The association between medical comorbidity and psychotherapy processes and outcomes for major depressive disorder in a community mental health setting

Psychotherapy (Chic). 2022 Jun;59(2):199-208. doi: 10.1037/pst0000380. Epub 2021 Aug 26.


Many individuals seeking mental health services for depression often suffer from a comorbid medical condition. The goal of the present study was to assess the presence of medical comorbidity in a community mental health center setting that primarily serves a Medicare and Medicaid population, characterize the types of comorbid medical conditions experienced in this setting, and explore the association between medical conditions on the alliance, attrition from services, and outcome. Medical diagnoses were collected from patient charts and structured clinical interviews from 353 participants who had a baseline assessment as part of a comparative effectiveness study of cognitive and dynamic therapies for major depressive disorder. We calculated the Charlson Comorbidity Index and the number of total medical diagnoses for each patient. Results from this study revealed that a high percentage of patients in this setting experienced a comorbid medical condition. No significant associations were found between the number of medical conditions or the Charlson Comorbidity Index and the alliance. No significant relationship was found between the number of medical conditions or the Charlson Comorbidity Index and early attrition from treatment or treatment outcome. However, exploratory analyses found that presence of a nervous system disorder was associated with relatively poorer treatment outcomes after initial engagement. Implications of these findings are discussed. Treatments for major depressive disorder may benefit from addressing the impact of medical disorders on physical functioning. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

MeSH terms

  • Aged
  • Comorbidity
  • Depressive Disorder, Major* / epidemiology
  • Depressive Disorder, Major* / therapy
  • Humans
  • Medicare
  • Mental Health
  • Psychotherapeutic Processes
  • United States / epidemiology