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Lindberg MS, Brattmyr M, Lundqvist J, Roos E, Solem S, Hjemdal O, Havnen A. Sociodemographic factors and use of pain medication are associated with health-related quality of life: results from an adult community mental health service in Norway. Qual Life Res 2023; 32:3135-3145. [PMID: 37338784 PMCID: PMC10522514 DOI: 10.1007/s11136-023-03461-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE Health-related quality of life (HRQoL) is an important aspect of mental health outcomes. There are few studies on HRQoL in heterogeneous patient populations seeking help at community mental health services. The aims of the study were to compare how HRQoL, measured by the EuroQol five dimensions with five levels (EQ-5D-5L), was distributed compared to other samples from national and international studies, and to explore what factors are associated with HRQoL. METHODS In a cross-sectional study, 1379 Norwegian outpatients reported their HRQoL before starting treatment. Associations with demographic variables, job status, socio-economic status, and use of pain medication were examined using multiple regression analysis. RESULTS Most of the sample, 70% to 90%, reported problems with usual activities, pain/discomfort, and anxiety/depression; 30% to 65% reported that these problems were of a moderate to extreme degree. Forty percent reported problems with mobility, and about 20% reported problems with self-care. The sample's HRQoL was considerably lower than the general population, and comparable to patient-groups from specialist mental health services. Originating from a developing country, lower level of education, lower yearly household income, being on sick leave or unemployed, and using pain medication were associated with lower HRQoL. Age, gender, and relationship status were not associated with HRQoL. This is the first study to simultaneously examine the unique contribution of these variables in one study. CONCLUSION The most impacted domains of HRQoL were pain/discomfort, anxiety/depression, and usual activities. Lower HRQoL was associated with several socio-demographic factors and use of pain medication. These findings might have clinical implications and suggest that mental health professionals should routinely measure HRQoL in addition to symptom severity, to identify areas that should be targeted to improve HRQoL.
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Affiliation(s)
- Martin Schevik Lindberg
- Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway.
- Health and Welfare, Trondheim Municipality, Trondheim, Norway.
| | - Martin Brattmyr
- Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
| | - Jakob Lundqvist
- Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
| | - Eirik Roos
- Health and Welfare, Trondheim Municipality, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
| | - Audun Havnen
- Department of Psychology, Norwegian University of Science and Technology, NO-7491, Trondheim, Norway
- Nidaros Community Mental Health Centre, Division of Psychiatry, St. Olav's University Hospital, Trondheim, Norway
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Tusa N, Kautiainen H, Elfving P, Sinikallio S, Mäntyselkä P. Depressive symptoms decrease health-related quality of life of patients with coronary artery disease and diabetes: a 12-month follow up study in primary care. Scand J Prim Health Care 2023; 41:276-286. [PMID: 37455531 PMCID: PMC10478631 DOI: 10.1080/02813432.2023.2233995] [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: 04/27/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE Health-related quality of life (HRQoL) is a multidimensional patient-related outcome. Less is known about the role of depressive symptoms on HRQoL in chronic diseases. This follow-up study analyzed depressive symptoms' association with HRQoL change measured with 15D in patients with chronic diseases. DESIGN AND SETTING A total of 587 patients from the Siilinjärvi Health Center, Finland were followed up due to the treatment of hypertension (HA), coronary artery disease (CAD) or diabetes (DM). Depressive symptoms were based on Beck Depression Inventory (BDI) (BDI ≥10 =depressive symptoms). HRQoL was assessed at the baseline and after 12 months. RESULTS There were 244 patients with HA (mean age 70 years, 59% women); 103 patients (72 years, 38%) with CAD and 240 with DM (67 years, 52%). The change from baseline to the 12-month follow-up in 15D was significantly different between patients without and with depressive symptoms in CAD (p < 0.001) and DM (p = 0.024). In CAD with depressive symptoms, the change was -0.064 (95% CI: -0.094 to -0.035) and in DM -0.018 (95% CI: -0.037 to 0.001). In the 15 HRQoL dimensions of 15D, a depressive symptoms-related decrease was found in three dimensions with HA, in 9 with CAD and in 7 with DM. As a function of the BDI at baseline, the 15D score decreased significantly among patients with CAD and DM. CONCLUSIONS Depressive symptoms impact negatively on future HRQoL among primary care patients with coronary artery disease and diabetes emphasizing that mood should be acknowledged in their care and follow-up. TRIAL REGISTRATION Clinical Trials registration number: NCT02992431, registered December 14th 2016.
