Psychiatry Research Communications (Dec 2021)

Effectiveness of a structured intervention to make routine clinical meetings therapeutically effective (DIALOG+) for patients with depressive and anxiety disorders in Bosnia and Herzegovina: A cluster randomised controlled trial

  • S. Slatina Murga,
  • S. Janković,
  • M. Muhić,
  • H. Sikira,
  • E. Burn,
  • S. Priebe,
  • A. Džubur Kulenović

Journal volume & issue
Vol. 1, no. 2
p. 100010

Abstract

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Background: DIALOG+ is a patient-centred, solution-focused intervention, which aims to make routine patient-clinician meetings therapeutically effective. Existing evidence suggests that it is effective for patients with psychotic disorders in high-income countries. We tested the effectiveness of DIALOG ​+ ​for patients with depressive and anxiety disorders in Bosnia and Herzegovina, a middle-income country. Methods: We conducted a parallel-group, cluster randomised controlled trial of DIALOG+ in an outpatient clinic in Sarajevo. Patients inclusion criteria were: 18 years and older, a diagnosis of depressive or anxiety disorders, and low quality of life. Clinicians and their patients were randomly allocated to either the DIALOG ​+ ​intervention or routine care in a 1:1 ratio. The primary outcome, quality of life, and secondary outcomes, psychiatric symptoms and objective social outcomes, were measured at 6- and 12-months by blinded assessors. Results: Fifteen clinicians and 72 patients were randomised. Loss to follow-up was 12% at 6-months and 19% at 12-months. Quality of life did not significantly differ between intervention and control group after six months, but patients receiving DIALOG ​+ ​had significantly better quality of life after 12 months, with a medium effect size (Cohen's d ​= ​0.632, p ​= ​0.007). General symptoms as well as specifically anxiety and depression symptoms were significantly lower after six and 12 months, and the objective social situation showed a statistical trend after 12 months, all in favour of the intervention group. No adverse events were reported. Limitations: Delivery of the intervention was variable and COVID-19 affected 12-month follow-up assessments in both groups. Conclusion: The findings suggest DIALOG ​+ ​could be an effective treatment option for improving quality of life and reducing psychiatric symptoms in patients with depressive and anxiety disorders in a low-resource setting.

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