201
|
Haagsma JA, Polinder S, Olff M, Toet H, Bonsel GJ, van Beeck EF. Posttraumatic stress symptoms and health-related quality of life: a two year follow up study of injury treated at the emergency department. BMC Psychiatry 2012; 12:1. [PMID: 22230388 PMCID: PMC3276433 DOI: 10.1186/1471-244x-12-1] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 01/09/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Among injury victims relatively high prevalence rates of posttraumatic stress disorder (PTSD) have been found. PTSD is associated with functional impairments and decreased health-related quality of life (HRQoL). Previous studies that addressed the latter were restricted to injuries at the higher end of the severity spectrum. This study examined the association between PTSD symptoms and health-related quality of life (HRQoL) in a comprehensive population of injury patients of all severity levels and external causes. METHODS We conducted a self-assessment survey which included items regarding demographics of the patient, accident type, sustained injuries, EuroQol health classification system (EQ-5D) and Health Utilities Index (HUI) to measure functional outcome and HRQoL, and the Impact of Event Scale (IES) to measure PTSD symptoms. An IES-score of 35 or higher was used as indication for the presence of PTSD. The survey was completed by 1,781 injury patients two years after they were treated at the Emergency Department (ED), followed by either hospital admission or direct discharge to the home environment. RESULTS Symptoms indicative of PTSD were associated with more problems on all EQ-5D and HUI3 domains of functional outcome and a considerable utility loss in both hospitalized (0.23-0.24) and non-hospitalized (0.32-0.33) patients. Differences in reported problems between patients with IES scores higher or lower than 35 were largest for EQ-5D health domains pain/discomfort (82% versus 28%) and anxiety/depression (53% versus 11%) and HUI domains emotion (92% versus 33%) and pain (84% versus 38%). After adjusting for potential confounders, PTSD remained strongly associated with adverse HRQoL. CONCLUSIONS Among patients treated at an ED posttraumatic stress symptoms indicative of PTSD were associated with a considerable decrease in HRQoL in both hospitalized and non-hospitalized patients. PTSD symptoms may therefore raise a major barrier for full recovery of injury patients of even minor levels of severity.
Collapse
Affiliation(s)
- Juanita A Haagsma
- Department of Public Health, Erasmus Medical Center, Erasmus University Rotterdam, The Netherlands.
| | - Suzanne Polinder
- Department of Public Health, Erasmus Medical Center, Erasmus University Rotterdam, The Netherlands
| | - Miranda Olff
- Center for Psychological Trauma, Department of Psychiatry, Academic Medical Center/de Meren, University of Amsterdam, The Netherlands
| | - Hidde Toet
- Consumer Safety Institute, The Netherlands
| | - Gouke J Bonsel
- Department of Public Health, Erasmus Medical Center, Erasmus University Rotterdam, The Netherlands
| | - Ed F van Beeck
- Department of Public Health, Erasmus Medical Center, Erasmus University Rotterdam, The Netherlands
| |
Collapse
|
202
|
Koivumaa-Honkanen H, Kaprio J, Korhonen T, Honkanen RJ, Heikkilä K, Koskenvuo M. Self-reported life satisfaction and alcohol use: a 15-year follow-up of healthy adult twins. Alcohol Alcohol 2012; 47:160-8. [PMID: 22215005 DOI: 10.1093/alcalc/agr151] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS To study the bidirectional relationships between life satisfaction (LS) and alcohol use. METHODS Health questionnaires were administered in 1975, 1981 and 1990 to a population-based sample of healthy Finnish twins aged 18-45 at baseline (n = 14,083). These included a LS scale and three indicators for adverse alcohol use: binge drinking, passing out and high consumption (women/men ≥400/800 g/month). In longitudinal analyses, logistic regression, pair-wise case-control analyses and growth models were applied. RESULTS All alcohol indicators increased the age-adjusted risk of becoming dissatisfied regardless of study period [binge drinking odds ratio (OR)(1975-1990 )= 1.29; 95% confidence interval (CI) 1.12-1.50; high consumption OR(1975-1990 )= 1.60; 1.29-1.99 and passing out OR(1981-1990 )= 2.01; 1.57-2.57]. Also, the dissatisfied had an increased subsequent risk for adverse alcohol use. The risk for passing out due to drinking (OR(1975-1990 )= 1.50; 1.22-1.86) was increased regardless of study period, while high consumption (OR(1975-1981 )= 1.97; 1.40-2.77; OR(1981-1990 )= 2.48; 1.50-4.12) and binge drinking (OR(1975-1981 )= 1.37; 1.12-1.67) showed some variation by the study period. Predictions remained after multiple adjustments. Longitudinally, high consumption predicted dissatisfaction somewhat more strongly than vice versa. The change/levels within the whole range of LS and alcohol consumption were only slightly associated in the entire study population. CONCLUSION Life dissatisfaction and adverse alcohol use reciprocally predict each other prospectively. The heavier the alcohol use the stronger the relationship.
Collapse
|
203
|
The local burden of emotional disorders. An analysis based on a large health survey in Catalonia (Spain). GACETA SANITARIA 2012; 26:24-9. [DOI: 10.1016/j.gaceta.2011.05.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 05/09/2011] [Accepted: 05/11/2011] [Indexed: 11/24/2022]
|
204
|
Quality of life in panic disorder: looking beyond symptom remission. Qual Life Res 2011; 21:945-59. [PMID: 21935739 DOI: 10.1007/s11136-011-0020-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2011] [Indexed: 12/23/2022]
Abstract
PURPOSE Panic Disorder (PD) is a classic example of a disease where symptom remission may be achieved, yet patient quality of life (QOL) remains low, providing further support for the need to measure QOL as an additional outcome in patient care. The objectives of this review are to examine the substantial QOL impairments in PD and to determine whether modern treatments for PD, which have been proven to achieve symptom remission, have been shown to restore QOL. METHODS We identified studies on QOL in PD from 1980 to 2010 by searching MEDLINE, PsycINFO, and PubMed databases. RESULTS The literature reveals substantial QOL impairments in PD, often resulting in poor sense of health, frequent utilization of medical services, occupational deficiency, financial dependency, and marital strife. Modern therapies have been demonstrated to achieve symptom remission and improve QOL in PD; however, post-treatment QOL is still significantly lower than community averages. CONCLUSIONS QOL needs to be added as an essential outcome measure in patient care. Further research should be conducted to better understand the nature of comorbidities in PD as well as to determine whether additional interventions that have been studied in other psychiatric disorders, such as exercise, meditation, yoga, humor, massage, and nutritional supplements, can be utilized to improve QOL in PD to normal community levels.
Collapse
|
205
|
Cuijpers P. Prevention of depressive disorders: towards a further reduction of the disease burden of mental disorders. Early Interv Psychiatry 2011; 5:179-80. [PMID: 21791028 DOI: 10.1111/j.1751-7893.2011.00282.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
206
|
Stein MB, Roy-Byrne PP, Craske MG, Campbell-Sills L, Lang AJ, Golinelli D, Rose RD, Bystritsky A, Sullivan G, Sherbourne CD. Quality of and patient satisfaction with primary health care for anxiety disorders. J Clin Psychiatry 2011; 72:970-6. [PMID: 21367351 PMCID: PMC3111814 DOI: 10.4088/jcp.09m05626blu] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 12/31/2009] [Indexed: 10/18/2022]
Abstract
BACKGROUND Most patients with anxiety disorders receive their care from primary care practitioners (PCPs). The purpose of this study was to evaluate quality of and patient satisfaction with primary health care for anxiety disorders. METHOD A survey was performed among 1,004 outpatients with anxiety disorders (diagnosed according to DSM-IV) referred by their PCPs from 17 primary care clinical settings (3 of which were university-affiliated) in 4 regions of the United States for participation in the Coordinated Anxiety Learning and Management (CALM) study, a therapeutic trial. Participating research institutions were the University of Washington at Seattle, the University of California at San Diego and Los Angeles, and the University of Arkansas for Medical Sciences at Little Rock. Enrollment took place between June 2006 and April 2008. Patients were contacted by telephone after enrollment to provide information about previous care received (during the 6 months prior to referral) and satisfaction with that care. Quality-of-care indicators were self-reported type, dose, and duration of antianxiety medication treatment and self-reported psychotherapy with cognitive-behavioral therapy (CBT) elements. RESULTS A total of 576 patients (57.4%) had received an appropriate antianxiety medication in the previous 6 months, but only 289 patients (29.4% of 983 who answered this question) had received the medication at adequate dose for at least 2 months. A total of 465 patients (46.3%) had received some counseling with at least 1 element of CBT, but only 213 patients (21.2%) had received counseling with a strong (3+ elements) CBT focus. Overall, 416 patients (41.4%) had received quality pharmacotherapy or psychotherapy, and 81 patients (8.1%) had received both. Only 432 patients (44.8% of 964 who answered this question) were at least somewhat satisfied with their mental health care. Receipt of quality psychotherapy was the sole positive predictor (adjusted odds ratio = 2.71; 95% CI, 1.94-3.80; P < .0005) of satisfaction with mental health care for anxiety. Moreover, there was a dose-response relationship between the number of CBT elements consistently delivered and satisfaction with care (test for trend, z = 4.06, P < .0005). CONCLUSIONS Despite recognition of these patients' anxiety disorders and referral by their PCPs to an anxiety treatment study, fewer than half of the patients had in the prior 6 months received quality pharmacologic and/or psychosocial mental health care. Receipt of CBT-oriented, quality psychosocial (but not pharmacologic) care showed a strong dose-response relationship with satisfaction with mental health care.
