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Kolaas K, Berman AH, Hedman-Lagerlöf E, Lindsäter E, Hybelius J, Axelsson E. Internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety or both: a systematic review with meta-analysis of randomised controlled trials. BMJ Open 2024; 14:e075796. [PMID: 38569713 PMCID: PMC11015301 DOI: 10.1136/bmjopen-2023-075796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 02/26/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE Depression and anxiety are major public health problems. This study evaluated the effects of internet-delivered transdiagnostic psychological treatments for individuals with depression, anxiety, or both. DESIGN Systematic review with meta-analysis. DATA SOURCES Medline (Ovid), Cochrane Library (Wiley), the Web of Science Core Collection (Clarivate), and PsycInfo (EBSCO) were searched on 24 May 2021, with an update on 6 February 2023. ELIGIBILITY CRITERIA Randomised controlled trials of internet-delivered transdiagnostic psychological treatments, open to both participants with primary depression and participants with primary anxiety. This review concerned all treatment frameworks, both guided and unguided formats and all age groups. DATA EXTRACTION AND SYNTHESIS In random-effects meta-analysis, we estimated pooled effects on depression symptoms and anxiety in terms of Hedges' g with 95% CIs. Absolute and relative heterogeneity was quantified as the τ2 and I 2. RESULTS We included 57 trials with 21 795 participants. Nine trials (16%) recruited exclusively from routine care, and three (5%) delivered treatment via video. For adults, large within-group reductions were seen in depression (g=0.90; 95% CI 0.81 to 0.99) and anxiety (g=0.87; 95% CI 0.78 to 0.96). Compared with rudimentary passive controls, the added effects were moderate (depression: g=0.52; 95% CI 0.42 to 0.63; anxiety: g=0.45; 95% CI 0.34 to 0.56) and larger in trials that required all participants to meet full diagnostic criteria for depression or an anxiety disorder. Compared with attention/engagement controls, the added effects were small (depression: g=0.30; 95% CI 0.07 to 0.53; anxiety: g=0.21; 95% CI 0.01 to 0.42). Heterogeneity was substantial, and the certainty of the evidence was very low. Two trials concerned adolescents and reported mixed results. One trial concerned older adults and reported promising results. CONCLUSION Internet-delivered transdiagnostic treatments for depression and anxiety show small-to-moderate added effects, varying by control condition. Research is needed regarding routine care, the video format, children and adolescents and older adults. PROSPERO REGISTRATION NUMBER CRD42021243172.
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Affiliation(s)
- Karoline Kolaas
- Centre for Psychiatry Research, Karolinska Institute Department of Clinical Neuroscience, Stockholm, Stockholm, Sweden
- Liljeholmen University Primary Health Care Center, Region Stockholm, Academic Primary Care Centre, Stockholm, Stockholm, Sweden
| | - Anne H Berman
- Centre for Psychiatry Research, Karolinska Institute Department of Clinical Neuroscience, Stockholm, Stockholm, Sweden
- Department of Psychology, Uppsala Universitet, Uppsala, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Karolinska Institute Department of Clinical Neuroscience, Stockholm, Stockholm, Sweden
- Gustavsberg University Primary Health Care Center, Academic Primary Care Centre, Stockholm, Stockholm, Sweden
| | - Elin Lindsäter
- Division of Psychology, Karolinska Institute Department of Clinical Neuroscience, Stockholm, Stockholm, Sweden
- Gustavsberg University Primary Health Care Center, Academic Primary Care Centre, Stockholm, Stockholm, Sweden
| | - Jonna Hybelius
- Liljeholmen University Primary Health Care Center, Region Stockholm, Academic Primary Care Centre, Stockholm, Stockholm, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Stockholm, Sweden
| | - Erland Axelsson
- Liljeholmen University Primary Health Care Center, Region Stockholm, Academic Primary Care Centre, Stockholm, Stockholm, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Stockholm, Sweden
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Verbist IL, Fabian H, Huey D, Brooks H, Lovell K, Blakemore A. Exploring access and engagement with Improving Access to Psychological Therapies (IAPT) services, before, during, and after the COVID-19 lockdown: A service evaluation in the Northwest of England. Psychother Res 2024; 34:216-227. [PMID: 36878217 DOI: 10.1080/10503307.2023.2184285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Abstract
The purpose of this study was to compare clients' prevalence and explore the characteristics that predicted access and engagement with IAPT treatment before, during, and after Lockdown. We conducted a retrospective observational service evaluation, using routinely collected IAPT data from n = 13,019 clients who entered treatment between March and September in 2019, 2020, and 2021. Chi-square and multiple logistic regression were used to explore associations and potential predictors of access and engagement with IAPT treatment. The number of people accessing and engaging with IAPT treatment was significantly higher after lockdown compared to before. Unemployed clients were less likely to access treatment during and after lockdown. Yet, perinatal clients and people from a black ethnic background were more likely to access treatment during lockdown. Being young and being unemployed were predictors of treatment disengagement across all three time points, whereas perinatal clients were less likely to engage only before and during lockdown. Clients who were not prescribed medication and clients with a long-term condition were more likely to engage during lockdown. The demonstrated changes in access and engagement with IAPT treatment after the introduction of remote therapy urges the services to further consider the individual needs of specific client groups.
