Background
Methods
Setting and design
Participants
Total (n = 113) | Step-down (n =59) | Outpatient (n = 54) | |
---|---|---|---|
Mean age (SD) | 31 (7.3) | 31 (7.2) | 31 (7.4) |
Women | 75% | 78% | 72% |
Education and work status
| |||
More than 12 years of education | 51% | 47% | 57% |
Full-time employee (100%) | 23% | 23% | 24% |
Half-time employee (approx. 50%) | 8% | 12% | 4% |
Student | 16% | 16% | 16% |
Unemployed | 50% | 49% | 50% |
Other | 3% | 0% | 6% |
Symptom severity
| |||
Mean symptom distress, GSI (SD) | 1.72 (0.66) | 1.71 (0.69) | 1.75 (0.62) |
Mean interpersonal problems, CIP (SD) | 1.69 (0.51) | 1.70 (0.53) | 1.72 (0.48) |
Mean psychosocial functioning, GAF (SD) | 47.6 (4.4) | 47.3 (4.3) | 47.9 (4.6) |
Self-injury / suicide attempts
| |||
Suicidal thoughts in the last 7 days | 50% | 50% | 50% |
Suicidal thoughts in the last 12 months | 85% | 88% | 82% |
Self-injury in the last 12 months | 31% | 36% | 26% |
Axis II diagnosis
| |||
Mean number PD diagnosis | 1.4 (0.6) | 1.5 (0.7) | 1.4 (0.6) |
Mean number PD criteria | 15 (5.7) | 15 (6.2) | 15 (5.2) |
Schizotype | 0% | 0% | 0% |
Schizoid | 1% | 2% | 0% |
Paranoid | 14% | 17% | 11% |
Histrionic | 0% | 0% | 0% |
Narcissistic | 2% | 0% | 4% |
Antisocial | 0% | 0% | 0% |
Borderline | 46% | 46% | 46% |
Avoidant | 41% | 44% | 37% |
Dependent | 7% | 7% | 7% |
Obsessive-compulsive | 9% | 12% | 6% |
PD NOS | 21% | 19% | 24% |
Axis I diagnosis
| |||
Mean number axis I diagnosis (SD) | 3.4 (1.4) | 3.7 (1.3) | 3.5 (1.5) |
Mood disorders | 87% | 85% | 89% |
Anxiety disorders | 87% | 90% | 83% |
Substance abuse disorder | 25% | 19% | 32% |
Completeness of data
Treatments
Step-down day hospital treatment (Step-down treatment)
Outpatient individual psychotherapy (Outpatient treatment)
Therapists
Group therapists in the step-down treatment
Individual therapists in the step-down treatment
Therapists in the outpatient treatment
Outcome measures
Psychosocial functioning
Interpersonal problems
Symptom distress
Axis I and II diagnoses
Self-harm, suicidal thoughts and suicide attempts
Statistical analysis
Results
Overall clinical course from baseline to the 6-year follow-up
Step-down | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Baseline | 8 months | 18 months | 3- years | 6- years |
d
| ||||||
GAF | 47.3 | (4.3) | 51.5 | (10.2) | 53.5 | (10.3) | 57.7 | (12.7) | 62.7 | (13.6) | 1.92 |
WSAS | 25.3 | (7.2) | 20.6 | (8.6) | 19 | (9) | 19.2 | (10.6) | 13.7 | (11.0) | 1.19 |
GSI | 1.71 | (0.69) | 1.43 | (0.65) | 1.32 | (0.75) | 1.19 | (0.75) | 0.91 | (0.72) | 1.14 |
BDI | 18.3 | (8.2) | 17.2 | (7.6) | 15.5 | (10.7) | 14.7 | (11.3) | 13,0 | (11.2) | 0.56 |
