Antidepressants combined with psychodrama in treatment of major depressive disorder with childhood trauma: a randomized controlled trial

To compare the intervention effects of antidepressants combined with Yi Shu psychodrama or with general health education on depression, anxiety, self-esteem and mental resilience in depression patients with childhood trauma so as to explore a better clinical program.

A total of 68 patients who met the diagnostic criteria of ICD-10 unipolar depressive episode and also were positive for Childhood Trauma Questionnaire 28 item Short Form (CTQ-SF) were recruited from the psychiatric outpatients of our hospital, and then they were randomly divided into antidepressants plus Yi Shu psychodrama group and antidepressants plus general health education group. The patients were subsequently intervened for 6 months and then followed up for another 6 months. Hamilton Depression Rating Scale-17 item (HAMD-17), Beck Anxiety Inventory-21 item (BAI-21), Self-Esteem Scale (SES) and Connor-Davidson Resilience Scale (CD-RISC) were used for assessment. Repeated-measures ANOVA was adopted to compare the effects on depression and anxiety improvement, as well as the results of self-esteem and resilience development between the 2 groups at the end of intervention and during follow-up.

① There were 35 cases enrolled in the psychodrama group and 33 in the joint health education group. By the end of follow-up, 4 cases were lost in the former and 13 in the latter group, with statistical difference in shedding rate between the 2 groups (11.4% vs 39.4%, P<0.01). ② At the end of intervention, the total efficacy rate of the psychodrama group was higher than that of the health education group (63.63% vs 37.04%, Chi-square=4.207, P<0.05). ③ The results of repeated-measures ANOVA and simple effect analysis revealed that at the end of intervention, the scores of depression and anxiety were decreased in both groups, while those of self-esteem, mental resilience and its dimensions were increased, with significant differences in scores of HAMD, SES, CD-RISC and its dimensions (P<0.05), except for BAI score. During the follow-up, the scores of self-esteem and strength dimension were higher in the psychodrama group than the health education group (P<0.05).

In the treatment of major depressive disorder with childhood trauma, antidepressants combined with Yi Shu psychodrama has better overall efficacy and maintenance effect in improving depression, anxiety, self-esteem and mental resilience than the joint general health education program, with better treatment compliance as well.