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Affiliation(s)
- Irini L Verbist
- Improving Access Psychological Therapies, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Hannah Fabian
- Improving Access Psychological Therapies, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Dale Huey
- Improving Access Psychological Therapies, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Helen Brooks
- Mental Health Research Group, Jean McFarlane Building, Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Karina Lovell
- Improving Access Psychological Therapies, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Mental Health Research Group, Jean McFarlane Building, Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Amy Blakemore
- Mental Health Research Group, Jean McFarlane Building, Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Renn BN, Sams N, Areán PA, Raue PJ. A low-intensity behavioral intervention for depression in older adults delivered by lay coaches: proof-of-concept trial. Aging Ment Health 2023; 27:1403-1410. [PMID: 35694856 PMCID: PMC9741665 DOI: 10.1080/13607863.2022.2084709] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 05/27/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES A broader workforce is necessary to expand U.S. geriatric mental health services. We examined (1) feasibility of training undergraduate students to deliver Do More, Feel Better (DMFB), an evidence-informed program for depression; and (2) feasibility, acceptability, and outcomes in a single-arm proof-of-concept trial. METHOD In Study 1, we taught DMFB to 18 upper-level undergraduate students and assessed fidelity using role plays. In Study 2, four students delivered six weekly DMFB sessions to 12 community-dwelling older adults (M = 66.83 years old, SD = 10.39) with depression (PHQ ≥ 10). Patient outcomes were change in pre- to post-treatment depressive symptoms, disability, and the target mechanism of increased activity. RESULTS Fidelity was high in the course (Study 1; 82.4% of role plays rated as 'passing') and the trial (Study 2; 100% of 24 sessions rated as 'passing'). The majority (83.3%) of patients were retained and evidenced statistically and clinically significant improvement in depressive symptoms (Hamilton Rating Scale for Depression [HAM-D]), disability (World Health Organization's Disability Assessment Schedule 2.0 [WHODAS 2.0], and activity (Behavioral Activation for Depression Scale [BADS]). CONCLUSION It is feasible to train bachelor's-level students to deliver a brief, structured intervention for depression. Future research should consider implementation strategies and stakeholder feedback.
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Affiliation(s)
- Brenna N Renn
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Nichole Sams
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Patricia A Areán
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Patrick J Raue
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Rawlings GH, Beail N, Armstrong I, Thompson AR. Self-help cognitive behavioural therapy for anxiety in pulmonary hypertension: pilot randomised controlled trial. ERJ Open Res 2022; 8:00526-2021. [PMID: 35265707 PMCID: PMC8899500 DOI: 10.1183/23120541.00526-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/14/2021] [Indexed: 11/05/2022] Open
Abstract
Objective People with pulmonary hypertension (PH) are at an increased risk of experiencing anxiety disorders. This study developed and tested the acceptability, feasibility and preliminary effectiveness of a cognitive behavioural self-help intervention for anxiety in adults with PH using a pilot randomised control trial design. Methods Individuals with PH recruited from pulmonary hypertension associations were randomised to either receive a newly developed self-help intervention (n=37) or a wait-list condition (n=40). Acceptability was explored using mixed-methods questionnaires. A 2×3 repeated-measures analysis of variance was used to explore anxiety (GAD-7), depression (PHQ-9), health-related quality of life (emPHAsis-10), dyspnoea (D-12), self-mastery (Self-Mastery Scale) and mood-related cognitions and behaviours (CBP-Q) at baseline, post-intervention and 1-month follow up. A mediation analysis was performed to examine potential mechanisms of change. Results Dropout was low at 15.6%. All participants would recommend the intervention to another person with PH and felt it had helped with their anxiety. Participants in the intervention group reported a reduction in anxiety, depression and cognitive and behavioural processes linked with mood disorders, compared to the control group. Change in unhelpful cognitions and behaviours mediated the relationship between intervention condition and change in anxiety and depression. Discussion The intervention was found to be acceptable, feasible and safe. Anxiety at baseline was higher than previously observed, which could be associated with the additional burden caused by COVID-19 as the intervention was trialled during the pandemic. Findings add to the growing evidence supporting the use of psychological therapies, including cognitive behavioural therapy, in this clinical group.
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Affiliation(s)
| | - Nigel Beail
- Clinical Psychology Unit, University of Sheffield, Sheffield, UK
| | - Iain Armstrong
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Andrew R. Thompson
- South Wales Clinical Psychology Training Programme, Cardiff University, Cardiff, UK
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Wakefield S, Kellett S, Simmonds‐Buckley M, Stockton D, Bradbury A, Delgadillo J. Improving Access to Psychological Therapies (IAPT) in the United Kingdom: A systematic review and meta‐analysis of 10‐years of practice‐based evidence. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 60:1-37. [DOI: 10.1111/bjc.12259] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 05/14/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Sarah Wakefield
- Clinical Psychology Unit Department of Psychology University of Sheffield UK
| | - Stephen Kellett
- University of Sheffield and Sheffield Health and Social Care NHS Foundation Trust UK
| | | | | | - Abigail Bradbury
- Clinical Psychology Unit Department of Psychology University of Sheffield UK
| | - Jaime Delgadillo
- Clinical Psychology Unit Department of Psychology University of Sheffield UK
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Referral patterns to primary mental health services in Western Sydney (Australia): an analysis of routinely collected data (2005-2018). Int J Ment Health Syst 2020; 14:37. [PMID: 32508982 PMCID: PMC7249634 DOI: 10.1186/s13033-020-00368-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 05/16/2020] [Indexed: 11/10/2022] Open
Abstract
Background Regionally-specific approaches to primary mental health service provision through Primary Health Networks (PHNs) have been a feature of recent national mental health reforms. No previous studies have been conducted to investigate local patterns of primary mental health care (PMHC) services in Western Sydney. This study is designed to (i) understand the socio-demographic and economic profiles (ii) examine the inequalities of service access, and (iii) investigate the service utilisation patterns, among those referred to PMHC services in Western Sydney, Australia. Methods This study used routinely collected PMHC data (2005–2018), population-level general practice and Medicare rebates data (2013–2018) related to mental health conditions, for the population catchment of the Western Sydney PHN. Sex- and age-specific PMHC referrals were examined by socio-demographic, diagnostic, referral- and service-level factors, and age-specific referrals to PMHC services as a percentage of total mental health encounters were investigated. Results There were 27,897 referrals received for 20,507 clients, of which, 79.19% referrals resulted in follow-up services with 138,154 sessions. Overall, 60.09% clients were female, and median age was 31 years with interquartile ranged 16–46 years. Anxiety and depression were the predominant mental health condition, and 9.88% referred for suicidal risk. Over two-thirds of referrals started treatments during the first month of the referral and 95.1% of the total sessions were delivered by face to face. The younger age group (0–24) had greater referral opportunities as a percentage of total visits to a general practitioner and Medicare rebates, however demonstrating poor attendance rates with reduced average sessions per referral compared with older adults. Conclusion Children and young adults were more likely to be referred to PMHC services than older adults, but were less likely to attend services. Further research is needed to identify the strategies to address these differences in access to PMHC services to optimise the effectiveness of services.
