Patient and course of care factors impacting time to response and remission in psychotherapy for depression.

INTRODUCTION

Psychotherapy effectively treats depression, but variation exists in response timing and treatment trajectories.

METHODS

Using data from 7,161 adults receiving psychotherapy for depression (baseline PHQ-9 ≥10), we examined how baseline patient characteristics predict time to first response (≥50% symptom reduction) and first remission (PHQ-9 < 5), and whether patient features predict later outcomes for non-responders after 24 psychotherapy sessions. Baseline predictors were identified using elastic net; time to outcomes used Poisson regression.

RESULTS

Overall, 67.9% achieved first response and 45.6% achieved first remission at median times of 6 and 8 sessions, (respectively); most responses occurred by session 12 (81.9%). Features predicting faster response included adjustment disorder diagnosis and good health; slower response related to comorbid anxiety, chronic pain, and diagnostic complexity. Among non-responders by session 24 (n = 778: first response, n = 1,477 first remission), only early symptom trajectories-not baseline characteristics-predicted later response.

DISCUSSION: Findings support using complexity assessments for initial treatment planning and ongoing symptom monitoring for mid-treatment adjustments.