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McGrath RL, Verdon S, Parnell T, Pope R. Australian physiotherapists' perceived frequency of contact with clients experiencing distress: A cross-sectional survey. Physiother Theory Pract 2023:1-18. [PMID: 37128766 DOI: 10.1080/09593985.2023.2204962] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/16/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Previous research suggests physiotherapists' perceived frequency of contact with clients experiencing psychological distress is common; however, there is significant variation in the frequency of such contact. OBJECTIVE The study aimed to 1) investigate Australian physiotherapists' perceived frequency of contact with clients experiencing various forms of psychological distress; 2) identify potential factors that predict perceived frequency of contact; and 3) explore physiotherapists' beliefs regarding their role and self-reported capability to identify and assess psychological distress. METHODS A nationwide online survey of 340 Australian physiotherapists was conducted, and the data were analyzed using descriptive analysis and regression analysis. RESULTS Physiotherapists' perceived frequencies of contact with psychologically distressed and severely distressed clients expressed as proportions of all clients seen each week were 36.1% and 15.6%, respectively. Factors related to the clinical setting were stronger predictors of the perceived frequency of contact (Cohen's f2 = 0.16) than factors related to the physiotherapists themselves (Cohen's f2 = 0.03). Despite believing that identifying psychological distress was within their scope of practice, the physiotherapists in the study felt that assessing and managing this distress fell outside or on the boundary of their scope of practice. CONCLUSION Australian physiotherapists frequently encounter clients they perceive to be experiencing psychological distress. Future research into physiotherapists' capability to assess and respond to client psychological distress, using non-self-reported measures, is required.
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Affiliation(s)
- Ryan L McGrath
- Department of Rural Health, The University of Melbourne, Shepparton, Australia
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
- Allied Health Education and Research Unit, Goulburn Valley Health, Shepparton, Australia
| | - Sarah Verdon
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
| | - Tracey Parnell
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
| | - Rodney Pope
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, Australia
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2
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Lamoureux-Lamarche C, Berbiche D, Vasiliadis HM. Treatment adequacy and remission of depression and anxiety disorders and quality of life in primary care older adults. Health Qual Life Outcomes 2021; 19:218. [PMID: 34526029 PMCID: PMC8444434 DOI: 10.1186/s12955-021-01851-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/31/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Studies on the long-term outcomes of receiving adequate treatment for depression and anxiety disorders are scarce. The aims of this study were to assess the association between adequacy of care and remission of common mental disorders (CMD) and change in quality of life among a population of older adults consulting in primary care. METHODS The study was conducted among 225 older adults with a CMD who participated in the longitudinal ESA-Services study. Adequacy of care was assessed using administrative and self-reported data and was based on Canadian guidelines and relevant literature. CMD were measured at baseline and follow-up using self-reported measures (DSM-5 criteria) and physician diagnostic codes (International Classification of Diseases, 9th and 10th revisions) for depression and anxiety disorders. The remission of CMD was defined by the presence of at least one disorder at baseline and absence at follow-up. Quality of life was measured at baseline and follow-up using a visual analog scale and the Satisfaction With Life Scale. To estimate the probability to receive adequate/inadequate care, a propensity score was calculated, and analyses were weighted by the inverse probability. Weighted multivariable analyses were carried out to assess the remission of CMD and change in quality of life as a function of adequacy of care controlling for individual and health system factors. RESULTS Results showed that 40% of older adults received adequate care for CMD and 55% were in remission at follow-up. Adequacy of care was associated with remission of CMD (AOR: 0.66; CI 0.45-0.97; p-value: 0.032). Participants receiving adequate care had an improvement between baseline and follow-up of 0.7 (beta: 0.69, CI 0.18; 1.20, p = 0.008) point on the Satisfaction With Life Scale, while a marginal association was observed with improvement in HRQOL (beta: 2.83, CI 0.12; 5.79, p = 0.060). CONCLUSION The findings contribute to the rare observational studies on the association between adequacy of care for CMD and long-term treatment effects. Future studies on population effectiveness should focus on patient indicators of quality of care which may better predict long-term outcomes for patients with depression and anxiety.
