Therapeutic change in interpersonal counselling (IPC) for depression: A mixed methods study of primary health care patients

Abstract

The aim of this research was to optimize the use of effective treatment for patients with depressive disorders in primary health care. The dissertation examines whether brief treatment, Interpersonal Counselling (IPC), is appropriate for treating depression, and which are the factors that may influence a positive response to this counselling. This thesis consists of three studies based on the same patient sample which was viewed on three levels: In Study I, 40 patients with a diagnosis of major depressive disorder (mild or moderate) were randomized into two groups, 20 of them receiving IPC (7 sessions) and 20 a comparable treatment modality, Interpersonal Psychotherapy (IPT) (16 sessions). Statistical analysis showed that IPC delivered by mental health nurses in primary health care was comparable to IPT in secondary care. Approximately 60% of the patients had recovered by the time of the 12 months follow-up in both groups. Study II considered five IPC patients who had recovered and five who remained unchanged. Qualitative content analysis and applied conversation analysis (CA) of the case formulation process and its content in the initial phase of IPC suggested three core conditions for recovery from depression: joint construction of the problems by the patient and counsellor, the ability to restrict the scope to one problem area and the availability of social support from close relationships outside the treatment. In Study III the analysis of a recovered case indicated how IPC’s interpersonal formulation approach and the focus within an IPC framework were able to guide the patient away from her self-accusation talk towards discussing her problematic relationship with her spouse. Overall, the results presented here have important clinical and organizational implications and support the conclusion that a significant proportion of major depressive disorder patients can be treated with brief treatment in primary care. Training front-line health care workers in psychotherapeutic skills could close the gap between mental health needs and access to care.