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Barriers and facilitators to accessing psychological therapies for severe mental health difficulties in later life. Behav Cogn Psychother 2019; 48:216-228. [DOI: 10.1017/s1352465819000596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:The number of people growing older with severe mental illness (SMI) is rising, reflecting societal trends towards an ageing population. Evidence suggests that older people are less likely to seek help, be referred for and receive psychological therapy compared with younger people, but past research has focused on those with mild to moderate mental health needs.Aims:This research aims to identify the specific barriers faced by older people with SMI.Method:We interviewed 53 participants (22 service users with SMI aged over 50 years, 11 carers of people with SMI, and 20 health care professionals) about their views and experiences of accessing therapy for SMI in later life.Results:Thematic analysis revealed five themes: organizational and resource issues; myths about therapy and attitudinal barriers; stigma; encouraging access to therapy; and meeting age-specific needs.Conclusions:Barriers faced by older people with SMI are not only age-related, but also reflect specific issues associated with having a SMI over many years. Improving awareness of the benefits of psychological therapies is important not only for older people with SMI themselves, but also for their carers and staff who work with them.
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Burroughs H, Bartlam B, Bullock P, Lovell K, Ogollah R, Ray M, Bower P, Waheed W, Gilbody S, Kingstone T, Nicholls E, Chew-Graham CA. Non-traditional support workers delivering a brief psychosocial intervention for older people with anxiety and depression: the NOTEPAD feasibility study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundAnxiety and depression often coexist in older people. These disorders are often underdiagnosed and undertreated, and are associated with increased use of health and social care services, and raised mortality. Barriers to diagnosis include the reluctance of older people to present to their general practitioner (GP) with mood symptoms because of the stigma they perceive about mental health problems, and because the treatments offered are not acceptable to them.ObjectivesTo refine a community-based psychosocial intervention for older people with anxiety and/or depression so that it can be delivered by non-traditional providers such, as support workers (SWs), in the third sector. To determine whether or not SWs can be trained to deliver this intervention to older people with anxiety and/or depression. To test procedures and determine if it is feasible to recruit and randomise patients, and to conduct a process evaluation to provide essential information to inform a randomised trial.DesignThree phases, all informed by a patient and public involvement and engagement group. Qualitative work with older people and third-sector providers, plus a consensus group to refine the intervention, training, SW manuals and patient participant materials (phase 1). Recruitment and training of SWs (phase 2). Feasibility study to test recruitment procedures and assess fidelity of delivery of the intervention; and interviews with study participants, SWs and GPs to assess acceptability of the intervention and impact on routine care (phase 3).SettingNorth Staffordshire, in collaboration with Age UK North Staffordshire.InterventionA psychosocial intervention, comprising one-to-one contact between older people with anxiety and/or depression and a SW employed by Age UK North Staffordshire, based on the principles of behavioural activation (BA), with encouragement to participate in a group activity.ResultsInitial qualitative work contributed to refinement of the psychosocial intervention. Recruitment (and retention) of the SWs was possible; the training, support materials and manual were acceptable to them, and they delivered the intervention as intended. Recruitment of practices from which to recruit patients was possible, but the recruitment target (100 patients) was not achieved, with 38 older adults randomised. Retention at 4 months was 86%. The study was not powered to demonstrate differences in outcomes. Older people in the intervention arm found the sessions with SWs acceptable, although signposting to, and attending, groups was not valued by all participants. GPs recognised the need for additional care for older people with anxiety and depression, which they could not provide. Participation in the study did not have an impact on routine care, other than responding to the calls from the study team about risk of self-harm. GPs were not aware of the work done by SWs with patients.LimitationsTarget recruitment was not achieved.ConclusionsSupport workers recruited from Age UK employees can be recruited and trained to deliver an intervention, based on the principles of BA, to older people with anxiety and/or depression. The training and supervision model used in the study was acceptable to SWs, and the intervention was acceptable to older people.Future workFurther development of recruitment strategies is needed before this intervention can be tested in a fully powered randomised controlled trial.Trial registrationCurrent Controlled Trials ISRCTN16318986.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 7, No. 25. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Heather Burroughs
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
| | - Bernadette Bartlam
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
| | | | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Reuben Ogollah
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Mo Ray