Collapse
Affiliation(s)
- Murray B. Stein
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0855), La Jolla, CA 92093-0855, Phone 858-534-6451, Fax 858-534-6460,
- Department of Family & Preventive Medicine, University of California San Diego
| | - Peter P. Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP), Seattle
| | - Michelle G. Craske
- Department of Psychology, University of California, Los Angeles
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Laura Campbell-Sills
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0855), La Jolla, CA 92093-0855, Phone 858-534-6451, Fax 858-534-6460,
| | - Ariel J. Lang
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0855), La Jolla, CA 92093-0855, Phone 858-534-6451, Fax 858-534-6460,
| | | | - Raphael D. Rose
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Center for Healthcare Improvement for Addictions, Mental Illness and Medically Vulnerable Populations (CHAMMP), Seattle
| | - Alexander Bystritsky
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Greer Sullivan
- Department of Psychiatry, University of Arkansas for Medical Science, North Little Rock, AR
| | | |
Collapse
|
207
|
Chou KL, Afifi TO. Disordered (pathologic or problem) gambling and axis I psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Am J Epidemiol 2011; 173:1289-97. [PMID: 21467151 DOI: 10.1093/aje/kwr017] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The authors' objective in this study was to examine the role of disordered gambling as a risk factor for the subsequent occurrence of specific Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I psychiatric disorders after adjusting for medical conditions, health-related quality of life, and stressful life events. Community-dwelling respondents from nationally representative US samples (n = 33,231) were interviewed in 2000-2001 and 2004-2005. Past-year disordered gambling at baseline was associated with the subsequent occurrence of any Axis I psychiatric disorder, any mood disorder, bipolar disorder, generalized anxiety disorder, posttraumatic stress disorder, any substance use disorder, alcohol use disorders, and alcohol dependence disorder after adjustment for sociodemographic variables. After simultaneous adjustment for medical conditions, health-related quality of life, and recent stressful life events, disordered gambling remained significantly related to any mood disorder, generalized anxiety disorder, posttraumatic stress disorder, alcohol use disorders, and alcohol dependence. The clinical implications of these findings are that treatment providers need to screen gambling patients for mood, anxiety, and substance use problems and monitor the possible development of later comorbid conditions.
Collapse
Affiliation(s)
- Kee-Lee Chou
- Department of Social Work and Social Administration, University of Hong Kong, Pokfulam Road, Hong Kong, China.
| | | |
Collapse
|
208
|
Guan B, Cohen P, Deng Y, Chen H. Relative impact of Axis I mental disorders on quality of life among adults in the community. J Affect Disord 2011; 131:293-8. [PMID: 21570579 PMCID: PMC3433573 DOI: 10.1016/j.jad.2011.01.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 12/17/2010] [Accepted: 01/13/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Little is known about the relative impact of different mental disorders on adult quality of life (QOL). This study estimated associations between several mental disorders and QOL in a representative American community sample. METHODS The QOL instrument was administered to 640 adult participants in the Children in the Community Study, a population-based longitudinal study. DSM-Axis I and Axis II mental disorder diagnoses were assessed by psychiatric interview. RESULTS Poorer QOL was strongly associated with having a mood disorder, especially major depression disorder (MDD) (effect size, ES = -0.57, p < 0.01), whereas poorer quality social relationships were associated with having dysthymia and bipolar disorders (ES = -0.92, p < 0.01; ES = -0.80, p < 0.05, respectively). Most anxiety disorders were not independently related to QOL with the exception of post traumatic stress disorder (PTSD), which was significantly related to poorer physical health (ES = -0.78, p < 0.01) and psychological well-being (ES = -0.73, p < 0.01) and to less overall QOL (ES = -0.57, p < 0.01). CONCLUSIONS MDD and PTSD are independently related to impaired QOL and dysthymia and bipolar disorder negatively influence social relationships.
Collapse
Affiliation(s)
- Bingqing Guan
- Department of Clinical Psychology, The Third Xiangya Hospital, Central South University. Tongzipo Road, Changsha, Hunan, China
| | - Patricia Cohen
- New York State Psychiatric Institute
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University
| | - Yunlong Deng
- Department of Clinical Psychology, The Third Xiangya Hospital, Central South University. Tongzipo Road, Changsha, Hunan, China
| | - Henian Chen
- New York State Psychiatric Institute
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University
- Office of Health Outcome Research, Winthrop University Hospital. Stony Brook University School of Medicine
| |
Collapse
|
209
|
Cuijpers P, Geraedts AS, van Oppen P, Andersson G, Markowitz JC, van Straten A. Interpersonal psychotherapy for depression: a meta-analysis. Am J Psychiatry 2011; 168:581-92. [PMID: 21362740 PMCID: PMC3646065 DOI: 10.1176/appi.ajp.2010.10101411] [Citation(s) in RCA: 237] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Interpersonal psychotherapy (IPT), a structured and time-limited therapy, has been studied in many controlled trials. Numerous practice guidelines have recommended IPT as a treatment of choice for unipolar depressive disorders. The authors conducted a meta-analysis to integrate research on the effects of IPT. METHOD The authors searched bibliographical databases for randomized controlled trials comparing IPT with no treatment, usual care, other psychological treatments, and pharmacotherapy as well as studies comparing combination treatment using pharmacotherapy and IPT. Maintenance studies were also included. RESULTS Thirty-eight studies including 4,356 patients met all inclusion criteria. The overall effect size (Cohen's d) of the 16 studies that compared IPT and a control group was 0.63 (95% confidence interval [CI]=0.36 to 0.90), corresponding to a number needed to treat of 2.91. Ten studies comparing IPT and other psychological treatments showed a nonsignificant differential effect size of 0.04 (95% CI=-0.14 to 0.21; number needed to treat=45.45) favoring IPT. Pharmacotherapy (after removal of one outlier) was more effective than IPT (d=-0.19, 95% CI=-0.38 to -0.01; number needed to treat=9.43), and combination treatment was not more effective than IPT alone, although the paucity of studies precluded drawing definite conclusions. Combination maintenance treatment with pharmacotherapy and IPT was more effective in preventing relapse than pharmacotherapy alone (odds ratio=0.37; 95% CI=0.19 to 0.73; number needed to treat=7.63). CONCLUSIONS There is no doubt that IPT efficaciously treats depression, both as an independent treatment and in combination with pharmacotherapy. IPT deserves its place in treatment guidelines as one of the most empirically validated treatments for depression.
Collapse
Affiliation(s)
- Pim Cuijpers
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, the Netherlands.
| | | | | | | | | | | |
Collapse
|
210
|
Klemenc-Ketis Z, Smogavec M, Softic N, Kersnik J. Health-related quality of life: a population based study from Slovenia. Cent Eur J Public Health 2011; 19:7-12. [PMID: 21526649 DOI: 10.21101/cejph.a3636] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Health status is represented by people's subjective assessment of their sense of well-being and ability to perform social roles and has been well accepted as a health indicator of different populations. The aim of this study was to determine health-related quality of life in Slovenian population. METHODS We performed a cross-sectional postal survey in a random stratified sample of 1,000 adult Slovenian inhabitants. The questionnaire consisted of the respondents' demographic data (sex, age, education level, employment status, living environment), self-reported chronic conditions, self-reported use of health services and EQ-5D instrument for measuring quality of life. RESULTS The response rate was 41% (53.1% men, mean age 51.5 years). Respondents reported most problems in the pain dimension of EQ-5D (59.3%), following by mobility (30.4%), anxiety/depression (30.3%), daily activities (29.8%) and self-care (9.0%). At least one moderate problem was reported by 272 (66.3%) respondents. Independent factors, associated with problems in any EQ-5D dimension were primary and vocational education, older age, high blood pressure, rheumatic diseases, back problems, anxiety/depression, a visit to the emergency department in the past year, and a house visit from a family doctor in the past year. CONCLUSIONS The present study showed that the health-related quality of life of the Slovenian inhabitants is lower than the one found in some other European countries. This finding is surprising and also worrying. Because we cannot find any perceptible reason for this observation, larger and prospective studies are needed to confirm those results and to determine the reasons for that.