CIP | 1.66 | (0.53) | 1.53 | (0.59) | 1.51 | (0.6) | 1.42 | (0.62) | 1.13 | (0.68) | 0.89 |
QOL | 3.3 | (1.6) | 4.5 | (1.6) | 4.9 | (2.1) | 5.4 | (2) | 6.1 | (2.3) | 1.49 |
PDcrit | 13.3 | (5.6) | 8.5 | (6.4) | 5.9 | (6.5) | 1.24 | ||||
Outpatient
| |||||||||||
Baseline
|
8 months
|
18 months
|
3- years
|
6- years
|
d
| ||||||
GAF | 47.9 | (4.6) | 50.2 | (12) | 56.8 | (11.7) | 66.9 | (12.6) | 57.1 | (14.5) | 1.10 |
WSAS | 24.7 | (8.2) | 18.9 | (9.9) | 15.7 | (11.2) | 12.6 | (10.9) | 18.3 | (11.3) | 0.68 |
GSI | 1.75 | (0.62) | 1.43 | (0.73) | 1.23 | (0.73) | 1.06 | (0.79) | 1.12 | (0.74) | 0.95 |
BDI | 19.9 | (9.5) | 18.5 | (11.8) | 16.6 | (12.5) | 12.2 | (10.3) | 13.4 | (9.95) | 0.66 |
CIP | 1.72 | (0.48) | 1.52 | (0.57) | 1.25 | (0.62) | 1.22 | (0.64) | 1.32 | (0.62) | 0.75 |
QOL | 3.6 | (1.7) | 4.4 | (1.9) | 5.1 | (2.3) | 5.9 | (2.2) | 5.5 | (1.85) | 1.08 |
PDcrit | 13.4 | (4.8) | 6.0 | (5.8) | 5.6 | (5.6) | 1.53 |
Clinical course from the 3- to 6-year follow-up
Outcome | Fixed effects | Estimates1
| SE | 95% CI |
---|---|---|---|---|
GAF |
Main effect group
| |||
Outpatient group | 0.63 | 0.86 | -1.07, 2.33 | |
Step-down group | 0 (Ref) | |||
Main effect time
| ||||
Time ≤ 3- years | 0.28*** | 0.05 | 0.18, 0.37 | |
Time > 3- years | 0.14* | 0.06 | 0.14, 0.26 | |
Interaction, group x time ≤ 3- years
| ||||
Outpatient group | 0.21** | 0.73 | 0.06, 0.36 | |
Step-down group | 0 (Ref) | |||
Interaction, group x time > 3- years
| ||||
Outpatient group | -0.38*** | 0.10 | -0.67, -0.18 | |
Step-down group | 0 (Ref) | |||
WSAS |
Main effect group
| |||
Outpatient group | -1.50 | 1.53 | -4.55, 1.55 | |
Step-down group | 0 (Ref) | |||
Main effect time
| ||||
Time ≤ 3- years | -0.06 | 0.03 | -0.12, 0.01 | |
Time > 3- years | -0.14* | 0.04 | -0.23, 0.05 | |
Interaction, group x time ≤ 3- years
| ||||
Outpatient group | -0.10 | 0.05 | -0.20, 0.004 | |
Step-down group | 0 (Ref) | |||
Interaction, group x time > 3- years
| ||||
Outpatient group | 0.25*** | 0.07 | 0.11, 0.38 | |
Step-down group | 0 (Ref) |
Secondary outcome variables at the 6-year follow-up
Total (n = 79) | Step-down (n =42) | Outpatient (n = 37) | |
---|---|---|---|
Patients with GP visits | 92% | 93% | 92% |
Patient visiting GP for mental health issues | 57% | 50% | 65% |
Median number of GP visits | 4 | 4 | 5 |
Currently receiving psychiatric treatment* | 48% | 44% | 53% |
Outpatient treatment | 29% | 21% | 38% |
Contact with psychiatric emergency | 3% | 2% | 3% |
Contact with a psychiatric nurse | 11% | 10% | 14% |
Substance addiction clinic | 5% | 2.5% | 3% |
Regular psychiatric medication | 43% | 33% | 54% |