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Affiliation(s)
- Nina Tusa
- Wellbeing services county of North Savo, Educational services, Finland
- Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, Kuopio, Finland
- Siilinjärvi Health Center, Siilinjärvi, Finland
| | | | - Pia Elfving
- Department of Medicine, Kuopio University Hospital, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | | | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, Kuopio, Finland
- Clinical Research and Trials Centre, Kuopio University Hospital, Kuopio, Finland
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Hohls JK, König HH, Hajek A. Trajectories of generalized anxiety disorder, major depression and change in quality of life in adults aged 50 + : findings from a longitudinal analysis using representative, population-based data from Ireland. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1201-1211. [PMID: 36224379 PMCID: PMC10366232 DOI: 10.1007/s00127-022-02373-0] [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: 06/21/2021] [Accepted: 10/02/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To investigate the longitudinal association between trajectories (incidence, remission) of generalized anxiety disorder (GAD), major depression (MD) and change in quality of life (QoL) in adults aged 50 + , and to assess the symmetry in these relationships using observational study data. METHODS Data were derived from two waves of The Irish Longitudinal Study on Aging (2014-2015, wave 3: n = 6400; 2016, wave 4: n = 5715), a nationally representative cohort of community-dwelling adults aged 50 +. GAD and MD were assessed by means of the short form of the Composite International Diagnostic Interview. QoL outcomes were assessed using the Control, Autonomy, Self-realization, and Pleasure scale (CASP-12 with two domains control/autonomy and self-realization/pleasure). Covariate-adjusted, asymmetric fixed effects panel regressions and post-estimation Wald tests were used for statistical analysis. RESULTS Regarding incident disorders, only incident MD was significantly associated with a reduction in QoL over time (control/autonomy domain: b = - 0.74, SE: 0.30). Regarding remission, both remission of MD (b = 0.61, SE: 0.20) and remission of GAD (b = 0.61, 0.26) were significantly associated with an increase in the self-realization/pleasure domain over time. Subsequent Wald tests of the estimates were not significant, indicating symmetric effects. CONCLUSION Particularly the remission of GAD and MD was associated with a significant improvement in one of the QoL domains, indicating domain- and trajectory-specific differences. However, symmetric effects observed in this study indicate that gains and losses in QoL associated with remission and incidence of GAD and MD are of similar magnitude in adults aged 50 +.
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Affiliation(s)
- Johanna Katharina Hohls
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Dionisie V, Puiu MG, Manea M, Pacearcă IA. Predictors of Changes in Quality of Life of Patients with Major Depressive Disorder-A Prospective Naturalistic 3-Month Follow-Up Study. J Clin Med 2023; 12:4628. [PMID: 37510745 PMCID: PMC10380991 DOI: 10.3390/jcm12144628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Major depressive disorder (MDD) is one of the leading causes of disease burden worldwide and affected patients frequently report impairments in quality of life (QoL). Therefore, the present research aimed to identify predictors of domain-specific QoL changes in MDD patients following the acute phase of pharmacological treatment (3-month). This study is a prospective, naturalistic, and observational analysis on 150 patients. Depressive symptoms, QoL, overall pain intensity, and functionality were assessed using Hamilton Depression Rating Scale, World Health Organization Quality of Life scale-abbreviated version, Visual Analog Scale, and Sheehan Disability Scale, respectively. Reductions in symptom severity and disability were predictors of improvement across all domains of QoL. Pain intensity reduction was a predictor of increases in the physical aspect of QoL. A reduced number of psychiatric hospitalizations and being in a relationship predicted an improvement of QoL in the psychological domain whereas a positive history of suicidal attempts was associated with better social relationships QoL. The predictive models explained 41.2% and 54.7% of the variance in psychological and physical health domains of QoL, respectively. Awareness of sociodemographic and changes in clinical factors that impact the change in domain-specific QoL might help in shaping personalized treatment.
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Affiliation(s)
- Vlad Dionisie
- Department of Psychiatry and Psychology, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Maria Gabriela Puiu
- Department of Psychiatry and Psychology, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- "Prof. Dr. Alexandru Obregia" Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
| | - Mirela Manea
- Department of Psychiatry and Psychology, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- "Prof. Dr. Alexandru Obregia" Clinical Hospital of Psychiatry, 041914 Bucharest, Romania
| | - Ioana Anca Pacearcă
- Doctoral School, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- "Sfântul Spiridon Vechi" Foundation, 040012 Bucharest, Romania
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Riihimäki K, Sintonen H, Vuorilehto M, Isometsä E. Health-related quality of life-based definition of remission from depression among primary care patients. Front Psychiatry 2023; 14:926410. [PMID: 37051167 PMCID: PMC10084667 DOI: 10.3389/fpsyt.2023.926410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 02/27/2023] [Indexed: 04/14/2023] Open
Abstract
Background Depression undermines health-related quality of life (HRQoL). Remission is the central aim of all treatments for depression, but the degree of remission necessary for depressive patients' HRQoL to correspond to the normal range of the general population remains unknown. Methods The Vantaa Primary Care Depression Study prospectively followed-up a screening-based cohort of depressive primary care patients for 5 years. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was used to diagnose major depressive disorder. HRQoL was measured by the generic 15D instrument at baseline and at 5 years (N = 106, 77% of baseline patients), and compared with the 15D results of an age-standardized general population sample from the Finnish Health 2011 Survey (N = 4,157). Receiver operating characteristic analyses determined the optimal Hamilton Depression Rating Scale (HAMD), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) cut-offs for remission, using the 15D score as the construct validator. Remission was defined as the score at which HRQoL reached the general population range (minimum mean - 1 SD). As age may influence HRQoL, patients older and younger than the median 52 years were investigated separately. Results For HAMD, the optimal cut-off point score was 8.5, for BDI 10.5, and for BAI 11.5. The differences between the findings of the younger and older patients were small. Limitations Cross-sectional analysis, small number of patients in the cohort. Conclusion Depressive primary care patients' HRQoL reaches the normal variation range of the general population when their depression and anxiety scores reach the conventional clinical cut-offs for remission.