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Affiliation(s)
- Catherine Lamoureux-Lamarche
- Faculty of Medicine and Health Sciences, Campus de Longueuil - Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada
| | - Djamal Berbiche
- Faculty of Medicine and Health Sciences, Campus de Longueuil - Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada
| | - Helen-Maria Vasiliadis
- Faculty of Medicine and Health Sciences, Campus de Longueuil - Université de Sherbrooke, 150 Place Charles-Le Moyne, Longueuil, QC, J4K 0A8, Canada. .,Centre de Recherche Charles-Le Moyne, 150 Place Charles Le Moyne, Longueuil, QC, J4K 0A8, Canada.
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3
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Moriana JA, Jurado-González FJ, García-Torres F, Contreras A, Muñoz-Navarro R, González-Blanch C, Medrano LA, Ruiz-Rodríguez P, Cano-Vindel A. Exploring the structure of the GAD-7 scale in primary care patients with emotional disorders: A network analysis approach. J Clin Psychol 2021; 78:283-297. [PMID: 34287885 DOI: 10.1002/jclp.23217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 06/22/2021] [Accepted: 06/28/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Anxiety symptoms are one of the most frequent manifestations in people attending primary care, although how the symptoms are associated is unclear. This study aimed to establish the symptom structure of the Generalized Anxiety Disorder scale (GAD-7) using a novel network approach in combination with traditional analytical tools. METHODS A sample of 1704 primary care patients with emotional disorders (i.e., anxiety, depression, and/or somatization) completed the GAD-7 to report their anxiety symptoms. We examined the GAD-7 structure using exploratory graph analysis (EGA) compared to exploratory factor analysis (EFA) and confirmatory factor analysis. RESULTS The EFA results showed a one-factor solution, but EGA revealed a two-factor solution (cognitive-emotional and somatic). "Worrying too much" and "difficulty relaxing" were the most relevant symptoms. CONCLUSIONS The results support the possible distinction between the somatic and cognitive-emotional components of the GAD-7, thus permitting more specific screening in primary care settings.
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Affiliation(s)
- Juan A Moriana
- Department of Psychology, Maimónides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Francisco J Jurado-González
- Department of Psychology, Maimónides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Francisco García-Torres
- Department of Psychology, Maimónides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Alba Contreras
- Department of Personality, Complutense University, Madrid, Spain
| | - Roger Muñoz-Navarro
- Department of Psychology and Sociology, University of Zaragoza, Teruel, Spain
| | - César González-Blanch
- Mental Health Centre, University Hospital Marques de Valdecilla-IDIVAL, Santander, Cantabria, Spain
| | | | - Paloma Ruiz-Rodríguez
- Castilla la Nueva Primary Care Centre, Health Service of Madrid, Fuenlabrada, Madrid, Spain
| | - Antonio Cano-Vindel
- Department of Experimental Psychology, Complutense University, Madrid, Spain
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Neurovegetative symptom subtypes in young people with major depressive disorder and their structural brain correlates. Transl Psychiatry 2020; 10:108. [PMID: 32312958 PMCID: PMC7170873 DOI: 10.1038/s41398-020-0787-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/17/2020] [Accepted: 02/26/2020] [Indexed: 01/29/2023] Open
Abstract
Depression is a leading cause of burden of disease among young people. Current treatments are not uniformly effective, in part due to the heterogeneous nature of major depressive disorder (MDD). Refining MDD into more homogeneous subtypes is an important step towards identifying underlying pathophysiological mechanisms and improving treatment of young people. In adults, symptom-based subtypes of depression identified using data-driven methods mainly differed in patterns of neurovegetative symptoms (sleep and appetite/weight). These subtypes have been associated with differential biological mechanisms, including immuno-metabolic markers, genetics and brain alterations (mainly in the ventral striatum, medial orbitofrontal cortex, insular cortex, anterior cingulate cortex amygdala and hippocampus). K-means clustering was applied to individual depressive symptoms from the Quick Inventory of Depressive Symptoms (QIDS) in 275 young people (15-25 years old) with MDD to identify symptom-based subtypes, and in 244 young people from an independent dataset (a subsample of the STAR*D dataset). Cortical surface area and thickness and subcortical volume were compared between the subtypes and 100 healthy controls using structural MRI. Three subtypes were identified in the discovery dataset and replicated in the independent dataset; severe depression with increased appetite, severe depression with decreased appetite and severe insomnia, and moderate depression. The severe increased appetite subtype showed lower surface area in the anterior insula compared to both healthy controls. Our findings in young people replicate the previously identified symptom-based depression subtypes in adults. The structural alterations of the anterior insular cortex add to the existing evidence of different pathophysiological mechanisms involved in this subtype.