Collapse
|
211
|
Gray RJ, Myint PK, Elender F, Barton G, Pfeil M, Price G, Wyatt N, Ravenhill G, Thomas E, Jagger J, Hursey A, Waterfield K, Hardy S. A Depression Recognition and Treatment package for families living with Stroke (DepReT-Stroke): study protocol for a randomised controlled trial. Trials 2011; 12:105. [PMID: 21529370 PMCID: PMC3096922 DOI: 10.1186/1745-6215-12-105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 04/30/2011] [Indexed: 11/28/2022] Open
Abstract
Background Depression occurs in up to 50% of patients after stroke and limits rehabilitation and recovery. Mood disorders are also highly prevalent in carers; their mental health intertwined with the physical and mental wellbeing of the person they are caring for. We argue that working with families, rather than patients alone may improve the treatment of depression in both patients and their carers enhancing the mental wellbeing and quality of life of both. Methods A single blind cluster randomised controlled trial to evaluate whether families after stroke who are treated with the Depression Recognition and Treatment package (DepReT-Stroke) in addition to treatment as usual (TAU) show improved mental well being compared to those families who receive only TAU. We aim to recruit one hundred and twenty-six families (63 in each group). The DepReT-Stroke intervention will help families to consider the various treatment options for depression, make choices about which are likely to fit best with their lives and support them in the use of self-help therapies (e.g. computerised Cognitive Behavioural Therapy or exercise). An essential component of the DepReT-Stroke package will be to help people adhere to their chosen treatment(s). The primary outcome will be the Mental Component Subscale of the SF-36 assessed at baseline and again six months post intervention. Effectiveness of the intervention will be determined using analysis of co-variance; comparing the mean change in MCS scores from baseline to six months follow-up adjusting for the clustering effects of baseline scores and family. An economic evaluation of the intervention will help us determine whether the intervention represents a cost-effective use of resources. Discussion Depression both for patients and their carers is common after stroke. Our Depression Recognition and Treatment package (DepReT-stroke) may help clinicians be more effective at detecting and managing a common co-morbidity that limits rehabilitation and recovery. Trial Registration ISRCTN: ISRCTN32451749 Research Ethics Committee Reference Number: 10/H0310/23 Grant Reference Number: (NIHR) PB-PG-0808-17056
Collapse
Affiliation(s)
- Richard J Gray
- Faculty of Medicine and Health Science, University of East Anglia, Norwich, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
212
|
Tariq L, Haagsma J, Havelaar A. Cost of illness and disease burden in The Netherlands due to infections with Shiga toxin-producing Escherichia coli O157. J Food Prot 2011; 74:545-52. [PMID: 21477467 DOI: 10.4315/0362-028x.jfp-10-252] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Infections with Shiga toxin-producing Escherichia coli O157 (STEC O157) are associated with hemorrhagic colitis, hemolytic uremic syndrome (HUS), and end-stage renal disease (ESRD). In the present study, we extend previous estimates of the burden of disease associated with STEC O157 with estimates of the associated cost of illness in The Netherlands. A second-order stochastic simulation model was used to calculate disease burden as disability-adjusted life years (DALYs) and cost of illness (including direct health care costs and indirect non-health care costs). Future burden and costs are presented undiscounted and discounted at annual percentages of 1.5 and 4%, respectively. Annually, approximately 2.100 persons per year experience symptoms of gastroenteritis, leading to 22 cases of HUS and 3 cases of ESRD. The disease burden at the population level was estimated at 133 DALYs (87 DALYs discounted) per year. Total annual undiscounted and discounted costs of illness due to STEC O157 infection for the Dutch society were estimated at €9.1 million and €4.5 million, respectively. Average lifetime undiscounted and discounted costs per case were both €126 for diarrheal illness, both €25,713 for HUS, and €2.76 million and €1.22 million, respectively, for ESRD. The undiscounted and discounted costs per case of diarrheal disease including sequelae were €4,132 and €2,131, respectively. Compared with other foodborne pathogens, STEC O157 infections result in relatively low burden and low annual costs at the societal level, but the burden and costs per case are high.
Collapse
Affiliation(s)
- Luqman Tariq
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | | | | |
Collapse
|
213
|
Alonso J, Vilagut G, Chatterji S, Heeringa S, Schoenbaum M, Üstün TB, Rojas-Farreras S, Angermeyer M, Bromet E, Bruffaerts R, de Girolamo G, Gureje O, Haro JM, Karam AN, Kovess V, Levinson D, Liu Z, Mora MEM, Ormel J, Posada-Villa J, Uda H, Kessler RC. Including information about co-morbidity in estimates of disease burden: results from the World Health Organization World Mental Health Surveys. Psychol Med 2011; 41:873-86. [PMID: 20553636 PMCID: PMC3045479 DOI: 10.1017/s0033291710001212] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The methodology commonly used to estimate disease burden, featuring ratings of severity of individual conditions, has been criticized for ignoring co-morbidity. A methodology that addresses this problem is proposed and illustrated here with data from the World Health Organization World Mental Health Surveys. Although the analysis is based on self-reports about one's own conditions in a community survey, the logic applies equally well to analysis of hypothetical vignettes describing co-morbid condition profiles. METHOD Face-to-face interviews in 13 countries (six developing, nine developed; n=31 067; response rate=69.6%) assessed 10 classes of chronic physical and nine of mental conditions. A visual analog scale (VAS) was used to assess overall perceived health. Multiple regression analysis with interactions for co-morbidity was used to estimate associations of conditions with VAS. Simulation was used to estimate condition-specific effects. RESULTS The best-fitting model included condition main effects and interactions of types by numbers of conditions. Neurological conditions, insomnia and major depression were rated most severe. Adjustment for co-morbidity reduced condition-specific estimates with substantial between-condition variation (0.24-0.70 ratios of condition-specific estimates with and without adjustment for co-morbidity). The societal-level burden rankings were quite different from the individual-level rankings, with the highest societal-level rankings associated with conditions having high prevalence rather than high individual-level severity. CONCLUSIONS Plausible estimates of disorder-specific effects on VAS can be obtained using methods that adjust for co-morbidity. These adjustments substantially influence condition-specific ratings.
Collapse
Affiliation(s)
- Jordi Alonso
- Health Services Research Unit, Institut Municipal d’Investigació Mèdica (IMIM-Hospital del Mar), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Gemma Vilagut
- Health Services Research Unit, Institut Municipal d’Investigació Mèdica (IMIM-Hospital del Mar), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | - Steven Heeringa
- University of Michigan, Institute for Social Research, Ann Arbor, MI USA
| | | | | | - Sonia Rojas-Farreras
- Health Services Research Unit, Institut Municipal d’Investigació Mèdica (IMIM-Hospital del Mar), Barcelona, Spain
| | | | - Evelyn Bromet
- State University of New York, Stony Brook, New York, USA
| | | | | | - Oye Gureje
- University College Hospital, Ibadan, Nigeria
| | | | - Aimee N. Karam
- Department of Psychiatry and Clinical Psychology, Saint George Hospital University Medical Center, Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University Medical School, and the Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | | | - Daphna Levinson
- Research & Planning, Mental Health Services Ministry of Health, Jerusalem, Israel
| | - Zhaorui Liu
- Institute of Mental Health, Peking University, Beijing, China
| | | | - J. Ormel
- Interdisciplinary Center for Psychiatric Epidemiology, University Medical Center Groningen, The Netherlands
| | | | - Hidenori Uda
- Health, Social Welfare, and Environmental Department, Osumi Regional Promotion Bureau, Kagoshima Prefecture, Japan
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA USA
| |
Collapse
|
214
|
Craske MG, Stein MB, Sullivan G, Sherbourne C, Bystritsky A, Rose RD, Lang AJ, Welch S, Campbell-Sills L, Golinelli D, Roy-Byrne P. Disorder-specific impact of coordinated anxiety learning and management treatment for anxiety disorders in primary care. ARCHIVES OF GENERAL PSYCHIATRY 2011; 68:378-88. [PMID: 21464362 PMCID: PMC3074172 DOI: 10.1001/archgenpsychiatry.2011.25] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Anxiety disorders commonly present in primary care, where evidence-based mental health treatments often are unavailable or suboptimally delivered. OBJECTIVE To compare evidence-based treatment for anxiety disorders with usual care (UC) in primary care for principal and comorbid generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), and posttraumatic stress disorder (PTSD). DESIGN A randomized controlled trial comparing the Coordinated Anxiety Learning and Management (CALM) intervention with UC at baseline and at 6-, 12-, and 18-month follow-up assessments. SETTING Seventeen US primary care clinics. PATIENTS Referred primary care sample, 1004 patients, with principal DSM-IV diagnoses of GAD (n = 549), PD (n = 262), SAD (n = 132), or PTSD (n = 61) (mean [SD] age, 43.7 [13.7] years; 70.9% were female). Eighty percent of the participants completed 18-month follow-up. INTERVENTIONS CALM (cognitive behavior therapy and pharmacotherapy recommendations) and UC. MAIN OUTCOME MEASURES Generalized Anxiety Disorder Severity Scale, Panic Disorder Severity-Self-report Scale, Social Phobia Inventory, and PTSD Checklist-Civilian Version scores. RESULTS CALM was superior to UC for principal GAD at 6-month (-1.61; 95% confidence interval [CI], -2.42 to -0.79), 12-month (-2.34; -3.22 to -1.45), and 18-month (-2.37; -3.24 to -1.50), PD at 6-month (-2.00; -3.55 to -0.44) and 12-month (-2.71; -4.29 to -1.14), and SAD at 6-month (-7.05; -12.11 to -2.00) outcomes. CALM was superior to UC for comorbid SAD at 6-month (-4.26; 95% CI, -7.96 to -0.56), 12-month (-8.12, -11.84 to -4.40), and 18- month (-6.23, -9.90 to -2.55) outcomes. Effect sizes favored CALM but were not statistically significant for other comorbid disorders. CONCLUSIONS CALM (cognitive behavior therapy and pharmacotherapy medication recommendations) is more effective than is UC for principal anxiety disorders and, to a lesser extent, comorbid anxiety disorders that present in primary care.