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Affiliation(s)
- Kirsi Riihimäki
- Mental Health Research Unit, National Institute for Health and Welfare, Helsinki, Finland
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Maria Vuorilehto
- Mental Health Research Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- *Correspondence: Erkki Isometsä,
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Bockting C, Legemaat AM, van der Stappen JGJ, Geurtsen GJ, Semkovska M, Burger H, Bergfeld IO, Lous N, Denys DAJP, Brouwer M. Augmenting neurocognitive remediation therapy to Preventive Cognitive Therapy for partially remitted depressed patients: protocol of a pragmatic multicentre randomised controlled trial. BMJ Open 2022; 12:e063407. [PMID: 35738653 PMCID: PMC9226921 DOI: 10.1136/bmjopen-2022-063407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Major depressive disorder (MDD) affects 163 million people globally every year. Individuals who experience subsyndromal depressive symptoms during remission (ie, partial remission of MDD) are especially at risk for a return to a depressive episode within an average of 4 months. Simultaneously, partial remission of MDD is associated with work and (psycho)social impairment and a lower quality of life. Brief psychological interventions such as preventive cognitive therapy (PCT) can reduce depressive symptoms or relapse for patients in partial remission, although achieving full remission with treatment is still a clinical challenge. Treatment might be more effective if cognitive functioning of patients is targeted as well since cognitive problems are the most persisting symptom in partial remission and predict poor treatment response and worse functioning. Studies show that cognitive functioning of patients with (remitted) MDD can be improved by online neurocognitive remediation therapy (oNCRT). Augmenting oNCRT to PCT might improve treatment effects for these patients by strengthening their cognitive functioning alongside a psychological intervention. METHODS AND ANALYSIS This study will examine the effectiveness of augmenting oNCRT to PCT in a pragmatic national multicentre superiority randomised controlled trial. We will include 115 adults partially remitted from MDD with subsyndromal depressive symptoms defined as a Hamilton Depression Rating Scale score between 8 and 15. Participants will be randomly allocated to PCT with oNCRT, or PCT only. Primary outcome measure is the effect on depressive symptomatology over 1 year. Secondary outcomes include time to relapse, cognitive functioning, quality of life and healthcare costs. This first dual approach study of augmenting oNCRT to PCT might facilitate full remission in partially remitted individuals as well as prevent relapse over time. ETHICS AND DISSEMINATION Ethical approval was obtained by Academic Medical Center, Amsterdam. Outcomes will be made publicly available. TRIAL REGISTRATION NUMBER NL9582.