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population of Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Waquas Waheed
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population of Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Simon Gilbody
- Mental Health and Addictions Research Group, University of York, York, UK
- Centre for Health and Population Sciences, Hull York Medical School, York, UK
| | - Tom Kingstone
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
- Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Elaine Nicholls
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
| | - Carolyn A Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
- Midlands Partnership NHS Foundation Trust, Stafford, UK
- Collaboration for Leadership in Applied Health Research and Care West Midlands, Warwick, UK
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Shastri A, Aimola L, Tooke B, Quirk A, Corrado O, Hood C, Crawford MJ. Recognition and treatment of depression in older adults admitted to acute hospitals in England. Clin Med (Lond) 2019; 19:114-118. [PMID: 30872291 PMCID: PMC6454375 DOI: 10.7861/clinmedicine.19-2-114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Levels of awareness and treatment of depression in older adults admitted to acute hospitals are unclear. This study aims to examine the proportion of older adults diagnosed with depression in acute hospitals, treatment, referral, and communication between secondary and primary healthcare services following discharge. Retrospective examination of records of 766 older adults admitted to 27 acute hospitals in England was carried out. Ninety-eight (12.7%, 95% confidence interval (CI) = 10.6-15.3) records included a diagnosis of depression of which eight (1.0%, 95% CI = 0.5-2.0) had a new diagnosis made during their hospital admission. All newly diagnosed and 76 (84.4%, 95% CI = 75.5-90.5) of those with an existing diagnosis of depression were prescribed antidepressant medication. Six (75.0%, 95% CI = 40.9-92.8) of those with a new diagnosis, and 21 (23.3%, 95% CI = 15.8-33.0) with an existing diagnosis of depression were referred to liaison psychiatry. References to mental health were made in 50 (51.0%, 95% CI = 41.2-60.6) discharge letters sent to primary care. Very few older adults admitted to acute hospitals in this study were diagnosed with depression during their inpatient stay. Opportunities for improving the mental and physical health of such patients appear to be being missed.
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Affiliation(s)
| | | | | | - Alan Quirk
- Royal College of Psychiatrists, London, UK
| | | | - Chloe Hood
- Royal College of Psychiatrists, London, UK
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Kingstone T, Bartlam B, Burroughs H, Bullock P, Lovell K, Ray M, Bower P, Waheed W, Gilbody S, Nicholls E, Chew-Graham CA. Can support workers from AgeUK deliver an intervention to support older people with anxiety and depression? A qualitative evaluation. BMC FAMILY PRACTICE 2019; 20:16. [PMID: 30660195 PMCID: PMC6339431 DOI: 10.1186/s12875-019-0903-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 01/07/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Anxiety and depression often co-exist. These disorders are under-diagnosed and under-treated, specifically among older people, and lead to increased use of health and social care services and raised mortality. Older people report a reluctance to present to their GP with depression or anxiety symptoms due to perceived stigma about mental health problems, lack of acceptable treatments and the prioritising of physical health problems. Third sector organisations, who work closely with older people in the community, are well-placed to provide additional support. We developed a brief intervention based on principles of Behavioural Activation, with encouragement to participate in a group activity, for delivery by Support Workers from AgeUK. The aim of the study was to examine whether this brief intervention could be delivered to older people with anxiety and/or depression, with sufficient fidelity, and whether this approach was acceptable to patients, GPs and AgeUK Support Workers. METHODS Semi-structured interviews with older people with self-reported anxiety and/or depression (who received the intervention), Support Workers and GPs to assess acceptability of the intervention and impact on routine care. A constant comparative approach was used to analyse the data. Intervention sessions between Support Workers and older people were digitally recorded and reviewed by the research team to assess fidelity. RESULTS The Support Workers delivered the intervention with fidelity; access to the training maual and ongoing supervision were important. Older people found the intervention acceptable and valued the one-to-one support they received; group activities suggested by Support Workers were not valued by all. GPs recognised the need for additional support for vulnerable older people, but acknowledged they could not provide this support. Participation in the study did not impact on GP routine care, other than responding to the calls from the study team about risk of self-harm. CONCLUSIONS Support Workers within AgeUK, can be recruited and trained to deliver an intervention, based on the principles of Behavioural Activation, to older people with anxiety and/or depression. The training and supervision model used in the study was acceptable to Support Workers, and the intervention was acceptable to older people and GPs. This model has the potential to contribute to improving the support and care of older people in primary care with anxiety and depression. Further testing is required in a full trial. TRIAL REGISTRATION Trial registration number ISRCTN16318986 . Registered 10/11/2016.