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Rantanen AT, Korkeila JJA, Kautiainen H, Korhonen PE. Non-melancholic depressive symptoms increase risk for incident cardiovascular disease: A prospective study in a primary care population at risk for cardiovascular disease and type 2 diabetes. J Psychosom Res 2020; 129:109887. [PMID: 31837539 DOI: 10.1016/j.jpsychores.2019.109887] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess subtypes of depressive symptoms and their relationship with cardiovascular disease (CVD) morbidity among CVD risk persons. METHODS A prospective study of 2522 CVD risk persons was conducted. Non-melancholic and melancholic depressive symptoms were assessed by Beck's Depression Inventory. Data on incident CVD was gathered from a national register, after 8 years of follow-up. RESULTS At baseline, the prevalence of non-melancholic and melancholic depressive symptoms was 14.9% and 5.2%, respectively. A total of 18,413 person-years was followed up, and the incidence of CVD was 9.6% in non-depressive, 14.1% in non-melancholically depressive, and 13.0% in melancholically depressive subjects. When adjusted for age, gender, education, smoking, alcohol use, leisure-time physical activity, hypertension, and dyslipidemia, the incidence rate ratios (IRR) for CVD in subjects with non-melancholic and melancholic depressive symptoms compared to non-depressiveness were IRR 1.69 (95% CI: 1.23-2.31) and IRR 1.31 (95% CI: 0.75-2.26). CONCLUSION Non-melancholic depressive symptoms seem to increase risk for incident CVD among CVD risk subjects. Considering non-melancholic depressive symptoms might be useful when treating subjects with other CVD risk factors.
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Affiliation(s)
- Ansa Talvikki Rantanen
- Department of General Practice, University of Turku and Turku University Hospital, Turku, Finland; Salo Health Center, Salo, Finland.
| | - Jyrki Jaakko Antero Korkeila
- Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland; Department of Psychiatry, Hospital District of Satakunta, Pori, Finland
| | - Hannu Kautiainen
- Folkhälsan Research Center, Helsinki, Finland; Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
| | - Päivi Elina Korhonen
- Department of General Practice, University of Turku and Turku University Hospital, Turku, Finland; Central Satakunta Health Federation of Municipalities, Harjavalta, Finland
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Factors contributing to the recognition of anxiety and depression in general practice. BMC FAMILY PRACTICE 2018; 19:99. [PMID: 29935537 PMCID: PMC6015659 DOI: 10.1186/s12875-018-0784-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 05/31/2018] [Indexed: 11/24/2022]
Abstract
Background Adequate recognition of anxiety and depression by general practitioners (GPs) can be improved. Research on factors that are associated with recognition is limited and shows mixed results. The aim of this study was to explore which patient and GP characteristics are associated with recognition of anxiety and depression. Methods We performed a secondary analysis on data from 444 patients who were recruited for a randomized trial. Recognition of anxiety and depression was defined in terms of information in the medical records, in patients who screened positive on the extended Kessler 10 (EK-10). A total of 10 patient and GP characteristics, measured at baseline, were tested and included in a multilevel regression model to examine their impact on recognition. Results Patients who reported a perceived need for psychological care (OR = 2.54, 95% CI 1.60–4.03) and those with higher 4DSQ distress scores (OR = 1.03; 95% CI 1.00–1.07) were more likely to be recognized. In addition, patients’ anxiety or depression was less likely to be recognized when GPs were less confident in their abilities to identify depression (OR = 0.97; 95% CI 0.95–0.99). Patients’ age, chronic medical condition, somatisation, severity of anxiety and depression, and functional status were not associated with the recognition of anxiety and depression. Conclusions There is room for improvement of the recognition of anxiety and depression. Quality improvement activities that focus on increasing GPs’ confidence in the ability to identify symptoms of distress, anxiety and depression, as part of care according to guidelines, may improve recognition. Electronic supplementary material The online version of this article (10.1186/s12875-018-0784-8) contains supplementary material, which is available to authorized users.
