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Psychiatrist Effects In The Psychopharmacological Treatment Of Depression.

Kevin M. McKay, Zac E. Imel, B. Wampold
Published 2006 · Medicine

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BACKGROUND The National Institutes of Mental Health's (NIMH) 1985 Treatment of Depression Collaborative Research Program (TDCRP) reported that imipramine hydrochloride with clinical management (IMI-CM) was significantly more beneficial than placebo with clinical management (PLA-CM) for individuals undergoing treatment for depression. Unfortunately, in analyzing the NIMH TDCRP data, researchers ignored the potential effect that psychiatrists have on patient outcomes, thereby assuming that psychiatrists are equally effective. However, this assumption has yet to be supported empirically. Therefore, the purpose of the current study is to examine psychiatrist effects in the NIMH TDCRP study and to compare the variation among psychiatrists to the variation between treatments. METHOD Data from 112 patients [IMI-CM (n = 57, 9 psychiatrists); PLA-CM (n = 55, 9 psychiatrists)] from the NIMH TDCRP study were reanalyzed using a multi-level model. RESULTS The proportion of variance in the BDI scores due to medication was 3.4% (p < .05), while the proportion of variance in BDI scores due to psychiatrists was 9.1% (p < .05). The proportion of variance in the HAM-D scores due to medication was 5.9% (p < .05), while the proportion of variance in HAM-D scores due to psychiatrist was 6.7% (p = .053). Therefore, the psychiatrist effects were greater than the treatment effects. CONCLUSIONS In this study, both psychiatrists and treatments contributed to outcomes in the treatment of depression. However, given that psychiatrists were responsible for more of the variance in outcomes it can be concluded that effective treatment psychiatrists can, in fact, augment the effects of the active ingredients of anti-depressant medication as well as placebo.
This paper references
Concerning the Effect of Intraclass Correlation on Certain Significance Tests
J. Walsh (1947)
Experimental Design: Procedures for the Behavioral Sciences
R. Kirk (1969)
Statistical Power with Group Mean as the Unit of Analysis
R. Barcikowski (1981)
NIMH Treatment of Depression Collaborative Research Program. Background and research plan.
I. Elkin (1985)
Consequences of violating the independence assumption in analysis of variance.
D. A. Kenny (1986)
Synopsis of psychiatry: Behavioral sciences : clinical psychiatry
H. Kaplan (1988)
National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments.
I. Elkin (1989)
Meta‐Analysis of Therapist Effects in Psychotherapy Outcome Studies
P. Crits-Christoph (1991)
Implications of therapist effects for the design and analysis of comparative studies of psychotherapies.
P. Crits-Christoph (1991)
Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry
J. Frank (1992)
Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences Clinical Psychiatry
Benjamin J. Sadock (1994)
Initial severity and differential treatment outcome in the National Institute of Mental Health Treatment of Depression Collaborative Research Program.
I. Elkin (1995)
Experimental design: Procedures for the behavioral sciences (3rd ed.).
R. E. Kirk (1995)
Characteristics of effective therapists: further analyses of data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program.
S. Blatt (1996)
The Psychotherapist Matters: Comparison of Outcomes Across Twenty-Two Therapists and Seven Patient Samples
L. Luborsky (1997)
Therapist effects in three treatments for alcohol problems
J. Allen (1998)
A Major Dilemma in Psychotherapy Outcome Research: Disentangling Therapists From Therapies
I. Elkin (1999)
Multilevel analysis. An introduction to basic and advanced multilevel modeling, 2nd edition (1st edition 1999).
T. Snijders (1999)
The consequence of ignoring a nested factor on measures of effect size in analysis of variance.
B. Wampold (2000)
HLM 6: Hierarchical Linear and Nonlinear Modeling
Y. F. Cheong (2000)
The Great Psychotherapy Debate: Models Methods and Findings
A. Horvath (2002)
Hierarchical Linear Models, 2nd ed
S. W. Raudenbush (2002)
Hierarchical Linear Models
J. Gill (2005)

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