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Affiliation(s)
- Tom Kingstone
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, UK
- Midlands Partnership HS Foundation Trust, St George’s Hospital, Stafford, Staffordshire UK
| | - Bernadette Bartlam
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Heather Burroughs
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Peter Bullock
- Chief Executive, North Staffordshire AgeUK, Staffordshire, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Mo Ray
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population of Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Waquas Waheed
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population of Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Simon Gilbody
- Mental Health and Addictions Research Group, University of York, and Centre for Health and Population Sciences, Hull/York Medical School, York, UK
| | - Elaine Nicholls
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, UK
| | - Carolyn A. Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Staffordshire, UK
- Midlands Partnership HS Foundation Trust, St George’s Hospital, Stafford, Staffordshire UK
- Collaboration for Leadership in Applied Health Research and Care, West Midlands, UK
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Bosanquet K, Adamson J, Atherton K, Bailey D, Baxter C, Beresford-Dent J, Birtwistle J, Chew-Graham C, Clare E, Delgadillo J, Ekers D, Foster D, Gabe R, Gascoyne S, Haley L, Hamilton J, Hargate R, Hewitt C, Holmes J, Keding A, Lewis H, McMillan D, Meer S, Mitchell N, Nutbrown S, Overend K, Parrott S, Pervin J, Richards DA, Spilsbury K, Torgerson D, Traviss-Turner G, Trépel D, Woodhouse R, Gilbody S. CollAborative care for Screen-Positive EldeRs with major depression (CASPER plus): a multicentred randomised controlled trial of clinical effectiveness and cost-effectiveness. Health Technol Assess 2018; 21:1-252. [PMID: 29171379 DOI: 10.3310/hta21670] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Depression in older adults is common and is associated with poor quality of life, increased morbidity and early mortality, and increased health and social care use. Collaborative care, a low-intensity intervention for depression that is shown to be effective in working-age adults, has not yet been evaluated in older people with depression who are managed in UK primary care. The CollAborative care for Screen-Positive EldeRs (CASPER) plus trial fills the evidence gap identified by the most recent guidelines on depression management. OBJECTIVES To establish the clinical effectiveness and cost-effectiveness of collaborative care for older adults with major depressive disorder in primary care. DESIGN A pragmatic, multicentred, two-arm, parallel, individually randomised controlled trial with embedded qualitative study. Participants were automatically randomised by computer, by the York Trials Unit Randomisation Service, on a 1 : 1 basis using simple unstratified randomisation after informed consent and baseline measures were collected. Blinding was not possible. SETTING Sixty-nine general practices in the north of England. PARTICIPANTS A total of 485 participants aged ≥ 65 years with major depressive disorder. INTERVENTIONS A low-intensity intervention of collaborative care, including behavioural activation, delivered by a case manager for an average of six sessions over 7-8 weeks, alongside usual general practitioner (GP) care. The control arm received only usual GP care. MAIN OUTCOME MEASURES The primary outcome measure was Patient Health Questionnaire-9 items score at 4 months post randomisation. Secondary outcome measures included depression severity and caseness at 12 and 18 months, the EuroQol-5 Dimensions, Short Form questionnaire-12 items, Patient Health Questionnaire-15 items, Generalised Anxiety Disorder-7 items, Connor-Davidson Resilience Scale-2 items, a medication questionnaire, objective data and adverse events. Participants were followed up at 12 and 18 months. RESULTS In total, 485 participants were randomised (collaborative care, n = 249; usual care, n = 236), with 390 participants (80%: collaborative care, 75%; usual care, 86%) followed up at 4 months, 358 participants (74%: collaborative care, 70%; usual care, 78%) followed up at 12 months and 344 participants (71%: collaborative care, 67%; usual care, 75%) followed up at 18 months. A total of 415 participants were included in primary analysis (collaborative care, n = 198; usual care, n = 217), which revealed a statistically significant effect in favour of collaborative care at the primary end point at 4 months [8.98 vs. 10.90 score points, mean difference 1.92 score points, 95% confidence interval (CI) 0.85 to 2.99 score points; p < 0.001], equivalent to a standard effect size of 0.34. However, treatment differences were not maintained in the longer term (at 12 months: 0.19 score points, 95% CI -0.92 to 1.29 score points; p = 0.741; at 18 months: < 0.01 score points, 95% CI -1.12 to 1.12 score points; p = 0.997). The study recorded details of all serious adverse events (SAEs), which consisted of 'unscheduled hospitalisation', 'other medically important condition' and 'death'. No SAEs were related to the intervention. Collaborative care showed a small but non-significant increase in quality-adjusted life-years (QALYs) over the 18-month period, with a higher cost. Overall, the mean cost per incremental QALY for collaborative care compared with usual care was £26,016; however, for participants attending six or more sessions, collaborative care appears to represent better value for money (£9876/QALY). LIMITATIONS Study limitations are identified at different stages: design (blinding unfeasible, potential contamination), process (relatively low overall consent rate, differential attrition/retention rates) and analysis (no baseline health-care resource cost or secondary/social care data). CONCLUSION Collaborative care was effective for older people with case-level depression across a range of outcomes in the short term though the reduction in depression severity was not maintained over the longer term of 12 or 18 months. Participants who received six or more sessions of collaborative care did benefit substantially more than those who received fewer treatment sessions but this difference was not statistically significant. FUTURE WORK RECOMMENDATIONS Recommendations for future research include investigating the longer-term effect of the intervention. Depression is a recurrent disorder and it would be useful to assess its impact on relapse and the prevention of future case-level depression. TRIAL REGISTRATION Current Controlled Trials ISRCTN45842879. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 67. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Joy Adamson
- Department of Health Sciences, University of York, York, UK
| | - Katie Atherton
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Della Bailey
- Department of Health Sciences, University of York, York, UK
| | | | | | | | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Emily Clare
- Northumberland, Tyne and Wear NHS Foundation Trust, National Institute for Health Research Clinical Research Network (Mental Health) North East and North Cumbria, Newcastle upon Tyne, UK
| | - Jaime Delgadillo
- Department of Health Sciences, University of York, York, UK.,Primary Care Mental Health Service, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - David Ekers
- Mental Health Research Group, Durham University, Durham, UK.,Research and Development Department, Tees, Esk & Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Deborah Foster
- Department of Health Sciences, University of York, York, UK
| | - Rhian Gabe
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | | | - Lesley Haley
- Research and Development Department, Tees, Esk & Wear Valleys NHS Foundation Trust, Middlesbrough, UK
| | - Jahnese Hamilton
- Northumberland, Tyne and Wear NHS Foundation Trust, National Institute for Health Research Clinical Research Network (Mental Health) North East and North Cumbria, Newcastle upon Tyne, UK