Collapse
Affiliation(s)
- Michelle G Craske
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA 90095-1563, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
215
|
Bobes J, Caballero L, Vilardaga I, Rejas J. Disability and health-related quality of life in outpatients with generalised anxiety disorder treated in psychiatric clinics: is there still room for improvement? Ann Gen Psychiatry 2011; 10:7. [PMID: 21401940 PMCID: PMC3064614 DOI: 10.1186/1744-859x-10-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 03/14/2011] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE We assessed the impact of generalised anxiety disorder (GAD) on disability and health-related quality of life in outpatients treated in psychiatric clinics via a secondary analysis conducted in 799 patients from a cross-sectional study of prevalence of GAD in psychiatric clinics. METHODS Patients were allocated into two groups: follow-up (15.7%) and newly diagnosed patients (84.3%), and were administered the Hamilton Anxiety Scale (HAM-A), Clinical Global Impressions Scale (CGI), Sheehan Disability Scale (SDS), and 36-item short form structured quality of life questionnaire (SF-36) scales. RESULTS The newly diagnosed group showed higher significant intensity of anxiety (56.9% vs 43.0% (HAM-A >24)), psychiatrist's CGI Severity (CGI-S) scores (4.2 vs 3.7), and perceived stress according to SDS (5.7 vs 5.2). They also showed lower scores in mental health-related quality of life: 25.4 vs 30.8. Statistical differences by gender were not observed. GAD was shown to have a significant impact on patient quality of life and disability, with a substantial portion having persistent, out of control symptoms despite treatment. CONCLUSIONS These results suggest that there is still room for improvement in the medical management of patients with GAD treated in psychiatric clinics.
Collapse
Affiliation(s)
- Julio Bobes
- Psychiatry Department - Oviedo University, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Asturias, Spain
| | - Luis Caballero
- Psychiatry Department, 'Puerta de Hierro' Hospital, Madrid, Spain
| | - Inma Vilardaga
- Biometrics Department, European Biometric Institute, Barcelona, Spain
| | - Javier Rejas
- Health Outcomes Research, Medical Business Unit, Pfizer España, Alcobendas, Madrid, Spain
| |
Collapse
|
216
|
Grandes G, Montoya I, Arietaleanizbeaskoa MS, Arce V, Sanchez A. The burden of mental disorders in primary care. Eur Psychiatry 2011; 26:428-35. [PMID: 21306876 DOI: 10.1016/j.eurpsy.2010.11.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 11/08/2010] [Accepted: 11/13/2010] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To describe and compare the prevalence of mental disorders across primary care populations, and estimate their impact on quality of life. METHODS Cross-sectional multilevel analysis of a systematic sample of 2539 attendees to eight primary care centres in different regions of Spain, assessed with the WHO Composite International Diagnostic Interview (CIDI 1.1), the Short Form Health Survey (SF-36) quality of life questionnaire and the SF-6D utility index. RESULTS The 12-month prevalence of any mental disorder was 23% (95% confidence interval: 21-24%), 10% had mood, 9% anxiety, 5% organic, 4% somatoform, and 1% alcohol use disorders, with a significant between-centre variability (P<0.001). People with mental disorders had one standard deviation lower mental quality of life than the general population. We estimated that 1831 quality-adjusted life-years (QALYs) are lost annually per 100,000 patients due to mental disorders, without considering mortality. Mood disorders have the worst impact with an annual loss of 1124 QALYs per 100,000 patients, excluding mortality (95% confidence interval: 912-1351). CONCLUSIONS Prevalence rates were similar to those obtained in international studies using the same diagnostic instrument and, given the significant between-centre variability found, it is recommended that mental health statistics be considered at small area level. Mental disorders, and especially mood disorders, are associated with very poor quality of life and higher scores on disability indexes than other common chronic conditions.
Collapse
Affiliation(s)
- G Grandes
- Primary Care Research Unit of Bizkaia, Basque Healthcare Service-Osakidetza, Luis Power, 18-4(a) Planta, 48014 Bilbao, Spain.
| | | | | | | | | | | |
Collapse
|
217
|
Pullenayegum EM, Tarride JE, Xie F, O’Reilly D. Calculating Utility Decrements Associated With an Adverse Event. Med Decis Making 2011. [DOI: 10.1177/0272989x10393284] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: When calculating the decreases in health utility associated with adverse events, often a number ofrespondents achieve the upper utility bound of 1. “Marginal” Tobit or CLAD coefficients have been used to account for this. These are calculated by using a Tobit or a CLAD model to estimate the decrease in a latent unbounded variable associated with the event or condition, then to multiply by the proportion of respondents falling below 1 in order to transform back to the utility scale. Objective & Methods: Starting with the Tobit model, we show mathematically that this procedure is not valid, when calculating decreases in utility associated with binary events. We then generalize the result to the CLAD model. A selection of published studies is used to illustrate the bias in the marginal Tobit decrements. Results: The degree of bias is more severe the greater the decrease in utility associated with the event, and the larger the proportion of individuals at the upper ceiling.In the examples studied, the degree of bias was often greater than 10%. We provide the correct formula for calculating the utility decrement. Conclusions: The marginal Tobit and CLAD coefficients should not be used as estimates of a utility decrement corresponding to an adverse event or health condition unless the coefficients are small in absolute value, or if the proportion of individuals at the upper utility bound is small. In other settings, the corrected formula or alternative regression methods (e.g. linear models of mean utility) should be considered.
Collapse
Affiliation(s)
- Eleanor M. Pullenayegum
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada (EMP, J-ET, FX, DO)
- Biostatistics Unit, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada (EMP)
- Programs for Assessment of Technology in Health Research Institute, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada (DO, J-ET, FX)
| | - Jean-Eric Tarride
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada (EMP, J-ET, FX, DO)
- Biostatistics Unit, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada (EMP)
- Programs for Assessment of Technology in Health Research Institute, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada (DO, J-ET, FX)
| | - Feng Xie
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada (EMP, J-ET, FX, DO)
- Biostatistics Unit, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada (EMP)
- Programs for Assessment of Technology in Health Research Institute, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada (DO, J-ET, FX)
| | - Daria O’Reilly
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada (EMP, J-ET, FX, DO)
- Biostatistics Unit, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada (EMP)
- Programs for Assessment of Technology in Health Research Institute, St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada (DO, J-ET, FX)
| |
Collapse
|
218
|
Comer JS, Blanco C, Hasin DS, Liu SM, Grant BF, Turner JB, Olfson M. Health-related quality of life across the anxiety disorders: results from the national epidemiologic survey on alcohol and related conditions (NESARC). J Clin Psychiatry 2011; 72:43-50. [PMID: 20816036 PMCID: PMC3000882 DOI: 10.4088/jcp.09m05094blu] [Citation(s) in RCA: 138] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 08/03/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Although clinical studies have documented that specific anxiety disorders are associated with impaired psychosocial functioning, little is known regarding their comparative effects on health-related quality of life within a general population. The current analysis compares health-related quality of life in a US community-dwelling sample of adults with DSM-IV social anxiety disorder, generalized anxiety disorders (GAD), panic disorder, and specific phobia. METHOD A face-to-face survey of a US nationally representative sample of over 43,000 adults aged 18 years and older residing in households and group quarters was conducted. Prevalence of DSM-IV anxiety disorders and relative associations with health-related quality of life indicators were examined. The survey was conducted from 2001 to 2002. RESULTS Roughly 9.8% of respondents met diagnostic criteria for at least 1 of 4 twelve-month DSM-IV anxiety disorders which, relative to the non-anxiety-disordered general population, were each associated with lower personal income, increased rates of 12-month physical conditions, and greater numbers of Axis I and Axis II DSM-IV psychiatric conditions. After adjusting for sociodemographic and clinical correlates, including other anxiety disorders, GAD was associated with significant decrements in the SF-12 mental component summary score. In similar models, GAD and, to a lesser extent, panic disorder were significantly associated with impairment in social functioning, role emotional, and mental health SF subscales. CONCLUSIONS GAD, followed by panic disorder, appears to exact significant and independent tolls on health-related quality of life. Results underscore the importance of prompt and accurate clinical identification and improving access to effective interventions for these disorders.
Collapse
|
219
|
McManus F, Shafran R, Cooper Z. What does a transdiagnostic approach have to offer the treatment of anxiety disorders? BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2010; 49:491-505. [DOI: 10.1348/014466509x476567] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
220
|
Saarni SI, Viertiö S, Perälä J, Koskinen S, Lönnqvist J, Suvisaari J. Quality of life of people with schizophrenia, bipolar disorder and other psychotic disorders. Br J Psychiatry 2010; 197:386-94. [PMID: 21037216 DOI: 10.1192/bjp.bp.109.076489] [Citation(s) in RCA: 163] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Health utility and quality of life (QoL) are increasingly important outcome measures in healthcare and health economics. AIMS To compare the loss of subjective QoL and utility-based health-related quality of life (HRQoL) associated with psychotic disorders. METHOD A representative sample of 8028 Finns was screened for psychotic disorders and bipolar I disorder. Lifetime psychotic disorders were diagnosed using the Structured Clinical Interview for DSM-IV and/or case records. Health-related quality of life was measured with EQ-5D and 15D, and QoL was measured with a 10-point scale. RESULTS Schizoaffective disorder was associated with the largest losses of QoL and HRQoL, with bipolar I disorder associated with similar or smaller losses than schizophrenia. Current depressive symptoms explained most of the losses. CONCLUSIONS Depressive symptoms are the strongest predictors of poor QoL/HRQoL in psychotic disorders. Subjective loss of QoL associated with psychotic disorders may be smaller than objective loss of functioning suggests. The EQ-5D is problematic as an outcome measure in psychotic disorders.
