Psychische Komorbidität bei muskuloskelettalen Erkrankungen

Age effects on treatment patterns in 138,097 patients with unipolar depression followed in general practices in Germany

BACKGROUND

Risk factors and comorbidities associated with depression vary with age and must be considered when selecting appropriate anti-depressant medication for patients. Studies are lacking which focus both on treatments prescribed and include a broad age spectrum. The goal of this study was to investigate whether age of patients at diagnosis impact the type of antidepressant drug class prescribed.

METHODS

This retrospective cohort study based on the Disease Analyzer database (IQVIA) included 138,097 patients with depression followed in 1188 general practices from date of first depression diagnosis given between 2015 and 2018 (index date). Patients aged 18-30, 31-65 and > 65 were compared in homogeneous groups based on gender and insurance type. Odds ratios adjusted by gender, insurance type, treatment site and Charlson-Comorbidity-Index were used to assess the difference in probability of receiving prescription for antidepressant drug classes as well as individual treatment drugs by age group.

RESULTS

The cohort included 13,553 (9.8%), 82,524 (59.8%) and 42,020 (30.4%) patients aged 18-30 years (young), 31-65 years (middle-aged) and >65 years (older). Less than half of patients received anti-depressant medication, with 4717 (34.8%) aged 18-30, 35,014 (42.4%) aged 31-65, and 20,294 (48.3%) aged 65 or older receiving at least one anti-depressant medication. Tri- and tetra-cyclic mediations were prescribed to 65.8% of patients aged >65, and 59.0% of patients aged 31-65. Selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) were prescribed to 55.5% of patients. Older patients showed an increased probability (OR: 1.3 [1.26-1.34 95% CI], p < 0.0001) for tri- and tetra-cyclic medication, while younger patients showed an increased probability for SSRIs and SNRIs (OR: 1.23 [1.16-1.30 95% CI], p < 0.0001).

CONCLUSION

Age-related differences in anti-depressant medication prescription were shown, with older patients above 65 years predominantly receiving tri- and tetra-cyclic medication, while younger patients aged 18-30 received SSRIs more frequently. Further studies with homogeneous groups relating to comorbidity profile and disease severity are needed to fully understand age effects on treatment patterns.

Calibration of an item bank in 474 orthopedic patients using Rasch analysis for computer-adaptive assessment of anxiety

OBJECTIVE

To calibrate an item bank of anxiety-related questions for use in orthopedic patients within a computer-adaptive test.

DESIGN

This is a psychometric study.

SETTING

The sample of orthopedic patients was recruited in two orthopedic rehabilitation clinics in Germany.

SUBJECTS

A total of 474 orthopedic rehabilitation patients were recruited for this study.

INTERVENTIONS

Not applicable.

MAIN MEASURES

The main measure is an adapted version of an existing anxiety item pool for cardiovascular rehabilitation patients.

RESULTS

The results of the confirmatory factor analysis and Mokken analysis confirmed a one-factor structure and double monotonicity. An anxiety item bank (48 items) could be developed and calibrated using Rasch analysis. It fitted to the Rasch model with a non-significant item-trait interaction (χ²(203) = 172.59; P = .94) and was free of differential item functioning. Unidimensionality could be verified and the person separation reliability was .96. The category threshold parameters varied between 4.72 and 3.16 (7.88 logits).

CONCLUSION

The unidimensional anxiety item bank provides the basis for a computer-adaptive test to assess a wide range of anxiety in rehabilitation patients with orthopedic diseases with very good psychometric characteristics.

Comparison of the Outcomes of Three Different Nutritional Supports in Patients with Oral and Maxillofacial Malignant Tumors following Surgery

Objective. This study aimed to compare the physical and mental states and the clinical effects of parenteral nutrition combined with enteral nutrition (PN+EN), total enteral nutrition (TEN), and total parenteral nutrition (TPN) after surgery in patients with maxillofacial malignant tumors. Methods. A total of 112 patients were divided into three groups, with 58, 33, and 21 patients in the PN+EN, TPN, and TEN groups, respectively. The psychological survey contained the Faces Pain Scale-Revised (FRS-R), visual analog scale (VAS), numerical rating scale (NRS), Hamilton anxiety rating scale (HAMA), and short-form 36 health survey questionnaire (SF-36). Spirit symptoms, length of hospital stay, nutritional assessments, and related biochemical indices were recorded and compared. Results. The traditional Chinese medicine (TCM) symptoms of anxiety and dysphoria were least frequently identified in the TPN group. The levels of lymphocytes, hemoglobin (HB), albumin (ALB), and prealbumin (PA) were significantly higher in the PE+EN group, whereas white blood cell count, neutrophil count, HB, PA, and ALB were significantly lower in the TPN group. Better psychological scores were observed in the TPN group. The PE+EN group had a shorter length of stay and higher SGA categories. Potassium, sodium, and chlorine levels were significantly lower in the TEN group (all P < 0.05). Conclusions. As an auxiliary method, TCM symptoms can help to identify spirit disequilibrium earlier and are associated with blood indices. Without the consideration of cost and long length of hospital stay, patients in the TPN group had the best mental status, with PN+EN therapy being an alternative.

Effectiveness and cost-effectiveness of a guided internet- and mobile-based depression intervention for individuals with chronic back pain: protocol of a multi-centre randomised controlled trial

INTRODUCTION

Depression often co-occurs with chronic back pain (CBP). Internet and mobile-based interventions (IMIs) might be a promising approach for effectively treating depression in this patient group. In the present study, we will evaluate the effectiveness and cost-effectiveness of a guided depression IMI for individuals with CBP (eSano BackCare-D) integrated into orthopaedic healthcare.

