Abstract
BACKGROUND: Depression management in hospitalized patients with moderate-to-severe major depressive disorder (MDD) often relies on pharmacotherapy, with limited integration of psychosocial interventions. This study introduces a novel multidimensional model combining cognitive-behavioral therapy (CBT) and structured social support, addressing a critical gap in inpatient care. METHODS: This single-center retrospective cohort study included 212 inpatients diagnosed with moderate-to-severe MDD between November 2023 and December 2024. Patients were assigned to either routine care (n = 104) or an intervention group (n = 108) receiving CBT and a structured, multi-level social support program in addition to standard treatment. The intervention included biweekly CBT sessions, family involvement, peer support, enhanced nurse-patient communication, and post-discharge follow-up. Depression (HAMD, PHQ-9), anxiety (HAMA), social support (MSPSS), suicidal ideation (BSI), quality of life (WHOQOL-BREF), and patient satisfaction were assessed at baseline, discharge, and at two and four weeks post-discharge. RESULTS: A total of 212 patients were included. Compared with routine care, the intervention group showed significantly greater improvements in depressive symptoms (HAMD at 4 weeks: 12.1 vs. 16.0, p < 0.001; PHQ-9: 8.8 vs. 12.4, p < 0.001), anxiety, social support, suicidal ideation, and quality of life (all p < 0.001). Social support was negatively correlated with depression severity, and the intervention (OR = 2.45) and good sleep quality (OR = 1.89) were independent predictors of treatment response. Sensitivity analyses confirmed results robustness. CONCLUSION: This novel integration of CBT and structured social support significantly enhances clinical outcomes and reduces suicide risk in hospitalized patients with depression, offering a scalable, patient-centered model. However, the retrospective design limits causal inferences, requiring prospective studies for validation. Its standardized design suggests potential applicability across diverse healthcare settings with cultural adaptations. CLINICAL TRIAL NUMBER: Not applicable.