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Manzanera R, Lahera G, Álvarez-Mon MÁ, Alvarez-Mon M. Maintained effect of a training program on attitudes towards depression in family physicians. Fam Pract 2018; 35:61-66. [PMID: 28985370 DOI: 10.1093/fampra/cmx071] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Family doctors' (FD) attitudes likely play an important role in the recognition and management of depression. OBJECTIVE The purpose of the study was to prospectively analyse the short-term and long-term impact of a specifically designed training program on attitudes towards depression among FDs. METHODS A prospective, educational intervention, single group pre- and post-test study with three assessments (pre, post, and 6-month follow-up) was conducted. Participants included 1322 certified FDs who had enrolled voluntarily in a structured postgraduate training in depression. This course was mainly practical and guided by case reports and real clinical experiences. The course was based on Patient's Unmet Needs and Doctors Educational Needs (PUNS & DENS) methodology. Primary outcome was assessed through the Depression Attitudes Questionnaire (DAQ). In total, 970 subjects completed the pre-post assessments, and 787 also completed the 6-month follow-up. RESULTS After training, FDs positively changed their attitudes towards the management of depression. A significant change was observed in 18 of 20 items of the DAQ. The distinction between unhappiness and depression was initially found to be difficult in 41% of FDs. After the course, the percentage was reduced to 27%. Agreement with the statement that 'psychotherapy is an exclusive practice of specialists' strikingly changed from 57% to 23%. Minimal differences were noted between the post-training assessment and the 6-month follow-up. CONCLUSIONS Attitudes towards depression in FDs can be modified by a structured training program, and this change is maintained over the long term. A short training in psychotherapy (cognitive-behavioural, problem-solving based and psycho-educative oriented) significantly increases the confidence of FDs in treating depression.
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Affiliation(s)
| | - Guillermo Lahera
- Department of Medicine and Medical Specialties, University of Alcalá, CIBERSAM, Madrid, Spain
| | | | - Melchor Alvarez-Mon
- Department of Medicine and Medical Specialties, University of Alcalá, Madrid, Spain
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8
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Nurmela K, Mattila A, Heikkinen V, Uitti J, Ylinen A, Virtanen P. Identification of major depressive disorder among the long-term unemployed. Soc Psychiatry Psychiatr Epidemiol 2018; 53:45-52. [PMID: 29124293 DOI: 10.1007/s00127-017-1457-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Depression is a common mental health disorder among the unemployed, but research on identifying their depression in health care is scarce. The present study aimed to explore the identification of major depressive disorder (MDD) in health care on long-term unemployed and find out if the duration of unemployment correlates with the risk for unidentified MDD. METHODS The study sample consisted the patient files of long-term unemployed people (duration of unemployment 1-35 years, median 11 years), who in a screening project diagnosed with MDD (n = 243). The MDD diagnosis was found in the health care records of 101. Binomial logistic regression models were used to explore the effect of the duration of unemployment, as a discrete variable, to the identification of MDD in health care. RESULTS MDD was appropriately identified in health care for 42% (n = 101) of the participants with MDD. The odds ratio for unidentified MDD in health care was 1.060 (95% confidence interval 1.011; 1.111, p = 0.016) per unemployment year. When unemployment had continued, for example, for five years the odds ratio for having unidentified MDD was 1.336. The association remained significant throughout adjustments for the set of background factors (gender, age, occupational status, marital status, homelessness, criminal record, suicide attempts, number of health care visits). CONCLUSIONS This study among depressed long-term unemployed people indicates that the longer the unemployment period has lasted, the more commonly these people suffer from unidentified MDD. Health services should be developed with respect to sensitivity to detect signs of depression among the long-term unemployed.