| | | | | | - John Holmes
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ada Keding
- Department of Health Sciences, University of York, York, UK
| | - Helen Lewis
- Department of Health Sciences, University of York, York, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
| | - Shaista Meer
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Sarah Nutbrown
- Department of Health Sciences, University of York, York, UK
| | - Karen Overend
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Jodi Pervin
- Department of Health Sciences, University of York, York, UK
| | - David A Richards
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | | | | | - Dominic Trépel
- Department of Health Sciences, University of York, York, UK
| | | | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK.,Hull York Medical School, University of York, York, UK
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M Williams C, Meeten F, Whiting S. 'I had a sort of epiphany!' An exploratory study of group mindfulness-based cognitive therapy for older people with depression. Aging Ment Health 2018; 22:208-217. [PMID: 27834499 DOI: 10.1080/13607863.2016.1247415] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Mindfulness-based cognitive therapy (MBCT) has been successful in reducing depressive symptoms in people with chronic-recurrent depression. However, the research evaluating the efficacy of this approach, and other innovative treatments for mood disorders, has mainly been with people under 65 years. This paper aims to help redress this imbalance by exploring older people's own reflections of their experience of MBCT. METHODS A qualitative approach was used to explore 13 participants' experiences of MBCT; participants were interviewed pre and post-intervention and again after six months. To see whether the standard course requires any adaptations for older participants, the two MBCT course facilitators were interviewed post-intervention. RESULTS Thematic analysis identified five overarching themes and showed that older people reported positive changes in their mental health and well-being and reported being 'released from the past'. The facilitators reported that they needed to be aware of later life issues, such as loneliness and potential physical limitations, but otherwise only minor adaptations were needed to the standard MBCT course for older people. CONCLUSION MBCT is an acceptable approach for people aged 65 years and over and further research should explore potential mechanisms of change including changes in meta-cognitive awareness and self-compassion.
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Affiliation(s)
| | - Frances Meeten
- a Sussex Partnership NHS Foundation Trust , UK.,b Clinical Imaging Sciences Centre, Brighton and Sussex Medical School , University of Sussex , Brighton , UK
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14
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Burch S, Preston C, Bateup S. True technology-enabled mental health care: trust, agency and ageing. Mhealth 2018; 4:30. [PMID: 30221165 PMCID: PMC6131528 DOI: 10.21037/mhealth.2018.08.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/02/2018] [Indexed: 11/06/2022] Open
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15
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White M, Casey L. Helping older adults to help themselves: the role of mental health literacy in family members. Aging Ment Health 2017; 21:1129-1137. [PMID: 27438165 DOI: 10.1080/13607863.2016.1206513] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Family members may play an important role in the health and well-being of older adults. However, little is known about the factors that influence the likelihood of family members supporting older relatives to seek help from mental health professionals for mental health concerns. Mental health literacy is associated with people's help-seeking intentions regarding their own mental health concerns, and some studies have suggested it may play a role in help-seeking on behalf of others. The purpose of this study was to investigate whether mental health literacy is associated with adults' likelihood of supporting an older relative to seek professional help for mental health concerns. METHOD Two hundred and sixty-three participants completed a measure of mental health literacy and responded to a hypothetical scenario by indicating their likelihood of supporting an older relative experiencing mental health problems to seek help from various sources. RESULTS Mental health literacy was positively associated with intentions to support older relative's help-seeking. CONCLUSIONS Interventions to increase the mental health literacy of the relatives of older adults may lead to additional support for older adults' help-seeking for mental health concerns.
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Affiliation(s)
- Margaret White
- a School of Applied Psychology , Griffith University , Mt Gravatt , Australia
| | - Leanne Casey
- a School of Applied Psychology , Griffith University , Mt Gravatt , Australia.,b Menzies Health Institute Queensland, Griffith University , Gold Coast , Australia
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16
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Salway SM, Payne N, Rimmer M, Buckner S, Jordan H, Adams J, Walters K, Sowden SL, Forrest L, Sharp L, Hidajat M, White M, Ben-Shlomo Y. Identifying inequitable healthcare in older people: systematic review of current research practice. Int J Equity Health 2017; 16:123. [PMID: 28697768 PMCID: PMC5505033 DOI: 10.1186/s12939-017-0605-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/13/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is growing consensus on the importance of identifying age-related inequities in the receipt of public health and healthcare interventions, but concerns regarding conceptual and methodological rigour in this area of research. Establishing age inequity in receipt requires evidence of a difference that is not an artefact of poor measurement of need or receipt; is not warranted on the grounds of patient preference or clinical safety; and is judged to be unfair. METHOD A systematic, thematic literature review was undertaken with the objective of characterising recent research approaches. Studies were eligible if the population was in a country within the Organisation for Economic Co-operation and Development and analyses included an explicit focus on age-related patterns of healthcare receipt including those 60 years or older. A structured extraction template was applied. Extracted material was synthesised in thematic memos. A set of categorical codes were then defined and applied to produce summary counts across key dimensions. This process was iterative to allow reconciliation of discrepancies and ensure reliability. RESULTS Forty nine studies met the eligibility criteria. A wide variety of concepts, terms and methodologies were used across these studies. Thirty five studies employed multivariable techniques to produce adjusted receipt-need ratios, though few clearly articulated their rationale, indicating the need for great conceptual clarity. Eighteen studies made reference to patient preference as a relevant consideration, but just one incorporated any kind of adjustment for this factor. Twenty five studies discussed effectiveness among older adults, with fourteen raising the possibility of differential effectiveness, and one differential cost-effectiveness, by age. Just three studies made explicit reference to the ethical nature of healthcare resource allocation by age. While many authors presented suitably cautious conclusions, some appeared to over-stretch their findings concluding that observed differences were 'inequitable'. Limitations include possible biases in the retrieved material due to inconsistent database indexing and a focus on OECD country populations and studies with English titles. CONCLUSIONS Caution is needed among clinicians and other evidence-users in accepting claims of healthcare 'ageism' in some published papers. Principles for improved research practice are proposed.