Collapse
Affiliation(s)
- Samuli I Saarni
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, PO Box 30, 00270 Helsinki, Finland.
| | | | | | | | | | | |
Collapse
|
221
|
Plaisier I, Beekman ATF, de Graaf R, Smit JH, van Dyck R, Penninx BWJH. Work functioning in persons with depressive and anxiety disorders: the role of specific psychopathological characteristics. J Affect Disord 2010; 125:198-206. [PMID: 20185180 DOI: 10.1016/j.jad.2010.01.072] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 01/27/2010] [Accepted: 01/27/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Depressive and anxiety disorders affect work functioning and cause high labour costs. AIMS To examine and compare psychopathological characteristics of depressive and anxiety disorders in their effect on work functioning. METHOD In 1876 working participants of the Netherlands Study of Depression and Anxiety (NESDA) associations of presence, severity, comorbidity, duration and type of DSM-IV anxiety and depressive disorders with both absenteeism (<2 weeks and >2 weeks) and work performance (reduced and impaired) were assessed. RESULTS People with current depressive disorders had 7.10 times greater odds for the risk of >2 weeks work-absence and 5.67 greater odds for the risk of impaired work performance, while persons with current anxiety disorders had 1.84 and 2.13 greater odds for the risk of >2 weeks absence and impaired work performance, respectively. Even when persons were recovered from depressive and anxiety disorders, they still had a higher risk of poor work functioning. Persons with comorbidity, chronic depressive disorder, a generalized anxiety disorder, and more severity of both anxiety and depressive disorder had higher odds for the risk of absenteeism and decreased work performance. CONCLUSION Anxiety disorders have significant negative impact on work functioning, although smaller than the effect of depressive disorders. Comorbidity, severity, type and duration of the disorder, differentiate the risk of poor work functioning.
Collapse
Affiliation(s)
- I Plaisier
- Dept. Sociology/Faculty of Social Sciences/VU University, Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
222
|
Mulvaney-Day NE, Horvitz-Lennon M, Chen CN, Laderman M, Alegría M. Valuing health in a racially and ethnically diverse community sample: an analysis using the valuation metrics of money and time. Qual Life Res 2010; 19:1529-40. [PMID: 20680690 DOI: 10.1007/s11136-010-9713-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2010] [Indexed: 12/27/2022]
Abstract
PURPOSE Limited research in health valuation analyzes samples with high proportions of racial/ethnic minorities within the United States. The primary objective was to explore patterns of health valuation across race/ethnicity using the Collaborative Psychiatric Epidemiology Surveys. A secondary objective was to analyze whether mental health disorder and immigrant status were associated with these estimates. METHODS Health valuation questions using different metrics (time and money) were analyzed. Ordered logit models stratified across poor and moderate health tested differences by race/ethnicity, with mental health disorder and immigrant status as covariates. RESULTS Asians in moderate health and Latinos were willing to pay more for health than non-Latino whites. Asians in moderate health were willing to trade more time for health. Latinos in poor health were less willing to trade time and gave disproportionate zero-trade responses. Lifetime history of anxiety disorder was positively associated with both metrics. Immigrant status confounded money valuation for Asians in moderate health, and time valuation for Latinos in poor health. CONCLUSIONS Health valuation estimates vary across race/ethnicity depending upon the metric. Time valuation scenarios appear less feasible for Latinos in poor health. More research is necessary to understand these differences and the role of immigrant status in health valuation.
Collapse
Affiliation(s)
- Norah E Mulvaney-Day
- Center For Multicultural Mental Health Research, Cambridge Health Alliance and Harvard Medical School, 120 Beacon Street, 4th Floor, Somerville, MA 02143, USA.
| | | | | | | | | |
Collapse
|
223
|
Beard C, Weisberg RB, Keller MB. Health-related Quality of Life across the anxiety disorders: findings from a sample of primary care patients. J Anxiety Disord 2010; 24:559-64. [PMID: 20418054 PMCID: PMC2876232 DOI: 10.1016/j.janxdis.2010.03.015] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Revised: 03/23/2010] [Accepted: 03/25/2010] [Indexed: 11/18/2022]
Abstract
Previous studies have not compared Health-related Quality of Life (HR-QoL) across all DSM-IV anxiety disorders and comorbid conditions. We compared the effects of each anxiety disorder on HR-QoL, controlling for demographic variables, medical conditions, and comorbid Axis I disorders. Data are obtained from the Primary Care Anxiety Project (PCAP), a naturalistic, longitudinal study of anxiety disorders in 539 primary care patients. Each of the anxiety disorders was associated with worse self-reported physical and mental functioning compared to general population means. While all of the anxiety disorders were univariate predictors of specific domains of HR-QoL, only presence of Post-traumatic Stress Disorder (PTSD) and comorbid Depressive Disorder (MDD) uniquely predicted worse functioning on both self-report and interview measures. The current study extends previous research by showing that different anxiety disorders and comorbid conditions may be associated with impairment in specific domains of HR-QoL.
Collapse
Affiliation(s)
- Courtney Beard
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI 02912, USA.
| | | | | |
Collapse
|
224
|
Klaghofer R, Stamm M, Buddeberg C, Bauer G, Hämmig O, Knecht M, Buddeberg-Fischer B. Development of life satisfaction in young physicians: results of the prospective SwissMedCareer Study. Int Arch Occup Environ Health 2010; 84:159-66. [DOI: 10.1007/s00420-010-0553-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Accepted: 05/26/2010] [Indexed: 10/19/2022]
|
225
|
Castaneda AE, Suvisaari J, Marttunen M, Perälä J, Saarni SI, Aalto-Setälä T, Lönnqvist J, Tuulio-Henriksson A. Cognitive functioning in a population-based sample of young adults with anxiety disorders. Eur Psychiatry 2010; 26:346-53. [PMID: 20627469 DOI: 10.1016/j.eurpsy.2009.11.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 10/12/2009] [Accepted: 11/17/2009] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Cognitive functioning in anxiety disorders has received little investigation, particularly among young adults and in non-clinical samples. The present study examined cognitive functioning in a population-based sample of young adults with anxiety disorders in comparison to healthy peers. METHODS A population-based sample of 21-35-year-olds with a lifetime history of anxiety disorders (n=75) and a random sample of healthy controls (n=71) derived from the same population were compared in terms of performance in neuropsychological tests measuring verbal and visual short-term memory, verbal long-term memory, attention, psychomotor processing speed, and executive functioning. RESULTS In general, young adults with anxiety disorders did not have major cognitive impairments when compared to healthy peers. When participants with anxiety disorder in remission were excluded, persons with current anxiety disorder scored lower in visual working memory tests. Current psychotropic medication use and low current psychosocial functioning associated with deficits in executive functioning, psychomotor processing speed, and visual short-term memory. CONCLUSION Lifetime history of anxiety disorders is not associated with cognitive impairment among young adults in the general population. However, among persons with anxiety disorders, current psychotropic medication use and low psychosocial functioning, indicating more severe symptoms, may associate with cognitive impairments.
Collapse
Affiliation(s)
- A E Castaneda
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Mannerheimintie 166, 00300 Helsinki, Finland.
| | | | | | | | | | | | | | | |
Collapse
|
226
|
Cuijpers P, Andersson G. Special issue on computerized treatments of depression. Cogn Behav Ther 2010; 38:193-5. [PMID: 20183694 DOI: 10.1080/16506070903302063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
227
|
Kananen L, Surakka I, Pirkola S, Suvisaari J, Lönnqvist J, Peltonen L, Ripatti S, Hovatta I. Childhood adversities are associated with shorter telomere length at adult age both in individuals with an anxiety disorder and controls. PLoS One 2010; 5:e10826. [PMID: 20520834 PMCID: PMC2876034 DOI: 10.1371/journal.pone.0010826] [Citation(s) in RCA: 201] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 05/05/2010] [Indexed: 01/17/2023] Open
Abstract
Accelerated leukocyte telomere shortening has been previously associated to self-perceived stress and psychiatric disorders, including schizophrenia and mood disorders. We set out to investigate whether telomere length is affected in patients with anxiety disorders in which stress is a known risk factor. We also studied the effects of childhood and recent psychological distress on telomere length. We utilized samples from the nationally representative population-based Health 2000 Survey that was carried out between 2000–2001 in Finland to assess major public health problems and their determinants. We measured the relative telomere length of the peripheral blood cells by quantitative real-time PCR from 321 individuals with DSM-IV anxiety disorder or subthreshold diagnosis and 653 matched controls aged 30–87 years, who all had undergone the Composite International Diagnostic Interview. While telomere length did not differ significantly between cases and controls in the entire cohort, the older half of the anxiety disorder patients (48–87 years) exhibited significantly shorter telomeres than healthy controls of the same age (P = 0.013). Interestingly, shorter telomere length was also associated with a greater number of reported childhood adverse life events, among both the anxiety disorder cases and controls (P = 0.005). Childhood chronic or serious illness was the most significantly associated single event affecting telomere length at the adult age (P = 0.004). Self-reported current psychological distress did not affect telomere length. Our results suggest that childhood stress might lead to accelerated telomere shortening seen at the adult age. This finding has potentially important implications supporting the view that childhood adversities might have a considerable impact on well being later in life.