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Affiliation(s)
- Kirsti Nurmela
- Faculty of Social Sciences, University of Tampere, 33014, Tampere, Finland. .,Mental Health and Substance Abuse Services, Tampere, Finland.
| | - Aino Mattila
- Faculty of Social Sciences, University of Tampere, 33014, Tampere, Finland.,Department of Adult Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Virpi Heikkinen
- Faculty of Social Sciences, University of Tampere, 33014, Tampere, Finland.,Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Jukka Uitti
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Clinic of Occupational Medicine, Tampere University Hospital, Tampere, Finland.,Finnish Institute of Occupational Health, Tampere, Finland
| | - Aarne Ylinen
- Department of Neurological Sciences, University of Helsinki, Helsinki, Finland.,Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Pekka Virtanen
- Faculty of Social Sciences, University of Tampere, 33014, Tampere, Finland
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9
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Norton J, Engberink AO, Gandubert C, Ritchie K, Mann A, David M, Capdevielle D. Health Service Utilisation, Detection Rates by Family Practitioners, and Management of Patients with Common Mental Disorders in French Family Practice. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:521-530. [PMID: 28107037 PMCID: PMC5546665 DOI: 10.1177/0706743716686918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Provide up-to-date detection rates for common mental disorders (CMD) and examine patient service-use since the Preferred Doctor scheme was introduced to France in 2005, with patients encouraged to register with and consult a family practitioner (FP) of their choice. METHODS Study of 1133 consecutive patients consulting 38 FPs in the Montpellier region, replicating a study performed before the scheme. Patients in the waiting room completed the self-report Patient Health Questionnaire (PHQ) and Client Service-Receipt Inventory with questions on registration with a Preferred Doctor and doctor-shopping. CMD was defined as reaching PHQ criteria for depression, somatoform, panic or anxiety disorder. For each patient, FPs completed a questionnaire capturing psychiatric caseness. RESULTS 81.2% of patients were seeing their Preferred Doctor on the survey-day. Of those with a CMD, 52.6% were detected by the FP. This increased with CMD severity and comorbidity. Detected cases were more likely to be consulting their Preferred Doctor (84.7% versus 79.4% for non-detected cases, p = 0.05) rather than another FP. They declared more visits to psychiatrists (17.2% versus 6.7%, p = 0.002). There was no association with consultation frequency or doctor-shopping, which both declined between the two studies. CONCLUSION The CMD detection rate is relatively high, with no increase compared to our previous study, despite a decline in doctor-shopping. An explanation is the same high proportion of patients visiting their usual FP on the survey-day at both periods, suggesting a limited impact of the scheme on care continuity. FP action taken highlights the importance of improving detection for providing care to patients with CMDs.
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Affiliation(s)
- Joanna Norton
- 1 Inserm, U1061, University of Montpellier, Montpellier, France
| | | | | | - Karen Ritchie
- 1 Inserm, U1061, University of Montpellier, Montpellier, France.,3 Center for Clinical Brain Sciences, University of Edinburgh, UK
| | - Anthony Mann
- 4 Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Michel David
- 2 Department of General Practice, University of Montpellier, France
| | - Delphine Capdevielle
- 1 Inserm, U1061, University of Montpellier, Montpellier, France.,5 University Department of Adult Psychiatry, Montpellier University Hospital, Montpellier, France
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10
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Eisele M, Rakebrandt A, Boczor S, Kazek A, Pohontsch N, Okolo-Kulak M, Blozik E, Träder JM, Störk S, Herrmann-Lingen C, Scherer M. Factors associated with general practitioners' awareness of depression in primary care patients with heart failure: baseline-results from the observational RECODE-HF study. BMC FAMILY PRACTICE 2017; 18:71. [PMID: 28599626 PMCID: PMC5466751 DOI: 10.1186/s12875-017-0641-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/24/2017] [Indexed: 12/30/2022]
Abstract
Background Depression is more prevalent in patients with heart failure (HF) than in those without, but its detection is complicated by the symptom overlap between the two diseases. General practitioners (GPs) are the first point of contact for patients with HF. Therefore, this study aims to investigate GPs’ awareness of depression in their HF patients and factors associated with this awareness. Methods In this cross-sectional, observational study 3224 primary care patients with HF were screened for depressive symptomatology using an algorithm based on the Hospital Anxiety and Depression Scale, the 9-item subscale on Depression of the Patient Health Questionnaire, and selected items from the PROMIS Depression and Anxiety scales. The 272 GPs of all patients involved in the study were interviewed by telephone regarding their patients’ somatic and psychological comorbidities. The awareness rates of depressive symptomatology by the patients’ GPs are analyzed using descriptive statistics. Logistic regression analyses are applied to investigate the patient- and GP-based factors associated with the GPs’ awareness of depressive symptomatology. Results GPs were aware of their patients’ depressive symptomatology in 35% of all cases. Factors associated with the awareness of depressive symptomatology were: higher patient education levels, a history of depression known to the GP, GP-consultations due to emotional distress within the last 6 months, a higher frequency of GP-contacts within the last 6 months, a higher New York Heart Association (NYHA) classification and more severe depressive symptomatology. The GPs’ characteristics, including further education in psychology/psychiatry, were not associated with GP awareness. Conclusions Many aspects, including the definition of awareness and the practical issues in primary care, may contribute to the unexpectedly low awareness rates of depressive symptomatology in HF patients in primary care. Awareness rates might increase, if GPs encouraged their patients to talk about emotional distress, held detailed medical interviews including a patient’s history of depression and payed special attention to HF patients with low education levels. However, it remains to be investigated whether GPs’ judgement of depressive symptomatology is a better or worse indicator for the future prognosis and quality of life of HF patients than psychiatry based diagnostic criteria.
