Effectiveness of Rational Emotive Behaviour Therapy in Clinical Social Work: Impact on Frequency of Visits and Use of Psychopharmacological Treatment

摘要

Introduction : Over 70% of mental health problems are exclusively managed in Primary Care. The yearly prevalence of depression and anxiety in Primary Care patients in Catalonia is 30% in women and 14% in men. The prevalence of major depressive disorder and of dysthymia is 1.3/1000 and 1.9/1000. As a consequence of their emotional distress, patients with dysthymia are typically frequent users of social and medical services and they are often prescribed psychopharmacological agents, which results in an increased risk of chronification and high pharmacy costs. Objective : The objective of this study is to evaluate the effectiveness of Rational Emotive Behavior Therapy (REBT) administered by a social worker in patients with dysthymia (Intervention Group) in reducing social and primary care (S&PC) attendance and prescription of psychopharmacological agents when compared with standard care (Control Group). Methods : Nonrandomized clinical trial with a 12month followup period from October 2009 to May 2013. Participants were patients with a diagnosis of dysthymia according to the Diagnostic and Statistical Manual of Mental Disorders–IV (DSMIV), recruited from two Primary Care Centers with similar sociodemographic characteristics in the Barcelona metropolitan area. Exclusion criteria were: cognitive impairment, illiteracy, refusal of treatment, severe psychiatric disorder and participation in psychoeducational groups and similar therapies. The Social Worker carried out the individual psychosocial intervention, with a maximum of 8 fortnightly sessions of 30 minutes in the Intervention Group while Control Group was treated as usual only by the general practitioner. Each session is aimed at identifying and analyzing the dysfunctional thoughts of the patients in order to suggest healthier alternatives. The treatment is active, directive, dynamic, and oriented towards psychosocial issues with the goal of empowering the person, group or community. Outcome variables were the frequency of use of primary care services related to the diagnosis of dysthymia and the prescription of psychopharmacological agents as registered in the electronic medical records during the previous 12 months. Other were sociodemographic variables, living arrangements, Beck Depression Inventory and comorbidities at baseline, mesured at baseline, 4 and 12 months. Baseline data from participants in the Intervention.