Collapse
Affiliation(s)
- Laura Kananen
- Research Program of Molecular Neurology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Medical Genetics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ida Surakka
- Public Health Genomics Unit, National Institute for Health and Welfare, Helsinki, Finland
- FIMM, Institute of Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Sami Pirkola
- Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - Jaana Suvisaari
- Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Jouko Lönnqvist
- Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - Leena Peltonen
- Department of Medical Genetics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Public Health Genomics Unit, National Institute for Health and Welfare, Helsinki, Finland
- FIMM, Institute of Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, United States of America
- Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom
| | - Samuli Ripatti
- Public Health Genomics Unit, National Institute for Health and Welfare, Helsinki, Finland
- FIMM, Institute of Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
| | - Iiris Hovatta
- Research Program of Molecular Neurology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Medical Genetics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
- * E-mail:
| |
Collapse
|
228
|
Fernández A, Saameño JAB, Pinto-Meza A, Luciano JV, Autonell J, Palao D, Salvador-Carulla L, Campayo JG, Haro JM, Serrano A. Burden of chronic physical conditions and mental disorders in primary care. Br J Psychiatry 2010; 196:302-9. [PMID: 20357307 DOI: 10.1192/bjp.bp.109.074211] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The World Health Organization (WHO) has stated that the three leading causes of burden of disease in 2030 are projected to include HIV/AIDS, unipolar depression and ischaemic heart disease. AIMS To estimate health-related quality of life (HRQoL) and quality-adjusted life-year (QALY) losses associated with mental disorders and chronic physical conditions in primary healthcare using data from the diagnosis and treatment of mental disorders in primary care (DASMAP) study, an epidemiological survey carried out with primary care patients in Catalonia (Spain). METHOD A cross-sectional survey of a representative sample of 3815 primary care patients. A preference-based measure of health was derived from the 12-item Short Form Health Survey (SF-12): the Short Form-6D (SF-6D) multi-attribute health-status classification. Each profile generated by this questionnaire has a utility (or weight) assigned. We used non-parametric quantile regressions to model the association between both mental disorders and chronic physical condition and SF-6D scores. RESULTS Conditions associated with SF-6D were: mood disorders, beta = -0.20 (95% CI -0.18 to -0.21); pain, beta = -0.08 (95%CI -0.06 to -0.09) and anxiety, beta = -0.04 (95% CI -0.03 to -0.06). The top three causes of QALY losses annually per 100 000 participants were pain (5064), mood disorders (2634) and anxiety (805). CONCLUSIONS Estimation of QALY losses showed that mood disorders ranked second behind pain-related chronic medical conditions.
Collapse
Affiliation(s)
- Anna Fernández
- Sant Joan de Déu-SSM, Fundació Sant Joan de Déu, Research and Development Unit, Dr. Antoni Pujadas, 42, 08830 Sant Boi de Llobregat, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
229
|
Health-related quality-of-life profiles in nonalexithymic and alexithymic subjects from general population. J Psychosom Res 2010; 68:279-83. [PMID: 20159214 DOI: 10.1016/j.jpsychores.2009.09.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 08/17/2009] [Accepted: 09/17/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Earlier studies have shown an association between alexithymia and health-related quality of life (HRQoL). There has been some controversy as to whether this is attributable solely to psycho-social domains of HRQoL or also to physical domains. Furthermore, there are no studies on HRQoL profiles in representative general population samples controlling for sociodemographic variables, mental health and somatic health. METHODS The study forms part of the Health 2000 Study. Altogether 5090 participants from general population, aged 30-97 years, filled in the 20-item Toronto Alexithymia Scale and the 15D HRQoL scale. Depressive and anxiety disorders were assessed in a structured psychiatric interview. Physical health was examined by physicians. The 15-dimension HRQoL profiles of both alexithymic and non-alexithymic subjects were obtained by analysis of covariance, controlling for sociodemographic and health-related variables. RESULTS The alexithymic group had significantly (P<.001) lower mean scores on every dimension of the 15D even after controlling for confounding demographic variables, somatic diagnoses and depressive and anxiety disorders. The differences were greatest in the psycho-social domains. CONCLUSIONS Alexithymia seems to be a personality trait with a statistically significant association to every dimension of HRQoL, not only to psychosocial domains. However, the associations between alexithymia and some somatic dimensions may be of little clinical significance.
Collapse
|
230
|
Gadalla TM. Association between mood and anxiety disorders and self-reported disability: Results from a nationally representative sample of Canadians. J Ment Health 2009. [DOI: 10.3109/09638230903111106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
231
|
Kuehner C, Huffziger S. Subjective quality of life aspects predict depressive symptoms over time: results from a three-wave longitudinal study. Acta Psychiatr Scand 2009; 120:496-9. [PMID: 19570106 DOI: 10.1111/j.1600-0447.2009.01436.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Little is known about predictive effects of quality of life aspects on the course of depressive symptoms in clinical and non-clinical settings. This study examines longitudinal associations between depressive symptoms and subjective quality of life (QOL) dimensions using a parallel sample of depressed patients and community controls. METHOD Eighty-two depressed patients were investigated 1, 6, and 42 months after hospital discharge together with 76 community controls regarding depressive symptoms measured by Montgomery Asberg Depression Rating Scale (MADRS) and QOL (WHOQOL-BREF). Data analysis included time-lagged linear models. RESULTS Physical, psychological, environmental and overall QOL, controlled for depressive symptoms, predicted future depression levels. Group status did not moderate these associations. Depressive symptoms predicted future QOL levels only regarding social relations. CONCLUSION Our study suggests that subjective QOL domains have prognostic value for the course of depressive symptoms over time, both in patient and community samples. Respective self-perceptions should therefore be directly addressed by therapeutic and preventive interventions.
Collapse
Affiliation(s)
- C Kuehner
- Research Group Longitudinal and Intervention Research, Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, D-68072 Mannheim, Germany.
| | | |
Collapse
|
232
|
Craske MG, Roy-Byrne PP, Stein MB, Sullivan G, Sherbourne C, Bystritsky A. Treatment for anxiety disorders: Efficacy to effectiveness to implementation. Behav Res Ther 2009; 47:931-7. [PMID: 19632667 PMCID: PMC2784096 DOI: 10.1016/j.brat.2009.07.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anxiety disorders are common, costly and debilitating, and yet often unrecognized or inadequately treated in real world, primary care settings. Our group has been researching ways of delivering evidence-based treatment for anxiety in primary care settings, with special interest to preserving the fidelity of the treatment while at the same time promoting its sustainability once the research is over. In this paper, we describe the programs we have developed and our directions for future research. Our first study evaluated the efficacy of CBT and expert pharmacotherapy recommendations for panic disorder in primary care, using a collaborative care model of service delivery (CCAP). Symptom, disability and mental health functioning measures were superior for the intervention group compared to treatment as usual both in the short term and the long term, although also more costly. In our ongoing CALM study, we have extended our population to include panic disorder, social anxiety disorder, generalized anxiety disorder and posttraumatic disorder, while at the same time utilizing clinicians with limited mental health care experience. In addition to pharmacotherapy management, we developed a computer-assisted CBT that guides both novice clinician and patient, thereby contributing to sustainability once the research is over. We have also incorporated a measurement based approach to treatment planning, using a web-based tracking system of patient status. To date, the computer-assisted CBT program has been shown to be acceptable to clinicians and patients. Clinicians rated the program highly, and patients engaged in the program. Future directions for our research include dissemination and implementation of the CALM program, testing potential alternations to the CALM program, and distance delivery of CALM.
Collapse
Affiliation(s)
- Michelle G Craske
- University of California, Los Angeles, Department of Psychology, Franz Hall, 405 Hilgard Avenue, Los Angeles, CA 90095, USA.
| | | | | | | | | | | |
Collapse
|
233
|
King JT, Tsevat J, Roberts MS. Measuring Preference-Based Quality of Life Using the Euroqol Eq-5D in Patients with Cerebral Aneurysms. Neurosurgery 2009; 65:565-72; discussion 572-3. [DOI: 10.1227/01.neu.0000350980.01519.d8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Cerebral aneurysms can adversely affect quality of life (QOL) via mass effect, subarachnoid hemorrhage, anxiety, or treatment sequelae. The EuroQol EQ-5D is a popular generic 5-item multiple-choice survey questionnaire that measures preference-based QOL on a 0 to 1 scale. We assessed the validity and reliability of the EQ-5D in patients with cerebral aneurysms.
METHODS
We collected data from 178 neurosurgery clinic patients with cerebral aneurysms. Patients were assigned Glasgow Outcome Scale, Rankin scale, Barthel index, and Physical Performance Test scores, and completed the Short-Form 12, Hospital Anxiety and Depression scale, and the EQ-5D. We assessed the construct validity of the EQ-5D by comparing the EQ-5D and the other scales using rank-order methods and multivariate linear regression. Reliability was assessed with Cronbach's α.