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Affiliation(s)
- Claudi Bockting
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Amanda M Legemaat
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | | | - Gert J Geurtsen
- Department of Medical Psychology, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Maria Semkovska
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Huibert Burger
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Isidoor O Bergfeld
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Damiaan A J P Denys
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
| | - Marlies Brouwer
- Department of Psychiatry, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands
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Peltzer K, Pengpid S. Determinants of quality of life among patients attending monk healers and primary healthcare centers in
Thailand. POPULATION MEDICINE 2021. [DOI: 10.18332/popmed/144226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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8
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Lappalainen L, Stenvall H, Lavikainen P, Miettinen H, Martikainen J, Sintonen H, Tolppanen AM, Roine RP, Hartikainen J. Patient-reported outcomes in coronary artery disease: the relationship between the standard, disease-specific set by the International Consortium for Health Outcomes Measurement (ICHOM) and the generic health-related quality of life instrument 15D. Health Qual Life Outcomes 2021; 19:206. [PMID: 34454528 PMCID: PMC8401180 DOI: 10.1186/s12955-021-01841-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) instruments measure health gains, including changes in health-related quality of life (HRQoL). Previous studies have assessed the reliability and relationship of multiple HRQoL instruments in search of the optimal instrument for feasible measurement of PROs. Although the 15D instrument was shown to have the best sensitivity and construct validity among cardiac patients, it is unknown how well it captures relevant disease-specific information scores compared to instruments included in the International Consortium for Health Outcomes Measurement (ICHOM) standard set. The aim of this study was to investigate whether the disease-specific PRO instruments and a generic HRQoL instrument capture disease related symptoms in coronary artery disease (CAD) patients. METHODS Health status and HRQoL were assessed with the instruments included in the ICHOM standard set: Seattle Angina Questionnaire short-form (SAQ-7), Rose Dyspnea Scale (RDS), two-item Patient Health Questionnaire (PHQ-2), and with the 15D HRQoL instrument at baseline and 1 year from the treatment in a university hospital setting. Spearman correlation and explanatory factor analysis were used to assess the relationship of baseline scores and 1-year change in scores of 297 patients. RESULTS At baseline, the overall 15D score and SAQ-physical limitation (SAQ-PL), 15D "breathing" and SAQ-PL, as well as "breathing" and RDS showed moderately strong correlations. The factor interpreted to reflect "Breathing-related physical activity", based on high loadings of "breathing", RDS, SAQ-PL, "mobility", "vitality", and "usual activities", explained 19.2% of the total variance. Correlations between 1-year changes in scores were fair. The factor of "Breathing-related physical activity", with significant loading of RDS, SAQ-PL, "breathing, "usual activities", "vitality", "sexual activity", "mobility", and disease-specific quality of life explained 20.5% of the total variance in 1-year change in scores. The correlation of angina frequency measured by SAQ-7 and the 15D instrument was poor. CONCLUSIONS The 15D detects dyspnea and depression similarly to RDS and PHQ-2 but not angina similarly to the SAQ-7. This may call for supplementing the 15D instrument with a disease-specific instrument when studying CAD patients.
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Affiliation(s)
- Laura Lappalainen
- Kuopio University Hospital, Heart Center C9, P.O. Box 100, 70029, Kuopio, Finland.
| | | | - Piia Lavikainen
- Kuopio University Hospital, Heart Center C9, P.O. Box 100, 70029, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Heikki Miettinen
- Kuopio University Hospital, Heart Center C9, P.O. Box 100, 70029, Kuopio, Finland
| | | | | | | | - Risto P Roine
- University of Helsinki, Helsinki, Finland
- University of Eastern Finland, Kuopio, Finland
| | - Juha Hartikainen
- Kuopio University Hospital, Heart Center C9, P.O. Box 100, 70029, Kuopio, Finland
- University of Eastern Finland, Kuopio, Finland
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Blomdahl C, Guregård S, Rusner M, Wijk H. Recovery From Depression—A 6-Month Follow-up of a Randomized Controlled Study of Manual-Based Phenomenological Art Therapy for Persons With Depression. ART THERAPY 2021. [DOI: 10.1080/07421656.2021.1922328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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10
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Luoto KE, Lindholm LH, Koivukangas A, Lassila A, Sintonen H, Leinonen E, Kampman O. Impact of Comorbid Alcohol Use Disorder on Health-Related Quality of Life Among Patients With Depressive Symptoms. Front Psychiatry 2021; 12:688136. [PMID: 34690824 PMCID: PMC8531581 DOI: 10.3389/fpsyt.2021.688136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background and Aim: In psychiatric clinical practice, comorbidity of depression and alcohol use disorder (AUD) is common. Both disorders have a negative impact on health-related quality of life (HRQoL) in general population. However, research on the impact of comorbid AUD on HRQoL among clinically depressed patients is limited. The purpose of this study was to explore the impact of a psychosocial treatment intervention on HRQoL for depressive patients in specialized psychiatric care with a special focus on the impact of AUD on HRQoL. Material and Methods: Subjects were 242 patients of the Ostrobothnia Depression Study (ClinicalTrials.gov Identifier NCT02520271). Patients referred to specialized psychiatric care who scored at least 17 points on the Beck Depression Inventory at baseline and who had no psychotic disorders were included in the ODS. The treatment intervention in ODS comprised behavioral activation for all but began with motivational interviewing for those with AUD. HRQoL was assessed regularly during 24-month follow-up by the 15D instrument. In the present study, HRQoL of ODS patients with or without AUD was compared and the factors explaining 15D score analyzed with a linear mixed model. In order to specify the impact of clinical depression on HRQoL during the early phase of treatment intervention, a general population sample of the Finnish Health 2011 Survey was used as an additional reference group. Results: HRQoL improved among all ODS study sample patients regardless of comorbid AUD during the first year of follow-up. During 12-24 months of follow-up the difference between groups was seen as HRQoL continued to improve only among the non-AUD patients. A combination of male gender, anxiety disorder, and AUD was associated with the poorest HRQoL in this sample. In combined sample analyses with the reference group, clinical depression had an impact on HRQoL in short-term follow-up regardless of the treatment intervention. Conclusions: This study suggests that, in terms of improvement in HRQoL, the heterogenous group of depressive patients in specialized psychiatric care can be successfully treated with behavioral activation in combination with motivational interviewing for those with AUD. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02520271. Ostrobothnia Depression Study (ODS). A Naturalistic Follow-up Study on Depression and Related Substance Use Disorders. (2015). Available online at: https://clinicaltrials.gov/ct2/show/NCT02520271.