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Affiliation(s)
- Marion Eisele
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Anja Rakebrandt
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Sigrid Boczor
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Agata Kazek
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Nadine Pohontsch
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Magdalena Okolo-Kulak
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Eva Blozik
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jens-Martin Träder
- Department of Primary Medical Care, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Straubmühlweg 2a, 97078, Würzburg, Germany
| | - Christoph Herrmann-Lingen
- University of Göttingen Medical Center and German Center for Cardiovascular Research, partner site Göttingen, von-Siebold-Str. 5, D-37099, Göttingen, Germany
| | - Martin Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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11
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Volker D, Zijlstra-Vlasveld MC, Brouwers EPM, Homans WA, Emons WHM, van der Feltz-Cornelis CM. Validation of the Patient Health Questionnaire-9 for Major Depressive Disorder in the Occupational Health Setting. JOURNAL OF OCCUPATIONAL REHABILITATION 2016; 26:237-44. [PMID: 26377480 PMCID: PMC4854933 DOI: 10.1007/s10926-015-9607-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Purpose Because of the increased risk of long-term sickness leave for employees with a major depressive disorder (MDD), it is important for occupational health professionals to recognize depression in a timely manner. The Patient Health Questionnaire-9 (PHQ-9) has proven to be a reliable and valid instrument for screening MDD, but has not been validated in the occupational health setting. The aim of this study was to validate the PHQ-9 for MDD within a population of employees on sickness leave by using the MINI-International Neuropsychiatric Interview (MINI) as a gold standard. Methods Participants were recruited in collaboration with the occupational health service. The study sample consisted of 170 employees on sickness leave between 4 and 26 weeks who completed the PHQ-9 and were evaluated with the MINI by telephone. Sensitivity, specificity, positive and negative predictive value, efficiency and 95 % confidence intervals (95 % CIs) were calculated for all possible cut-off values. A receiver operator characteristics (ROC) analysis was computed for PHQ-9 score versus the MINI. Results The optimal cut-off value of the PHQ-9 was 10. This resulted in a sensitivity of 86.1 % [95 % CI (69.7-94.8)] and a specificity of 78.4 % [95 % CI (70.2-84.8)]. Based on the ROC analysis, the area under the curve for the PHQ-9 was 0.90 [SE = 0.02; 95 % CI (0.85-0.94)]. Conclusion The PHQ-9 shows good sensitivity and specificity as a screener for MDD within a population of employees on sickness leave.
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Affiliation(s)
- D Volker
- Trimbos-Institute, Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS, Utrecht, The Netherlands.