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Affiliation(s)
- Sarah M. Salway
- School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Nick Payne
- School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Melanie Rimmer
- School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Stefanie Buckner
- Department of Public Health and Primary Care, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
| | - Hannah Jordan
- School of Health & Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, CB2 0QQ UK
| | - Kate Walters
- Centre for Ageing & Population Studies, Department of Primary Care & Population Health, University College London, Rowland Hill Street, London, NW3 2PF UK
| | - Sarah L. Sowden
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon, Tyne NE2 4AX UK
| | - Lynne Forrest
- Administrative Data Research Centre, University of Edinburgh, Edinburgh Bioquarter, 9 Little France Road, Edinburgh, EH16 4UX UK
| | - Linda Sharp
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon, Tyne NE2 4AX UK
| | - Mira Hidajat
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, School of Clinical Medicine, Cambridge, CB2 0QQ UK
- Institute of Health and Society, Newcastle University, Baddiley-Clark Building, Newcastle upon, Tyne NE2 4AX UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
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17
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Gratzer D, Goldbloom D. Making Evidence-Based Psychotherapy More Accessible in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:618-23. [PMID: 27310234 PMCID: PMC5348091 DOI: 10.1177/0706743716642416] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- David Gratzer
- The Scarborough Hospital, Toronto, Ontario Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - David Goldbloom
- Department of Psychiatry, University of Toronto, Toronto, Ontario Centre for Addiction and Mental Health, Toronto, Ontario
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18
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Asthana S, Gibson A, Bailey T, Moon G, Hewson P, Dibben C. Equity of utilisation of cardiovascular care and mental health services in England: a cohort-based cross-sectional study using small-area estimation. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BackgroundA strong policy emphasis on the need to reduce both health inequalities and unmet need in deprived areas has resulted in the substantial redistribution of English NHS funding towards deprived areas. This raises the question of whether or not socioeconomically disadvantaged people continue to be disadvantaged in their access to and utilisation of health care.ObjectivesTo generate estimates of the prevalence of cardiovascular disease (CVD) and common mental health disorders (CMHDs) at a variety of scales, and to make these available for public use via Public Health England (PHE). To compare these estimates with utilisation of NHS services in England to establish whether inequalities of use relative to need at various stages on the health-care pathway are associated with particular sociodemographic or other factors.DesignCross-sectional analysis of practice-, primary care trust- and Clinical Commissioning Group-level variations in diagnosis, prescribing and specialist management of CVD and CMHDs relative to the estimated prevalence of those conditions (calculated using small-area estimation).ResultsThe utilisation of CVD care appears more equitable than the utilisation of care for CMHDs. In contrast to the reviewed literature, we found little evidence of underutilisation of services by older populations. Indeed, younger populations appear to be less likely to access care for some CVD conditions. Nor did deprivation emerge as a consistent predictor of lower use relative to need for either CVD or CMHDs. Ethnicity is a consistent predictor of variations in use relative to need. Rates of primary management are lower than expected in areas with higher percentages of black populations for diabetes, stroke and CMHDs. Areas with higher Asian populations have higher-than-expected rates of diabetes presentation and prescribing and lower-than-expected rates of secondary care for diabetes. For both sets of conditions, there are pronounced geographical variations in use relative to need. For instance, the North East has relatively high levels of use of cardiac care services and rural (shire) areas have low levels of use relative to need. For CMHDs, there appears to be a pronounced ‘London effect’, with the number of people registered by general practitioners as having depression, or being prescribed antidepressants, being much lower in London than expected. A total of 24 CVD and 41 CMHD prevalence estimates have been provided to PHE and will be publicly available at a range of scales, from lower- and middle-layer super output areas through to Clinical Commissioning Groups and local authorities.ConclusionsWe found little evidence of socioeconomic inequality in use for CVD and CMHDs relative to underlying need, which suggests that the strong targeting of NHS resources to deprived areas may well have addressed longstanding concerns about unmet need. However, ethnicity has emerged as a significant predictor of inequality, and there are large and unexplained geographical variations in use relative to need for both conditions which undermine the principle of equal access to health care for equal needs. The persistence of ethnic variations and the role of systematic factors (such as rurality) in shaping patterns of utilisation deserve further investigation, as does the fact that the models were far better at explaining variation in use of CVD than mental health services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Sheena Asthana
- School of Government, University of Plymouth, Plymouth, UK
| | - Alex Gibson
- School of Government, University of Plymouth, Plymouth, UK
| | - Trevor Bailey
- College of Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Graham Moon
- School of Geography and the Environment, University of Southampton, Southampton, UK
| | - Paul Hewson
- School of Computing and Mathematics, University of Plymouth, Plymouth, UK
| | - Chris Dibben
- School of Geosciences, University of Edinburgh, Edinburgh, UK
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Sanglier T, Saragoussi D, Milea D, Tournier M. Depressed older adults may be less cared for than depressed younger ones. Psychiatry Res 2015; 229:905-12. [PMID: 26233825 DOI: 10.1016/j.psychres.2015.07.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 06/16/2015] [Accepted: 07/12/2015] [Indexed: 12/31/2022]
Abstract
The aim of the study was to investigate depression treatment use, either psychotherapy (PT) or antidepressant drugs (ADT) in the older and younger depressed population. Cohorts of 6316 elderly (≥65 year-old) and 25,264 matched non-elderly (25-64 year-old) depressed patients were created from a large national claims database of managed care plans from 2003 to 2006. Factors associated with ADT or PT were assessed using multivariate logistic models. During the 120 days following the depression diagnosis, the elderly persons were less often treated than the younger adults either by ADT (25.6% vs. 33.8%) or by PT (13.0% vs. 34.4%). ADT dispensing occurred later in the elderly group (51 vs. 14 days). ADT was associated with comorbid chronic conditions or polypharmacy in the elderly and younger adults. The selection of treatment (ADT or PT) was associated with the history of treated depression using the same type of treatment, in both groups. Thus, depression goes commonly untreated. Comorbidity was associated with higher ADT dispensing rates. However, although depressed elderly commonly presented with comorbidity, this age group was at higher risk of untreated illness or later treatment.