METHODS AND ANALYSIS

In this multicentre randomised controlled trial of parallel design, the groups eSano BackCare-D versus treatment as usual will be compared. 210 participants with CBP and diagnosed depression will be recruited subsequent to orthopaedic rehabilitation care. Assessments will be conducted prior to randomisation and 9 weeks (post-treatment) and 6 months after randomisation. The primary outcome is depression severity (Hamilton Rating Scale for Depression-17). Secondary outcomes are depression remission and response, health-related quality of life, pain intensity, pain-related disability, self-efficacy and work capacity. Demographic and medical variables as well as internet affinity, intervention adherence, intervention satisfaction and negative effects will also be assessed. Data will be analysed on an intention-to-treat basis with additional per-protocol analyses. Moreover, a cost-effectiveness and cost-utility analysis will be conducted from a societal perspective after 6 months.

ETHICS AND DISSEMINATION

All procedures are approved by the ethics committee of the Albert-Ludwigs-University of Freiburg and the data security committee of the German Pension Insurance (Deutsche Rentenversicherung). The results will be published in peer-reviewed journals and presented on international conferences.

TRIAL REGISTRATION NUMBER

DRKS00009272; Pre-results.

In Patients Undergoing Cochlear Implantation, Psychological Burden Affects Tinnitus and the Overall Outcome of Auditory Rehabilitation

Cochlear implantation (CI) is increasingly being used in the auditory rehabilitation of deaf patients. Here, we investigated whether the auditory rehabilitation can be influenced by the psychological burden caused by mental conditions. Our sample included 47 patients who underwent implantation. All patients were monitored before and 6 months after CI. Auditory performance was assessed using the Oldenburg Inventory (OI) and Freiburg monosyllable (FB MS) speech discrimination test. The health-related quality of life was measured with Nijmegen Cochlear implantation Questionnaire (NCIQ) whereas tinnitus-related distress was measured with the German version of Tinnitus Questionnaire (TQ). We additionally assessed the general perceived quality of life, the perceived stress, coping abilities, anxiety levels and the depressive symptoms. Finally, a structured interview to detect mental conditions (CIDI) was performed before and after surgery. We found that CI led to an overall improvement in auditory performance as well as the anxiety and depression, quality of life, tinnitus distress and coping strategies. CIDI revealed that 81% of patients in our sample had affective, anxiety, and/or somatoform disorders before or after CI. The affective disorders included dysthymia and depression, while anxiety disorders included agoraphobias and unspecified phobias. We also diagnosed cases of somatoform pain disorders and unrecognizable figure somatoform disorders. We found a positive correlation between the auditory performance and the decrease of anxiety and depression, tinnitus-related distress and perceived stress. There was no association between the presence of a mental condition itself and the outcome of auditory rehabilitation. We conclude that the CI candidates exhibit high rates of psychological disorders, and there is a particularly strong association between somatoform disorders and tinnitus. The presence of mental disorders remained unaffected by CI but the degree of psychological burden decreased significantly post-CI. The implants benefitted patients in a number of psychosocial areas, improving the symptoms of depression and anxiety, tinnitus, and their quality of life and coping strategies. The prevalence of mental disorders in patients who are candidates for CI suggests the need for a comprehensive psychological and psychosomatic management of their treatment.

Inappropriate prescriptions of antidepressant drugs in patients with subthreshold to mild depression: time for the evidence to become practice

Recent studies indicate that antidepressant drugs are largely ineffective in patients with subthreshold to mild depression when compared to placebo. In spite of this evidence, researchers continue to judge the prescription of antidepressant drugs to patients with subthreshold to mild depression as an adequate treatment, which in turn serves to further reinforce the undifferentiated treatment strategy adopted by clinicians. The present narrative review critically reflects on current research practice and highlights the need for a more differentiated, evidence-based clinical and research practice.

Direct and indirect costs in persons with chronic back pain and comorbid mental disorders--a systematic review

OBJECTIVE

Direct inpatient and outpatient healthcare costs as well as indirect costs (e.g. productivity losses) are hypothesized to be increased in chronic back pain (CBP) patients with mental disorders. The aim of this systematic review is to examine this hypothesis by comparing costs in CBP patients with and without mental disorders.

METHODS

A comprehensive literature search (Medline, EMBASE, PsycINFO, Psyndex, EconLit, IBSS) was conducted. All studies were included which allowed for a comparison of direct and indirect costs between CBP patients with and without mental disorders.

RESULTS

Of 2283 potentially relevant articles, 10 studies fulfilled the inclusion criteria. Total healthcare costs (SMD=0.16 [SE=0.06]; n=1), CBP-related healthcare costs (SMD=0.21 [0.06]; n=1), CBP-related primary care visits (OR=1.6 [95%-CI:1.2-2.3]; n=1), CBP-related specialty care visits (OR=1.4 [1.0-2.0];n=1), CBP-related radiologic procedures (OR=1.6 [1.0-2.5]; n=1) and mental health visits (OR=8.1 [7.3-9.1]; n=2) were increased in CBP patients with depression. The incidence of new surgeries was increased in CBP patients with PTSD (OR=4.2 [1.6-10.8]; n=1). Pain-related healthcare use (n=1) in CBP patients with both depression and anxiety and CBP-related hospital admissions (n=1) in CBP patients with depression were not increased. Regarding indirect costs results were inconsistent for both return to work rates (n=3) and work absence (n=2).

CONCLUSION

The results indicate increased direct but not indirect costs in CBP patients with mental disorders. However, the evidence is limited due to the low number of studies per outcome. This is all the more problematic, since the adequate allocation of healthcare resources will become a major topic of health care policy due to limited resources.