RESULTS
Patients had a mean age of 54.7 years (standard deviation, 12.6 years), 131 (74%) were women, and 98 (55%) had survived a subarachnoid hemorrhage. The mean EQ-5D score was 0.80 (standard deviation, 0.19). Construct validity of the EQ-5D was confirmed by statistically significant associations between EQ-5D and Glasgow Outcome Scale, Rankin scale, Barthel index, Physical Performance Test, Short-Form 12 Physical Component Summary, and Hospital Anxiety and Depression scores (for all, P ≤ 0.05). Multivariate regression showed that the EQ-5D scores were independently associated with the Barthel index, Short-Form 12 Physical Component Summary, and Hospital Anxiety and Depression scale anxiety and depression subscales (pseudo R2 = 0.40). Reliability was demonstrated by Cronbach's α of 0.70.
CONCLUSION
The EQ-5D is a valid and reliable instrument for measuring QOL in patients with cerebral aneurysms. The EQ-5D provides a single QOL value incorporating functional status, physical functioning, and mental health.
Collapse
Affiliation(s)
- Joseph T. King
- Section of Neurosurgery, VA Connecticut Healthcare System, West Haven, Connecticut, and Department of Neurosurgery, Yale University, New Haven, Connecticut
| | - Joel Tsevat
- Veterans Affairs Medical Center, Cincinnati, Ohio, and Section of Outcomes Research, Division of General Internal Medicine, Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Mark S. Roberts
- Center for Research on Health Care, University of Pittsburgh, Pittsburgh, Pennsylvania
- Section of Decision Sciences and Clinical Systems Modeling, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
234
|
Subjective quality of life in a nationwide sample of Kuwaiti subjects using the short version of the WHO quality of life instrument. Soc Psychiatry Psychiatr Epidemiol 2009; 44:693-701. [PMID: 19037572 DOI: 10.1007/s00127-008-0477-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 11/13/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The usefulness of quality of life (QOL) as an outcome measure in medicine has inspired general population studies to establish normative values. The objectives of the study were to: (1) highlight the pattern of satisfaction with aspects of life circumstances among a nationwide sample of Kuwaiti subjects, using the 26-item WHOQOL Instrument (WHOQOL-Bref); (2) establish the QOL domain normative values; (3) highlight the relationship of QOL with socio-demographic variables and scores on scales for anxiety and depression; and (4) assess the relationship between domains of QOL. METHOD A one-in-three systematic random proportionate sample of consenting Kuwaiti nationals attending the large cooperative stores and municipal government offices in the six governorates, were requested to complete the questionnaires anonymously. RESULTS There were 3,303 participants (44.8% m, 55.2% f, mean age 35.4, SD 11.9; range, 16-87). As a group, they were only moderately satisfied with their life circumstances. The domain scores for physical health (14.6 or 66.2%) and psychological health (14.2 or 63.9%) were at the middle of the range for the WHO 23-country report, while the social relations (15.0 or 68.8%) and environment (14.5 or 65.4%) domains were at the upper end of the WHO range. The general facet (GF) score (15.5 or 71.6%) was significantly higher than all domains. Diminished QOL was significantly associated with female gender, older age, social disadvantage, and high scores on anxiety/depression. Depression was the most important predictor of QOL, accounting for over 77% of total variance. CONCLUSION QOL was sensitive to distressing and unfulfilled life circumstances. Hence, coupled with the difficulty of conducting house-to-house surveys in such a conservative society, a cost effective way of tracking societal distress is by including a brief and responsive measure of QOL during national census exercises. Clinicians need to be aware of QOL issues because QOL is associated with clinical and social variables. The differences between GF (representing subjective well-being) and the domains, has implications for QOL theory.
Collapse
|
235
|
Gadalla TM. Socioeconomic gradient of functional limitations in individuals diagnosed with mood disorders. Women Health 2009; 49:181-96. [PMID: 19533509 DOI: 10.1080/03630240902973233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The association between unfavorable socioeconomic conditions and higher prevalence of mood disorders has been well established. The detrimental impact of mood disorders on disability is also well established. Less is known about the socioeconomic gradient of disability in individuals with mood disorders. The objective of this study was to investigate whether a socioeconomic gradient in functional limitation existed in individuals with mood disorders living in Canada (4,720 women and 2,645 men). The study was based on secondary analyses of data collected in the Canadian Community Health Survey in 2005. Significant positive associations between prevalence of functional limitations and age, number of chronic conditions, and number of consultations with medical doctors were found for both genders. Adjusting for these factors, the odds of functional limitations declined with increasing socioeconomic status for both men and women. This gradient was more evident with income level than with education level. The odds of having functional limitations for women in the lowest income decile were 2.33 times the odds for women in the highest income decile. The corresponding odds for men were 3.56. Compared with post secondary graduates, women and men with less than high school education had 1.46 and 2.31 higher odds of functional limitations, respectively. No significant gender difference was observed in the associations between socioeconomic indicators and functional limitations. These findings suggest the importance of assessing functional limitations in individuals with mood disorders, especially those living in disadvantaged economic conditions.
Collapse
Affiliation(s)
- Tahany M Gadalla
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
236
|
Bereza BG, Machado M, Einarson TR. Systematic review and quality assessment of economic evaluations and quality-of-life studies related to generalized anxiety disorder. Clin Ther 2009; 31:1279-308. [PMID: 19695395 DOI: 10.1016/j.clinthera.2009.06.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2009] [Indexed: 02/05/2023]
|
237
|
Bolton JM, Robinson J, Sareen J. Self-medication of mood disorders with alcohol and drugs in the National Epidemiologic Survey on Alcohol and Related Conditions. J Affect Disord 2009; 115:367-75. [PMID: 19004504 DOI: 10.1016/j.jad.2008.10.003] [Citation(s) in RCA: 293] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 09/13/2008] [Accepted: 10/03/2008] [Indexed: 02/05/2023]
Abstract
BACKGROUND Using alcohol or drugs to reduce emotional distress (self-medication) has been proposed as an explanation for the high comorbidity rates between anxiety and substance use disorders. Self-medication has been minimally studied in mood disorders despite equally high rates of alcohol and drug use. METHODS Data came from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a large (n=43,093, age 18 years and older) nationally representative survey of mental illness in community-dwelling adults. Prevalence rates of self-medication were determined for DSM-IV mood disorders: dysthymia, major depressive disorder, bipolar I disorder, and bipolar II disorder. Multiple logistic regression generated odds ratios for the association between each category of self-medication and anxiety and personality disorders. RESULTS Almost one-quarter of individuals with mood disorders (24.1%) used alcohol or drugs to relieve symptoms. The highest prevalence of self-medication was seen in bipolar I disorder (41.0%). Men were more than twice as likely as women to engage in self-medication (Adjusted Odds Ratio=2.18; 95% Confidence Interval 1.90-2.49). After controlling for the effects of substance use disorders, self-medication was associated with higher odds of comorbid anxiety and personality disorders when compared to individuals who did not self-medicate. LIMITATIONS Cross-sectional design. CONCLUSIONS The use of alcohol and drugs to relieve affective symptoms is common among individuals with mood disorders in the general population, yet is associated with substantial psychiatric comorbidity. These findings may help clinicians identify a subgroup of people with mood disorders who suffer from a higher mental illness burden.
Collapse
Affiliation(s)
- James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.
| | | | | |
Collapse
|
238
|
Daig I, Herschbach P, Lehmann A, Knoll N, Decker O. Gender and age differences in domain-specific life satisfaction and the impact of depressive and anxiety symptoms: a general population survey from Germany. Qual Life Res 2009; 18:669-78. [DOI: 10.1007/s11136-009-9481-3] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 04/10/2009] [Indexed: 11/28/2022]
|
239
|
Mattila AK, Saarni SI, Salminen JK, Huhtala H, Sintonen H, Joukamaa M. Alexithymia and health-related quality of life in a general population. PSYCHOSOMATICS 2009; 50:59-68. [PMID: 19213974 DOI: 10.1176/appi.psy.50.1.59] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Alexithymia is thought to reflect a deficit in the cognitive processing of emotion, and, therefore, it may predispose individuals to both psychological and somatic symptoms. OBJECTIVE The authors investigated the relationship between alexithymia and health-related quality of life (HRQoL) in a nationally representative population sample of 5,418 subjects, age 30 to 97 years. METHOD Alexithymia was measured with the 20-item Toronto Alexithymia Scale (TAS-20) and HRQoL measured with the 15D, a generic HRQoL measure. RESULTS Alexithymia was significantly associated with lower HRQoL independently of other variables. The TAS-20 subfactor Difficulties Identifying Feelings was the strongest common denominator between alexithymia and HRQoL. CONCLUSION Alexithymia may be a predisposing factor to poorer HRQoL.
