A dual-factor model perspective on depressed inpatients: examining the dynamics of mental health and therapy outcomes

Julia Brailovskaia; Ruth von Brachel; Franziska van Hall; Tobias Teismann; Gerrit Hirschfeld; Jürgen Margraf

doi:10.3389/fpsyt.2023.1295032

A dual-factor model perspective on depressed inpatients: examining the dynamics of mental health and therapy outcomes

Front Psychiatry. 2024 Jan 11:14:1295032. doi: 10.3389/fpsyt.2023.1295032. eCollection 2023.

Authors

Julia Brailovskaia^{1

2}, Ruth von Brachel¹, Franziska van Hall³, Tobias Teismann¹, Gerrit Hirschfeld⁴, Jürgen Margraf^{1

2}

Affiliations

¹ Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany.
² DZPG (German Center for Mental Health), Partner Site Bochum/Marburg, Bochum, Germany.
³ CuraMed Private Clinic Stillachhaus, Oberstdorf, Germany.
⁴ University of Applied Sciences, Bielefeld, Germany.

Abstract

Background: The dual-factor model of mental health posits that mental health and mental illness constitute two distinct axes; accordingly the model identifies four mental health groups: (1) complete mental health, (2) troubled, (3) vulnerable, (4) symptomatic but content. Yet, only a few studies investigated effectiveness of therapy on both dimensions of mental health simultaneously. Against this background, the present study aimed to determine proportions and changes of group assignments in depressed inpatients undergoing therapy.

Method: N = 1,044 depressed inpatients (age in years: M = 53.36, SD = 9.81, range: 17-83) completed a pre- and a post-treatment survey including questionnaires on depression, anxiety, and positive mental health. A total of n = 328 persons completed the survey also at 6-month and 12-month follow-up assessments.

Results: In the classification that included depression symptoms and positive mental health, 49% of the participants were classified as troubled and 13.2% were classified as completely mentally healthy at the pre-treatment assessment. At the post-treatment, 9.5% were classified as troubled and 55.7% were classified as completely mentally healthy. In the classification that included anxiety symptoms and positive mental health, 21.9% of the participants were classified as troubled and 14.2% were classified as completely mentally healthy at the pre-treatment assessment. At the post-treatment, 3.7% were classified as troubled and 56.1% were classified as completely mentally healthy. About 10 to 20% of patients showed an improvement in depression/anxiety and positive mental health, whereas another 10 to 20% showed a reduction in depression/anxiety, but only a minor increase in positive mental health between pre- and post-treatment.

Conclusion: Findings are in line with past research inspired by the dual-factor model in showing that enhancing positive mental health and alleviating psychopathology do not always co-occur in treatment. It is therefore important to implement measures of both psychopathology and positive mental health in therapy outcome studies, and to promote interventions targeting both psychopathology and positive mental health.

Keywords: anxiety; depression; dual-factor model; inpatient treatment; positive mental health.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The Open Access Publication Funds of the Ruhr-Universität Bochum supported the open access publication of this paper.