Integrative Modular Psychotherapy During Psychiatric Hospitalisation for Severe Major Depression with Suicide Risk: A Case Report

Abstract

Background: Major depressive disorder (MDD) is associated with elevated suicide risk. Integrative psychotherapeutic approaches that combine psychoeducation, behavioural activation, cognitive restructuring, mindfulness, social connection, and relapse prevention may be effective and feasible in routine care. Case: A 36-year-old male software engineer presented with a severe major depressive episode without psychotic features, precipitated by occupational stressors. Assessment indicated high depressive severity (e.g., MADRS), high stress and anxiety (DASS 21), elevated dysfunctional attitudes (DAS A), and moderate suicide risk without plan (C SSRS). Intervention: A four week, six module program included: (1) psychoeducation about depression and personalised triggers; (2) behavioural activation and daily routine; (3) problem solving and cognitive restructuring to address catastrophising and self-blame; (4) mindfulness practices to reduce rumination; (5) social connection skills and structured re- engagement in valued relationships; and (6) relapse prevention planning and values based goals. Sessions were accompanied by homework and symptom monitoring. Outcomes: Over the course of four weeks, the patient reported reduced rumination and anxiety,an  improved sleep routine and energy levels, greater engagement in work and family activities, and increased self-efficacy. Suicidality decreased from recurrent passive ideation to infrequent, brief thoughts without plan or intent, along with enhanced safety planning and help seeking. Conclusion: A brief, structured integrative psychotherapeutic intervention may reduce suicide risk and improve functioning in severe depression. The modular format and emphasis on activation, cognitive change, mindfulness, social reconnection, and relapse prevention suggest practical utility for similar cases.