Collapse
Affiliation(s)
- Aino K Mattila
- Tampere School of Public Health, FIN-33014, University of Tampere, Tampere, Finland.
| | | | | | | | | | | |
Collapse
|
240
|
Pfeil M, Gray R, Lindsay B. Depression and stroke: a common but often unrecognized combination. ACTA ACUST UNITED AC 2009; 18:365-9. [PMID: 19329901 DOI: 10.12968/bjon.2009.18.6.40769] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Stroke is an extremely common rapid onset medical emergency that can cause permanent neurological damage. Depression is very common in both stroke survivors and their carers, but it is frequently overlooked in both groups. Nurses can make a substantial improvement to patient care by not only being aware of this issue, but also by making an active contribution to the detection of depression in stroke survivors and their carers. The mental health of carers is intertwined with the mental health and disease presentation of the patient. A family centred approach with a dual focus on the stroke survivor and the carer is therefore needed to maximize success in post-stroke care. Nurses can teach families to recognize depression and assist them to accept treatment. They can use the Patient Health Questionnaire 9-item depression scale (PHQ-9) as probably the most suitable screening and diagnostic tool for both groups. Nurses can play a role in destigmatizing the diagnosis and the link between symptoms of depression and treatment. Finally, nurses can play an important part in initiating, monitoring and adjusting treatment.
Collapse
Affiliation(s)
- Michael Pfeil
- School of Nursing and Midwifery, Faculty of Health, University of East Anglia, Norwich
| | | | | |
Collapse
|
241
|
Abstract
BACKGROUND Although most depressive disorders are treated in primary care and several studies have examined the effects of psychological treatment in primary care, hardly any meta-analytic research has been conducted in which the results of these studies are integrated. AIM To integrate the results of randomised controlled trials of psychological treatment of depression in adults in primary care, and to compare these results to psychological treatments in other settings. DESIGN OF STUDY A meta-analysis of studies examining the effects of psychological treatments of adult depression in primary care. SETTING Primary care. METHOD An existing database of studies on psychological treatments of adult depression that was built on systematic searches in PubMed, PsychINFO, EMBASE, and Dissertation Abstracts International was used. Randomised trials were included in which the effects of psychological treatments on adult primary care patients with depression were compared to a control condition. RESULTS In the 15 included studies, the standardised mean effect size of psychological treatment versus control groups was 0.31 (95% CI = 0.17 to 0.45), which corresponds with a numbers-needed-to-treat (NNT) of 5.75. Studies in which patients were referred by their GP for treatment had significantly higher effect sizes (d = 0.43; NNT = 4.20) than studies in which patients were recruited through systematic screening (d = 0.13, not significantly different from zero; NNT = 13.51). CONCLUSIONS Although the number of studies was relatively low and the quality varied, psychological treatment of depression was found to be effective in primary care, especially when GPs refer patients with depression for treatment.
Collapse
|
242
|
Psychoeducational treatment and prevention of depression: the "Coping with Depression" course thirty years later. Clin Psychol Rev 2009; 29:449-58. [PMID: 19450912 DOI: 10.1016/j.cpr.2009.04.005] [Citation(s) in RCA: 156] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 04/03/2009] [Accepted: 04/10/2009] [Indexed: 11/23/2022]
Abstract
The "Coping with Depression" course (CWD) is by the far the best studied psychoeducational intervention for the treatment and prevention of depression, and is used in routine practice in several countries. The CWD is a highly structured cognitive-behavioral intervention, which has been adapted for several goals, contexts, and target populations. The efficacy of the CWD has been examined in 25 randomized controlled trials. We conducted a meta-analysis of these studies. The 6 studies aimed at the prevention of new cases of major depression were found to result in a reduced risk of getting major depression of 38% (incidence rate ratio was 0.62). The 18 studies examining the CWD as a treatment of depression found a mean effect size (Cohen's d) of 0.28. Direct comparisons with other psychotherapies did not result in any indication that the CWD was less efficacious. The CWD is a flexible treatment which can easily be adapted for different populations and this may have led researchers to use this intervention for complex target groups, which in turn may have resulted in a lower mean effect size. The CWD has contributed considerably to the development and innovation of prevention and treatment of depression in many target populations.
Collapse
|
243
|
Self-help and Internet-guided interventions in depression and anxiety disorders: a systematic review of meta-analyses. CNS Spectr 2009; 14:34-40. [PMID: 19238128 DOI: 10.1017/s1092852900027279] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is a growing database of research on self-help and internet-guided interventions in the treatment of common mental disorders, and a number of meta-analyses have now been published. This article provides a systematic review of meta-analyses on the efficacy of self-help interventions, including internet-guided therapy, for depression and anxiety disorders. Searches were conducted in PubMed, PsychINFO, EMBASE, and the Cochrane database for statistical meta-analyses of randomized, controlled trials of self-help or internet-guided interventions for depression or anxiety disorders published in English. Reference lists were also used to find additional studies. Effect sizes were tabulated; 13 meta-analyses reported medium to large effect sizes for self-help interventions. Studies included in the meta-analyses differed in samples, type of self-help (eg, computer-aided, internet-guided), control conditions, and study design. The meta-analyses indicate that self-help methods are effective in a range of different disorders, including depression and anxiety disorders. Most meta-analyses found relatively large effect sizes for self-help treatments, independent of the type of self-help, and comparable to effect sizes for face-to-face treatments. However, further research is needed to optimize the use of self-help methods.
Collapse
|
244
|
Abstract
Our understanding of social anxiety disorder (also known as social phobia) has moved from rudimentary awareness that it is not merely shyness to a much more sophisticated appreciation of its prevalence, its chronic and pernicious nature, and its neurobiological underpinnings. Social anxiety disorder is the most common anxiety disorder; it has an early age of onset--by age 11 years in about 50% and by age 20 years in about 80% of individuals--and it is a risk factor for subsequent depressive illness and substance abuse. Functional neuroimaging studies point to increased activity in amygdala and insula in patients with social anxiety disorder, and genetic studies are increasingly focusing on this and other (eg, personality trait neuroticism) core phenotypes to identify risk loci. A range of effective cognitive behavioural and pharmacological treatments for children and adults now exists; the challenges lie in optimum integration and dissemination of these treatments, and learning how to help the 30-40% of patients for whom treatment does not work.
Collapse
Affiliation(s)
- Murray B Stein
- Department of Psychiatry, University of California San Diego 92093-0855, USA.
| | | |
Collapse
|
245
|
Strine TW, Mokdad AH, Dube SR, Balluz LS, Gonzalez O, Berry JT, Manderscheid R, Kroenke K. The association of depression and anxiety with obesity and unhealthy behaviors among community-dwelling US adults. Gen Hosp Psychiatry 2008; 30:127-37. [PMID: 18291294 DOI: 10.1016/j.genhosppsych.2007.12.008] [Citation(s) in RCA: 361] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Revised: 12/11/2007] [Accepted: 12/12/2007] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The aim of this study was to examine the extent to which depression and anxiety are associated with smoking, obesity, physical inactivity and alcohol consumption in the US population using the Patient Health Questionnaire 8 (PHQ-8) and two questions on lifetime diagnosis of anxiety and depression. METHODS Data were analyzed in 38 states, the District of Columbia and two territories using the 2006 Behavioral Risk Factor Surveillance System (n=217,379), a large state-based telephone survey. RESULTS Overall, adults with current depression or a lifetime diagnosis of depression or anxiety were significantly more likely than those without each diagnosis to smoke, to be obese, to be physically inactive, to binge drink and drink heavily. There was a dose-response relationship between depression severity and the prevalence of smoking, obesity and physical inactivity and between history of depression (never depressed, previously depressed, currently depressed) and the prevalence of smoking, obesity, physical inactivity, binge drinking and heavy drinking. Lifetime diagnosis of depression and anxiety had an additive association with smoking prevalence. CONCLUSION The associations between depression, anxiety, obesity and unhealthy behaviors among US adults suggest the need for a multidimensional and integrative approach to health care.
Collapse
Affiliation(s)
- Tara W Strine
- Division of Adult and Community Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
| | | | | | | | | | | | | | | |
Collapse
|
246
|
Saarni SI, Joutsenniemi K, Koskinen S, Suvisaari J, Pirkola S, Sintonen H, Poikolainen K, Lönnqvist J. Alcohol consumption, abstaining, health utility, and quality of life – a general population survey in finland. Alcohol Alcohol 2008; 43:376-86. [DOI: 10.1093/alcalc/agn003] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
247
|
Distel MA, Vink JM, Willemsen G, Middeldorp CM, Merckelbach HLGJ, Boomsma DI. Heritability of self-reported phobic fear. Behav Genet 2007; 38:24-33. [PMID: 18074221 PMCID: PMC2226022 DOI: 10.1007/s10519-007-9182-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 10/19/2007] [Indexed: 01/22/2023]
Abstract
Twin studies on fear and phobia suggest moderate genetic effects. However, results are inconclusive regarding the presence of dominant genetic effects and sex differences. Using an extended twin design, including male and female twins (n = 5,465) and their siblings (n = 1,624), we examined the genetic and environmental influences on blood-injury, social, and agoraphobic fear and investigated their interaction with sex and age. Data of spouses (n = 708) of twins were used to evaluate assortative mating for the three fear dimensions. Results showed that there was no assortative mating for blood-injury, social and agoraphobic fear. Resemblance between biological relatives could be explained by additive and non-additive genetic effects for blood-injury and agoraphobic fear in all participants, and social fear in participants aged 14–25 years. For social fear in participants aged 26–65 only additive genetic effects were detected. Broad-sense heritability estimates ranged from 36 to 51% and were similar for men and women.
Collapse
Affiliation(s)
- Marijn A Distel
- Department of Biological Psychology, VU University, van der Boechorststraat 1, Amsterdam, 1081 BT, The Netherlands.
| | | | | | | | | | | |
Collapse
|