Improving social functioning in depressed mothers: results from a randomised controlled trial

ABSTRACT

Clinical social work (CSW) may play an important role in the treatment of persons with depressive disorders. The aim of this study was to investigate the effects of a resource-oriented CSW intervention on social functioning in a population of mothers diagnosed with depression. In a randomised controlled trial (RCT), 61 mothers were assigned to a clinical social work intervention group (CSW; N = 30) or a treatment-as-usual group (TAU; N = 31). Assessment points were before and after the 10-session intervention. Global psychosocial functioning assessed with the Global Assessment of Functioning Scale of the Diagnostic and Statistical Manual (DSM) was the primary outcome variable. Other relevant variables included depressed mood, psychopathological symptoms, satisfaction with life and self-efficacy. Overall, 55 of the 61 participants completed the study; intention-to-treat analyses included data from 59 participants. All outcome measures revealed significant main effects with high effect sizes for the time of measurement. In addition, the results showed significantly stronger improvements in psychosocial functioning, psychopathological symptoms, and self-efficacy in the CSW group compared to the TAU group. Additional clinical social work was associated with larger improvements in global level of functioning and other psychologically relevant variables than treatment-as-usual.

ABSTRAKT

Klinische Sozialarbeit könnte eine bedeutsame Rolle in der Behandlung von Menschen mit depressiven Störungen spielen. Das Ziel der vorliegenden Studie war die Überprüfung der Effekte einer ressourcen-orientierten klinisch-sozialarbeiterischen Intervention auf das soziale Funktionsniveau von Müttern, bei denen eine depressive Störung diagnostiziert wurde. In einer randomisiert-kontrollierten Studie wurden 61 Mütter per Zufall entweder der Bedingung “Klinische Sozialarbeit” (N = 30) oder “Treatment as Usual” (N = 31) zugeordnet. Erhebungszeitpunkte waren vor und nach der 10 Sitzungen umfassenden Intervention. Das Globale Funktionsniveau war die primäre Outcome-Variable, andere Variablen waren: depressive Stimmung, psychopathologische Symptome, Lebenszufriedenheit und Selbstwirksamkeitserwartung. Insgesamt schlossen 55 von 61 Teilnehmerinnen die Studie ab. Intention-to-treat-Analysen umfassten die Daten von 59 Teilnehmerinnen. Für alle Outcome-Maße zeigten sich signifikante Haupteffekte mit hohen Effektstärken für den Messzeitpunkt. Zusätzlich zeigten sich signifikant stärkere Verbesserungen im Hinblick auf das psychosoziale Funktionsniveau, psychopathologische Symptome und Selbstwirksamkeitserwartung in der Bedingung “klinische Sozialarbeit” im Vergleich zur “Treatment as usual” Gruppe. Zusätzliche klinische Sozialarbeit zeigte demnach stärkere Verbesserungen im globalen Funktionsniveau und anderen psychologisch relevanten Variablen.

KEYWORDS:

• Depression
• mothers
• clinical social work
• resource orientation

SCHLÜSSELWORTE:

• Depression
• Mütter
• Klinische Sozialarbeit
• Ressourcenorientierung

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 Social workers generally use the term ‘client’ instead of ‘patient’ to refer to the individual, group, family or community that seeks or is provided with professional services. The client in social work is defined as both the individual and the client system or those in the client's environment (NASW, 2005).

2 ‘Rather than focus on pathology, the social work case manager elicits, supports and builds on the resilience and potential for growth and development inherent in each individual. Clients’ strengths and assets may be intrapersonal, found within the environment or developed in response to the environment.’ (NASW, 2013, p. 18)

3 For further information, see Renz, Gebrande, Schaller, and Heidenreich (2011, p. 383ff). In spite of the standardisation of the course of intervention, the social workers were responsive to the individual wishes, needs and demands of the participants and were not bound to maintain the hierarchy.

Additional information

Funding

This work was supported by Ministerium für Wissenschaft, Forschung und Kunst Baden-Württemberg.

Notes on contributors

Thomas Heidenreich

Thomas Heidenreich, PhD, born 1966, is a professor of psychology for social work and nursing at Esslingen University of Applied Sciences. He earned his diploma in psychology at Konstanz University and is PhD at Frankfurt University. Also, he is a psychological psychotherapist and supervisor with specialised training in cognitive behaviour therapy.

Julia Gebrande

Julia Gebrande, PhD, born 1978, Professor of social work at Esslingen University of Applied Sciences. She is a certified social pedagogue and social worker with several years of experience as a counsellor for psychotraumatology. Her focus lies on clinical social work, especially in the aftermath of sexual violence and other traumatic events.

Johanna Renz

Johanna Renz, master of social work, born 1980. She is working for several years as a social worker in child and youth services. Since 2016 she is expert adviser for child day care.

Alexander Noyon

Alexander Noyon, PhD, born 1968, psychologist and psychotherapist. Several years of working in hospitals and as a scientific assistant at Frankfurt Goethe University. Since 2000 therapist in private practice. Since 2007 professor for psychology in social work at Mannheim University of Applied Sciences. Specialised training in cognitive behaviour therapy and existential psychotherapy. Lecturer and supervisor in several institutes for psychotherapy training.

Michaela Zinnöcker

Michaela Zinnöcker, born ‪1984, is a psychologist and psychotherapist, specialised in cognitive behaviour therapy. She earned her diploma at the Eberhard Karls University of Tuebingen and since then she is working in the psychiatric section of Klinikum Stuttgart, especially with female patients who suffer from postpartal depression.

Martin Hautzinger

Martin Hautzinger, PhD, born 1950, psychologist and psychotherapist, supervisor and director of outpatient clinic of psychotherapy and chair of clinical psychology and psychotherapy at the department of psychology at Eberhard Karls University of Tuebingen, Germany. Research focus on depression and bipolar disorder, psychotherapy research. Currently involved in the implementation of a university programme for psychotherapy and psychotraumatology in Northern Irak (Dohuk, Kurdistan).