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Affiliation(s)
- Thibaut Sanglier
- Université Claude Bernard Lyon I, Villeurbanne, France; Lundbeck SAS, Global Outcomes Research Division, Issy-les-Moulineaux, France
| | - Delphine Saragoussi
- Lundbeck SAS, Global Outcomes Research Division, Issy-les-Moulineaux, France
| | - Dominique Milea
- Lundbeck SAS, Global Outcomes Research Division, Issy-les-Moulineaux, France
| | - Marie Tournier
- Université de Bordeaux, U657, F-33000 Bordeaux, France; INSERM, U657, F-33000 Bordeaux, France; Centre Hospitalier Charles Perrens, F-33000 Bordeaux, France.
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20
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Abstract
BACKGROUND Older adults with mental health disorders underutilize mental health services more than other adults. While there are well known general barriers to help seeking across the population, specific barriers for older adults include difficulties with transportation, beliefs that it is normal to be anxious and depressed in old age, and beliefs by referrers that psychological therapy is less likely to be effective. This study examined barriers related to identifying the need for help, seeking help and participating in therapy in a clinical population of older adults. METHOD Sixty older adults (aged 60-79 years) with comorbid anxiety and unipolar mood disorders completed barriers to treatment questionnaires before and after psychological group treatment, as well as measures of cognitive ability, anxiety, depression, and quality of life at baseline. RESULTS The greatest barriers to help seeking related to difficulties identifying the need for help, with 50% of the sample reporting their belief that their symptoms were normal as a major barrier. Other major barriers identified were related to: self-reliance, cost of treatment, and fear of medication replicating previous findings. The main barriers reported for difficulties in continuing therapy included not finding therapy helpful, cost of treatment, and thinking that the therapist did not understand their issues. CONCLUSIONS The main barriers identified related to issues with identifying the need to seek help. More attention is needed to educate older adults and professionals about the need for, and effectiveness of, psychological therapies for older adults with anxiety and depression to reduce this barrier to help seeking.
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Overend K, Lewis H, Bailey D, Bosanquet K, Chew-Graham C, Ekers D, Gascoyne S, Hems D, Holmes J, Keding A, McMillan D, Meer S, Meredith J, Mitchell N, Nutbrown S, Parrott S, Richards D, Traviss G, Trépel D, Woodhouse R, Gilbody S. CASPER plus (CollAborative care in Screen-Positive EldeRs with major depressive disorder): study protocol for a randomised controlled trial. Trials 2014; 15:451. [PMID: 25409776 PMCID: PMC4247639 DOI: 10.1186/1745-6215-15-451] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/14/2014] [Indexed: 11/25/2022] Open
Abstract
Background Depression accounts for the greatest disease burden of all mental health disorders, contributes heavily to healthcare costs, and by 2020 is set to become the second largest cause of global disability. Although 10% to 16% of people aged 65 years and over are likely to experience depressive symptoms, the condition is under-diagnosed and often inadequately treated in primary care. Later-life depression is associated with chronic illness and disability, cognitive impairment and social isolation. With a progressively ageing population it becomes increasingly important to refine strategies to identity and manage depression in older people. Currently, management may be limited to the prescription of antidepressants where there may be poor concordance; older people may lack awareness of psychosocial interventions and general practitioners may neglect to offer this treatment option. Methods/design CASPER Plus is a multi-centre, randomised controlled trial of a collaborative care intervention for individuals aged 65 years and over experiencing moderate to severe depression. Selected practices in the North of England identify potentially eligible patients and invite them to participate in the study. A diagnostic interview is carried out and participants with major depressive disorder are randomised to either collaborative care or usual care. The recruitment target is 450 participants. The intervention, behavioural activation and medication management in a collaborative care framework, has been adapted to meet the complex needs of older people. It is delivered over eight to 10 weekly sessions by a case manager liaising with general practitioners. The trial aims to evaluate the clinical and cost effectiveness of collaborative care in addition to usual GP care versus usual GP care alone. The primary clinical outcome, depression severity, will be measured with the Patient Health Questionnaire-9 (PHQ-9) at baseline, 4, 12 and 18 months. Cost effectiveness analysis will assess health-related quality of life using the SF-12 and EQ-5D and will examine cost-consequences of collaborative care. A qualitative process evaluation will be undertaken to explore acceptability, gauge the extent to which the intervention is implemented and to explore sustainability beyond the clinical trial. Discussion Results will add to existing evidence and a positive outcome may lead to the commissioning of this model of service in primary care. Trial registration ISRCTN45842879 (24 July 2012).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Simon Gilbody
- Department of Health Sciences, University of York, Seebohm Rowntree, Building, Heslington, York YO10 5DD, UK.
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