Outcomes of a Crisis Intervention program in a Psychiatry Day Hospital and the discussion of the effects of Empathy

Abstract

Background: The Day Hospital in Psychiatry was created in the 20th century as an outpatient multidisciplinary intervention, for acute mental conditions. However, such approach is heterogeneous in practice and lacks support in published evidence.

Aims: To assess the outcomes of a Day Hospital  intervention and study possible variables responsible for the therapeutic effect.

Methods: We performed a prospective observational study of patients consecutively admitted to the Day Hospital ten-week programme at a Portuguese health institution. Inclusion criteria were the presence of acute depressive and anxiety disorders and impaired psychosocial functioning, related to adverse life- events. At baseline and discharge, we assessed daily functioning on Global Assessment of Functioning scale; anxiety and depression symptoms on Hospital Anxiety and Depression Scale (HADS); and coping mechanisms on Brief-COPE scale. We ran statistical t-tests on SPSS Statistics 22. Furthermore, we performed a comprehensive literature review to support the discussion of our results, especially on empathy as a possible therapeutic effector in Day Hospital intervention.

Results and Conclusions: At discharge, we found in the patients a significantly higher level of functioning on GAF (p<0,001); lower anxiety (p=0,003) and depression levels (p=0,015) on HADS; increased “emotional support” (p=0,022) and “active coping” (p=0,007) and decreased “self-guilt” (p=0,013) and “denial” (p=0,016) coping mechanisms. Day Hospital intervention had proved beneficial for acute mental disorders in crisis situations. Additionally, published data on Day Hospital is little and yields heterogeneous models, lacking evidence for the therapeutic mechanism. We propose empathy between therapist and patient as such the effector, given the knowledge on its mirror neural  echanisms.