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For patients with PDD, psychiatric rehabilitation using self-management interventions is advised as the next therapeutic step after multiple unsuccessful treatment attempts. The \u201c\n                      <jats:italic>Patient and Partner Education Program for All Chronic Diseases<\/jats:italic>\n                      \u201d (PPEP4All) is a brief, structured self-management program that focuses on functional recovery for patients and their partners\/caregivers. In chronic somatic disorder populations, PPEP4All has already been shown to be clinically effective. We examined whether PPEP4All adapted for PDD (PPEP4All-PDD, nine weekly group or individual sessions) is also clinically effective for adults\/elderly with PDD and their partners\/caregivers compared to care-as-usual (CAU) in specialized mental healthcare.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this mixed-method multicenter pragmatic randomized controlled trial, 70 patients with PDD and 14 partners\/caregivers were allocated to either PPEP4All-PDD (patients,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200937; partners\/caregivers,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200914) or CAU (patients\n                      <jats:italic>, n<\/jats:italic>\n                      \u2009=\u200933; partners\/caregivers, not included) and completed questionnaires at 0, 3, 6, and 12\u00a0months regarding depressive symptoms, psychopathology, psychosocial burden, mental resilience, and happiness\/well-being. Qualitative data were collected regarding treatment satisfaction. Data were analyzed using mixed model analyses and an intention-to-treat (ITT) approach.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There was no statistically significant difference in any outcome regarding clinical effectiveness between PPEP4All-PDD and CAU. Subgroup analysis for depressive symptoms did not show any interaction effect for any subgroup. Although 78% of participants recommended PPEP4All-PDD, there was no difference in treatment satisfaction between PPEP4All-PDD (score\u2009=\u20096.6; SD\u2009=\u20091.7) and CAU (score\u2009=\u20097.6; SD\u2009=\u20091.2),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.06.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Although depressive symptoms did not improve relative to CAU, this only confirmed that treatment for patients with treatment-resistant PDD should move from symptom reduction to functional recovery. Also, functional recovery may be reflected in other outcomes than psychosocial burden, such as self-empowerment, in patients with treatment-resistant PDD. Future research on PPEP4All-PDD could focus on a longer-term program and\/or online program that may also be offered earlier in the treatment process as an empowerment intervention.\u00a0<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      Netherlands Trial Register Identifier NL5818. Registered on 20 July 2016\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrialregister.nl\/nl\/trial\/20302\">https:\/\/clinicaltrialregister.nl\/nl\/trial\/20302<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13063-024-08033-9","type":"journal-article","created":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T10:02:36Z","timestamp":1710324156000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["The clinical effectiveness of a self-management intervention for patients with persistent depressive disorder and their partners\/caregivers: results from a multicenter, pragmatic randomized controlled trial"],"prefix":"10.1186","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6956-0995","authenticated-orcid":false,"given":"Ericka C.","family":"Solis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid V. 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