysis of a randomized clinical trial, applying a time-varying longitudinal network model to data on the psychotherapeutic treatment of chronic depression demonstrated that symptom interactions changed during treatment and that this change differed among treatments and individuals. Meaning: This evidence for conceptualizing treatment effects for mental disorders as changes in symptom networks supports further testing of the network approach in clinical research and practice. This secondary analysis of a randomized clinical trial evaluates 4 treatment-related hypotheses by developing a new longitudinal network model and analyzing data from the clinical trial on the treatment of patients with chronic depression. Importance: Conceptualizing mental disorders as latent entities has been challenged by the network theory of mental disorders, which states that psychological problems are constituted by a network of mutually interacting symptoms. While the implications of the network approach for planning and evaluating treatments have been intensively discussed, empirical support for the claims of the network theory regarding treatment effects is lacking. Objective: To assess the extent to which specific hypotheses derived from the network theory regarding the (interindividual) changeability of symptom dynamics in response to treatment align with empirical data. Design, Setting, and Participants: This secondary analysis entails data from a multisite randomized clinical trial, in which 254 patients with chronic depression reported on their depressive symptoms at every treatment session. Data collection was conducted between March 5, 2010, and October 14, 2013, and this analysis was conducted between November 1, 2021, and May 31, 2022. Intervention: Thirty-two sessions of either disorder-specific or nonspecific psychotherapy for chronic depression. Main Outcomes and Measures: Longitudinal associations of depressive symptoms with each other and change of these associations through treatment estimated by a time-varying longitudinal network model. Results: In a sample of 254 participants (166 [65.4%] women; mean [SD] age, 44.9 [11.9] years), symptom interactions changed through treatment, and this change varied across treatments and individuals. The mean absolute (ie, valence-ignorant) strength of symptom interactions (logarithmic odds ratio scale) increased from 0.40 (95% CI, 0.36-0.44) to 0.60 (95% CI, 0.52-0.70) during nonspecific psychotherapy and to 0.56 (95% CI, 0.48-0.64) during disorder-specific psychotherapy. In contrast, the mean raw (ie, valence-sensitive) strength of symptom interactions decreased from 0.32 (95% CI, 0.28-0.36) to 0.26 (95% CI, 0.20-0.32) and to 0.09 (95% CI, 0.02-0.16), respectively. Changing symptom severity could be explained to a large extent by symptom interactions. Conclusions and Relevance: These findings suggest that specific treatment-related hypotheses of the network theory align well with empirical data. Conceptualizing mental disorders as symptom networks and treatments as measures that aim to change these networks is expected to give further insights into the working mechanisms of mental health treatments, leading to the improvement of current and the development of new treatments. Trial Registration: ClinicalTrials.gov Identifier: NCT00970437
- Subjects
CLINICAL trials; MENTAL health services; MENTAL illness; SECONDARY analysis; MEDICAL research
- Publication
JAMA Psychiatry, 2023, Vol 80, Issue 11, p1160
- ISSN
2168-622X
- Publication type
Article
- DOI
10.1001/jamapsychiatry.2023.2823