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Affiliation(s)
- Kaisa E Luoto
- Department of Psychiatry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Psychiatry, Hospital District of South Ostrobothnia, Seinäjoki, Finland.,Department of Psychiatry, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland
| | - Lars H Lindholm
- Department of Psychiatry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Psychiatry, Hospital District of South Ostrobothnia, Seinäjoki, Finland
| | - Antti Koivukangas
- Department of Psychiatry, Hospital District of South Ostrobothnia, Seinäjoki, Finland
| | - Antero Lassila
- Department of Psychiatry, Hospital District of South Ostrobothnia, Seinäjoki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Esa Leinonen
- Department of Psychiatry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Psychiatry, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland
| | - Olli Kampman
- Department of Psychiatry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Psychiatry, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland
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11
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Thériault FL, Gardner W, Momoli F, Garber BG, Kingsbury M, Clayborne Z, Cousineau-Short DY, Sampasa-Kanyinga H, Landry H, Colman I. Mental Health Service Use in Depressed Military Personnel: A Systematic Review. Mil Med 2020; 185:e1255-e1262. [PMID: 32073617 DOI: 10.1093/milmed/usaa015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/23/2019] [Accepted: 05/22/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Major depression is a leading cause of morbidity in military personnel and an important impediment to operational readiness in military organizations. Although treatment options are available, a large proportion of individuals with depression do not access mental health services. Quantifying and closing this treatment gap is a public health priority. However, the scientific literature on the major depression treatment gap in military organizations has never been systematically reviewed. METHODS We systematically searched the EMBASE, MEDLINE, and PsychINFO databases for studies measuring recent mental health service use in personnel serving in the armed forces of a Five-Eye country (Australia, Canada, New Zealand, the United Kingdom, or the United States). We excluded studies conducted with retired veterans. Because of the substantial heterogeneity in included studies, we did not pool their results. Instead, we computed median period prevalence of mental health service use. RESULTS Twenty-eight studies were included in the systematic review; 12 had estimated mental health service use in personnel with depression, and another 16 had estimated mental health service use in personnel with depression or another mental health disorder. The period prevalence of mental health service use in depressed military personnel ranged from 20 to 75% in 12 included studies, with a median of 48%, over 2-12 months. The other 16 studies yielded similar conclusions; they reported period prevalence of mental health service use in personnel with any mental health disorder ranging from 14 to 75%, with a median of 36%, over 1-12 months. The median was higher in studies relying on diagnostic interviews to identify depressed personnel, compared to studies relying on screening tools (60% vs. 44%). CONCLUSIONS There is a large treatment gap for major depression in particular, and for mental health disorders in general, among military personnel. However, our results highlight the association between the use of measurement tools and treatment gaps: estimated treatment gaps were larger when depressed patients were identified by screening tools instead of diagnostic interviews. Researchers should be wary of overestimating the mental health treatment gap when using screening tools in future studies.
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Affiliation(s)
- François L Thériault
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada.,Canadian Forces Health Services Group, Department of National Defence, National Defence HQ (Carling), 60 Moodie Drive, Ottawa, ON K1A 0K2, Canada
| | - William Gardner
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada.,CHEO Research Institute, Children Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
| | - Franco Momoli
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada.,CHEO Research Institute, Children Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada.,Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Bryan G Garber
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada.,Canadian Forces Health Services Group, Department of National Defence, National Defence HQ (Carling), 60 Moodie Drive, Ottawa, ON K1A 0K2, Canada
| | - Mila Kingsbury
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada
| | - Zahra Clayborne
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada
| | - Daniel Y Cousineau-Short
- Canadian Forces Health Services Group, Department of National Defence, National Defence HQ (Carling), 60 Moodie Drive, Ottawa, ON K1A 0K2, Canada.,Department of Health Sciences, Carleton University, 2305 Health Sciences Building, 1125 Colonel By Drive, Ottawa, ON K1S 5B6, Canada
| | - Hugues Sampasa-Kanyinga
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada
| | - Hannah Landry
- School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON,K1G 5Z3, Canada
| | - Ian Colman
- Centre for Fertility and Health, Norwegian Institute of Public Health, Postbox 222 Skøyen, N-0213 Oslo, Norway
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12