- Tranzo, Tilburg University, Tilburg, The Netherlands.
| | - M C Zijlstra-Vlasveld
- Trimbos-Institute, Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS, Utrecht, The Netherlands
| | | | | | - W H M Emons
- Department of Methodology and Statistics, Tilburg University, Tilburg, The Netherlands
| | - C M van der Feltz-Cornelis
- Tranzo, Tilburg University, Tilburg, The Netherlands
- Top Clinical Centre for Body, Mind and Health, GGZ Breburg, Tilburg, The Netherlands
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Use of general practice services 5 years after an episode of mental illness: case-control study using electronic records. Br J Gen Pract 2016; 66:e347-53. [PMID: 27080316 DOI: 10.3399/bjgp16x684973] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/25/2015] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Depression, anxiety, and emotional distress occur frequently and are usually treated in general practice. Little has been reported about the long-term course of these conditions and the long-term use of medical services. AIM To follow up patients with depression, anxiety, and emotional distress in general practice for 5 years and examine the length and number of index episodes, prescribing behaviour, and the use of services in general practice. DESIGN AND SETTING A case-control study using data from electronic medical records. METHOD Three cohorts of patients with depression (n = 453), anxiety (n = 442), and emotional distress (n = 185) were compared against a cohort of control patients (n = 4156) during a 5-year follow-up from 2007 to 2011. The occurrence or recurrence of the index disorders, other psychological disorders or medical conditions, the numbers of prescriptions, and the number of contacts with the general practice were all examined. RESULTS Patients in the depression group had 1.1 followup episodes of depression, those in the anxiety group had 0.9 follow-up episodes of anxiety, and those in the emotional distress group had 0.5 follow-up episodes of emotional distress during the 5 years. All three groups had more consultations (for both psychological and somatic reasons) during each of the follow-up years than control patients. Furthermore, the groups with mental health disorders were given more prescriptions for psychopharmacological treatment. CONCLUSION Five years after the index episode in 2007, patients with an episode of depression, anxiety, or emotional distress are still not comparable with control patients, in terms of the prevalence of mental health conditions, the number of prescriptions, and healthcare use.
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Yzermans J, Baliatsas C, van Dulmen S, Van Kamp I. Assessing non-specific symptoms in epidemiological studies: Development and validation of the Symptoms and Perceptions (SaP) questionnaire. Int J Hyg Environ Health 2016; 219:53-65. [DOI: 10.1016/j.ijheh.2015.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 08/27/2015] [Accepted: 08/27/2015] [Indexed: 01/24/2023]
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Psychiatric liaison consultations of patients without psychiatric illness in a general hospital in Germany: a retrospective analysis. Wien Med Wochenschr 2015; 165:436-44. [PMID: 26376981 DOI: 10.1007/s10354-015-0384-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 08/13/2015] [Indexed: 10/23/2022]
Abstract
The aim of the study was to explore the utilization of consultation-liaison psychiatric (CLP) service among nonpsychiatric patients in a general hospital. A retrospective analysis was conducted on all patients seen by the CLP in 2013. In 66 (5.9 %) of these 1112 consultations, no psychiatric diagnosis could be identified. These cases were analyzed by department of referral, assumed psychiatric symptoms, consensus with the symptoms found by the CLP, and recommended procedures. Assumed depressive symptoms, suicidal ideations and "difficult" behavior were the predominant reasons for CLP referrals. As the results suggest, CLP service was mostly "overprovided" because of uncertainty about the working areas of psychiatrists or overestimation of the severity of symptoms. These findings emphasize the importance to develop more precise guidelines for CLP services and that it could be worth striving for a more profound psychiatric training for nonpsychiatric physicians to achieve an optimal treatment for patients.
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Stoop CH, Nefs G, Pommer AM, Pop VJM, Pouwer F. Effectiveness of a stepped care intervention for anxiety and depression in people with diabetes, asthma or COPD in primary care: A randomized controlled trial. J Affect Disord 2015; 184:269-76. [PMID: 26118755 DOI: 10.1016/j.jad.2015.05.063] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 05/22/2015] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Depression and anxiety are common in people with a chronic somatic disease. Although guidelines recommend stepped care, the effectiveness of this approach has not been evaluated in people with diabetes, asthma, or COPD in primary care. METHODS 3559 People were sent screening questionnaires (41% response). Of 286 persons with anxiety and/or depression (Generalized Anxiety Disorder questionnaire, GAD-7, cut-off ≥ 8 and/or Patient Health Questionnaire, PHQ-9, cut-off ≥ 7), 46 were randomized into the intervention (stepped care and monitoring of symptoms; n = 23) or control (usual care) group (n = 23). Main outcomes were symptoms of anxiety and depression after the 12-months intervention and six months post intervention. Analysis of covariance was first adjusted for condition and baseline GAD-7/PHQ-9 scores and additionally for age, sex and education. RESULTS The intervention group had a significantly lower level of anxiety symptoms at the end of the program (GAD-7 6 ± 6 vs. 9 ± 6; Cohen's d = 0.61). This effect was still present six months post intervention. The effect on depression was statistically significant in the first model (PHQ-9 6 ± 4 vs. 9 ± 6; p = 0.035), but not in the fully adjusted model (p = 0.099), despite a large effect size (d = 0.63). At six months post intervention there was no statistically significant difference in symptoms of depression between the two groups although the difference in symptoms was still clinically significant (Cohen's d = 0.61). LIMITATIONS Many people were screened, but relatively few participated in the randomized controlled trial. CONCLUSIONS Stepped care with monitoring resulted in a lower level of symptoms of anxiety and depression in people with a chronic condition.