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Amirani E, Milajerdi A, Mirzaei H, Jamilian H, Mansournia MA, Hallajzadeh J, Ghaderi A. The effects of probiotic supplementation on mental health, biomarkers of inflammation and oxidative stress in patients with psychiatric disorders: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med 2020; 49:102361. [PMID: 32147043 DOI: 10.1016/j.ctim.2020.102361] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVE In the current meta-analysis of randomized controlled trials (RCTs), the effects of probiotic supplementation on mental health, biomarkers of inflammation and oxidative stress in patients with psychiatric disorders were assessed. METHODS The following databases were search up to February 2019: PubMed, Scopus, Web of Science, Google scholar and Cochrane Central Register of Controlled Trials. RESULTS Twelve studies were included in the current meta-analysis. The findings demonstrated that probiotic supplementation resulted in a significant reduction in Hamilton Depression Rating Scale (HAMD) [Weighted Mean Difference (WMD): -9.60; 95 % CI: -10.08, -9.11]. In addition, a significant reduction in C-reactive protein (CRP) (WMD: -1.59; 95 % CI: -2.22, -0.97), interleukin 10 (IL-10) (WMD: -0.29; 95 % CI: -0.48, -0.11) and malondialdehyde (MDA) levels (WMD: -0.38; 95 % CI: -0.63, -0.13) was found after probiotics supplementation. No significant change was seen in Beck Depression Inventory (BDI) score (WMD: -11.17; 95 % CI: -24.99, 2.65), tumor necrosis factor-α (TNF-α) (WMD: -0.12; 95 % CI: -0.20, -0.05), IL-1B (WMD: -0.34; 95 % CI: -1.43, 0.74), IL-6 (WMD: 0.03; 95 % CI: -0.32, 0.38), nitric oxide (NO) (WMD: -0.54; 95 % CI: -2.16, 1.08), glutathione (GSH) (WMD: 46.79; 95 % CI: -17.25, 110.83) and total antioxidant capacity (TAC) levels (WMD: 15.21; 95 % CI: -59.96, 90.37) after probiotics supplementation. CONCLUSION Overall, the current meta-analysis demonstrated that taking probiotic by patients with psychiatric disorders had beneficial effects on HAMD, CRP, IL-10 and MDA levels, but it did not affect BDI score, other markers of inflammation and oxidative stress.
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Affiliation(s)
- Elaheh Amirani
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran.
| | - Alireza Milajerdi
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran.
| | - Hamidreza Jamilian
- Traditional and Complementary Medicine Research Center, Arak University of Medical Sciences, Arak, Iran; Department of Psychiatry, Arak University of Medical Sciences, Arak, Iran.
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Jamal Hallajzadeh
- Department of Biochemistry and Nutrition, Research Center for Evidence-Based Health Management, Maragheh University of Medical Science, Maragheh, Iran.
| | - Amir Ghaderi
- Department of Addiction Studies, School of Medical, Kashan University of Medical Sciences, Kashan, Iran; Clinical Research Development Unit-Matini/Kargarnejad Hospital, Kashan University of Medical Sciences, Kashan, Iran.
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Kirchberger I, Maleckar B, Meisinger C, Linseisen J, Schmauss M, Baumgärtner J. Long-term outcomes in patients with severe depression after in-hospital treatment - study protocol of the depression long-term Augsburg (DELTA) study. BMJ Open 2019; 9:e032507. [PMID: 31874880 PMCID: PMC7008442 DOI: 10.1136/bmjopen-2019-032507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/26/2019] [Accepted: 12/03/2019] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Depressive disorders are very common diseases entailing a great burden on affected people. However, comprehensive information on long-term disease course in patients with severe depression is lacking so far. The objectives of the DELTA study are to examine long-term outcomes and their predicting factors, to assess clinical response of antidepressant pharmacotherapy by applying therapeutic drug monitoring, to identify predictors of therapeutic non-response, to describe the long-term healthcare utilisation and to investigate the role of biomarkers in disease course. METHODS AND ANALYSIS A cohort study including all adult hospitalised cases (age range 18 to 75 years) of severe major depression who are admitted to the Bezirkskrankenhaus Augsburg is established. It is planned to include 300 patients. During the hospital stay, information is gathered through personal interview, self-administered questionnaires, cognitive tests and chart review. Furthermore, biomaterials are collected. After hospital discharge, patients are repeatedly re-examined over time (3, 6, 12, 24 and 36 months) to collect information about mortality, relapse, depression severity, health-related quality of life (HRQOL), perceived stigma, cognitive functions, diet, physical activity, treatment and healthcare utilisation. Follow-up blood samples are collected to determine therapeutic drug levels. The primary study aim is to investigate long-term therapeutic response, survival, relapse, HRQOL and cognitive functions. Survival time and time to relapse or re-hospitalisation will be analysed using Cox regression models. Changes of HRQOL, depressive symptoms and cognitive functions over time will be examined using generalised linear regression models for repeated measures or mixed models. Correlates of the disease course will be modelled using suitable generalised linear, mixed, estimating equation and growth curve models. ETHICS AND DISSEMINATION The study protocol was approved by the Ethics Committee of the Ludwig-Maximilians-Universität München (date of approval: 23 October 2017, reference number: 17-625). Study results will be presented at scientific conferences and published in peer-reviewed scientific journals.
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Affiliation(s)
- Inge Kirchberger
- Chair of Epidemiology at UNIKA-T, Ludwig-Maximilians-Universität München, Augsburg, Germany
| | - Barbara Maleckar
- Chair of Epidemiology at UNIKA-T, Ludwig-Maximilians-Universität München, Augsburg, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Christine Meisinger
- Chair of Epidemiology at UNIKA-T, Ludwig-Maximilians-Universität München, Augsburg, Germany
| | - Jakob Linseisen
- Chair of Epidemiology at UNIKA-T, Ludwig-Maximilians-Universität München, Augsburg, Germany
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München Deutsches Forschungszentrum für Umwelt und Gesundheit, Neuherberg, Germany
| | - Max Schmauss
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
| | - Jessica Baumgärtner
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
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14
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Jamilian H, Amirani E, Milajerdi A, Kolahdooz F, Mirzaei H, Zaroudi M, Ghaderi A, Asemi Z. The effects of vitamin D supplementation on mental health, and biomarkers of inflammation and oxidative stress in patients with psychiatric disorders: A systematic review and meta-analysis of randomized controlled trials. Prog Neuropsychopharmacol Biol Psychiatry 2019; 94:109651. [PMID: 31095994 DOI: 10.1016/j.pnpbp.2019.109651] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/08/2019] [Accepted: 05/12/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND In the current meta-analysis of randomized controlled trials (RCTs), the effects of vitamin D supplementation on mental health, and biomarkers of inflammation and oxidative stress in patients with psychiatric disorders are assessed. METHODS The following databases were search up to March 2019: MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials. The quality of the relevant extracted data was assessed according to the Cochrane risk of bias tool. Data were pooled by the use of the inverse variance method and expressed as mean difference with 95% Confidence Intervals (95% CI). RESULTS Eleven effect sizes from nine studies were included in the final analyses. A pooled analysis of 9 effect sizes showed a significant reduction in Beck Depression Inventory (BDI) score following supplementation with vitamin D [weighted mean difference (WMD): -3.91; 95% CI: -5.15 -2.66), I2= 85.9%]. Combining data from two available studies on the effects of vitamin D supplementation on Pittsburgh Sleep Quality Index (PSQI) also revealed a significant reduction in this score following the intervention (WMD: -1.78; 95% CI: -2.28, -1.28). In addition, there were significant increase in glutathione (GSH) through 3 studies (WMD: 180.70; 95% CI: 6.76, 354.64), and in total antioxidant capacity (TAC) through 3 studies (WMD: 90.09; 95% CI: 56.36, 123.82) after vitamin D supplementation. Combining data from five studies, we found a significant reduction in C-reactive protein (CRP) concentrations after vitamin D supplementation (WMD: -1.74; 95% CI: -2.82, -0.66). CONCLUSIONS Overall, the current meta-analysis demonstrated that taking vitamin D supplements among patients with psychiatric disorders had beneficial effects on BDI, PSQI, GSH, TAC and CRP levels, but did not affect other biomarkers of inflammation and oxidative stress.
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Affiliation(s)
- Hamidreza Jamilian
- Department of Psychiatry, Arak University of Medical Sciences, Arak, Iran; Traditional and Complementary Medicine Research Center, Arak University of Medical Sciences, Arak, Iran
| | - Elaheh Amirani
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran.
| | - Alireza Milajerdi
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Kolahdooz
- Indigenous and Global Health Research, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran
| | - Marsa Zaroudi
- Student Research Committee, Faculty of Public Health Branch, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Ghaderi
- Department of Addiction studies, School of Medical, Kashan University of Medical Sciences, Kashan, Iran; Clinical Research Development Unit-Matini/Kargarnejad Hospital, Kashan University of Medical Sciences, Kashan, Iran
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran.
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15
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Wersebe H, Lieb R, Meyer AH, Miche M, Mikoteit T, Imboden C, Hoyer J, Bader K, Hatzinger M, Gloster AT. Well-being in major depression and social phobia with and without comorbidity. Int J Clin Health Psychol 2018; 18:201-208. [PMID: 30487925 PMCID: PMC6225024 DOI: 10.1016/j.ijchp.2018.06.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/29/2018] [Indexed: 11/22/2022] Open
Abstract
Background/Objective: Lower levels in well-being have been observed in individuals with Major Depression (MDD) and Social Phobia (SP), but well-planned direct comparisons with control individuals, not suffering from a mental disorder, are lacking. Furthermore, MDD is highly comorbid with anxiety disorders, and SP with depressive disorders. This study is among the first to examine differences in well-being in individuals with a clinical diagnosis of MDD or SP compared to individuals with no such diagnosis and to test differences in well-being within the combined diagnostic categories respective with and without anxiety-depressive comorbidity. Method: Participants were 119 individuals with a diagnosis of MDD, 47 SP and 118 controls. Results: Results revealed that overall well-being as well as emotional, psychological, and social well-being were lower in the MDD and SP group compared to the control group. Individuals with comorbidity reported lower well-being than individuals without comorbidity. Conclusions: These findings have clinical implications as presence of comorbidity may require a different therapeutic approach than with no comorbidity.
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Affiliation(s)
- Hanna Wersebe
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Switzerland
| | - Roselind Lieb
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Switzerland
| | - Andrea H. Meyer
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Switzerland
| | - Marcel Miche
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Switzerland
| | - Thorsten Mikoteit
- Psychiatric Services Solothurn and University of Basel, Switzerland
- Psychiatric Hospital, University of Basel, Basel, Switzerland
| | - Christian Imboden
- Psychiatric Services Solothurn and University of Basel, Switzerland
- Private Clinic Wyss, Muenchenbuchsee, Switzerland
| | - Jürgen Hoyer
- Technische Universität Dresden, Clinical Psychology and Psychotherapy, Germany
| | - Klaus Bader
- Psychiatric Hospital, University of Basel, Basel, Switzerland
| | - Martin Hatzinger
- Psychiatric Services Solothurn and University of Basel, Switzerland
| | - Andrew T. Gloster
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Switzerland
- Department of Psychology, Division of Clinical Psychology and Intervention Science, University of Basel, Switzerland
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16
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Grauwmeijer E, Heijenbrok-Kal MH, Peppel LD, Hartjes CJ, Haitsma IK, de Koning I, Ribbers GM. Cognition, Health-Related Quality of Life, and Depression Ten Years after Moderate to Severe Traumatic Brain Injury: A Prospective Cohort Study. J Neurotrauma 2018; 35:1543-1551. [PMID: 29343203 DOI: 10.1089/neu.2017.5404] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to evaluate cognitive function 10 years after moderate-severe traumatic brain injury (TBI) and to investigate the associations among cognitive function, depression, and health-related quality of life (HRQoL). In this prospective cohort study, with measurements at 3, 6, 12, 18, 24, 36, and 120 months post-TBI, patients 18-67 years of age (n = 113) with moderate-severe TBI were recruited. Main outcome measures were depression (Center for Epidemiologic Studies-Depression Scale [CES-D]), subjective cognitive functioning (Cognitive Failure Questionnaire [CFQ]), objective cognitive functioning, and HRQoL (Medical Outcomes Study 36-Item Short Form Health Survey [SF-36]). Fifty of the initial 113 patients completed the 10 year follow-up. Twenty percent showed symptoms of depression (CES-D ≥ 16). These patients had more psychiatric symptoms at hospital discharge (p = 0.048) and were more often referred to rehabilitation or nursing homes (p = 0.015) than non-depressed patients. Further, they also had significantly lower scores in six of the eight subdomains of the SF-36. The non-depressed patients had equivalent scores to those of the Dutch norm-population on all subdomains of the SF-36. Cognitive problems at hospital discharge were related with worse cognitive outcome 10 years post-TBI, but not with depression or HRQoL. Ten years after moderate-severe TBI, only weak associations (p < 0.05) between depression scores and two objective cognitive functioning scores were found. However, there were moderate associations (p < 0.01) among depression scores, HRQoL, and subjective cognitive functioning. Therefore, signaling and treatment of depressive symptoms after moderate-severe TBI may be of major importance for optimizing HRQoL in the long term. We did not find strong evidence for associations between depression and objective cognitive functioning in the long term post-TBI. Disease awareness and selective dropping out may play a role in long-term follow-up studies in moderate-severe TBI. More long-term research is needed in this field.
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Affiliation(s)
- Erik Grauwmeijer
- 1 Rijndam Rehabilitation , Rotterdam, The Netherlands .,2 Department of Rehabilitation Medicine, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Majanka H Heijenbrok-Kal
- 1 Rijndam Rehabilitation , Rotterdam, The Netherlands .,2 Department of Rehabilitation Medicine, Erasmus University Medical Center , Rotterdam, The Netherlands
| | - Lianne D Peppel
- 1 Rijndam Rehabilitation , Rotterdam, The Netherlands .,2 Department of Rehabilitation Medicine, Erasmus University Medical Center , Rotterdam, The Netherlands
| | | | - Iain K Haitsma
- 3 Department of Neurosurgery, Erasmus University Medical Center , Rotterdam, The Netherlands
| | | | - Gerard M Ribbers
- 1 Rijndam Rehabilitation , Rotterdam, The Netherlands .,2 Department of Rehabilitation Medicine, Erasmus University Medical Center , Rotterdam, The Netherlands
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