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Affiliation(s)
- C H Stoop
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - G Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - A M Pommer
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - V J M Pop
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - F Pouwer
- Department of Medical and Clinical Psychology, Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands.
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16
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Aakhus E, Granlund I, Oxman AD, Flottorp SA. Tailoring interventions to implement recommendations for the treatment of elderly patients with depression: a qualitative study. Int J Ment Health Syst 2015; 9:36. [PMID: 26366193 PMCID: PMC4567788 DOI: 10.1186/s13033-015-0027-5] [Citation(s) in RCA: 9] [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: 02/15/2015] [Accepted: 08/31/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To improve adherence to evidence-based recommendations, it is logical to identify determinants of practice and tailor interventions to address these. We have previously prioritised six recommendations to improve treatment of elderly patients with depression, and identified determinants of adherence to these recommendations. The aim of this article is to describe how we tailored interventions to address the determinants for the implementation of the recommendations. METHODS We drafted an intervention plan, based on the determinants we had identified in a previous study. We conducted six group interviews with representatives of health professionals (GPs and nurses), implementation researchers, quality improvement officers, professional and voluntary organisations and relatives of elderly patients with depression. We informed about the gap between evidence and practice for elderly patients with depression and presented the prioritised determinants that applied to each recommendation. Participants brainstormed individually and then in groups, suggesting interventions to address the determinants. We then presented evidence on the effectiveness of strategies for implementing depression guidelines. We asked the groups to prioritise the suggested interventions considering the perceived impact of determinants and of interventions, the research evidence underlying the interventions, feasibility and cost. We audiotaped and transcribed the interviews and applied a five step framework for our analysis. We created a logic model with links between the determinants, the interventions, and the targeted improvements in adherence. RESULTS Six groups with 29 individuals provided 379 suggestions for interventions. Most suggestions could be fit within the drafted plan, but the groups provided important amendments or additions. We sorted the interventions into six categories: resources for municipalities to develop a collaborative care plan, resources for health professionals, resources for patients and their relatives, outreach visits, educational and web-based tools. Some interventions addressed one determinant, while other interventions addressed several determinants. CONCLUSIONS It was feasible and helpful to use group interviews and combine open and structured approaches to identify interventions that addressed prioritised determinants to adherence to the recommendations. This approach generated a large number of suggested interventions. We had to prioritise to tailor the interventions strategies.
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Affiliation(s)
- Eivind Aakhus
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, 2312 Ottestad, Norway ; Norwegian Knowledge Centre for the Health Services, Box 7004 St Olavs plass, 0130 Oslo, Norway
| | - Ingeborg Granlund
- Norwegian Knowledge Centre for the Health Services, Box 7004 St Olavs plass, 0130 Oslo, Norway
| | - Andrew D Oxman
- Norwegian Knowledge Centre for the Health Services, Box 7004 St Olavs plass, 0130 Oslo, Norway
| | - Signe A Flottorp
- Norwegian Knowledge Centre for the Health Services, Box 7004 St Olavs plass, 0130 Oslo, Norway ; The Department of Health Management and Health Economics, University of Oslo, P.O Box 1089, Blindern, 0317 Oslo, Norway
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van den Bemt L, Luijks H, Bor H, Termeer E, Lucassen P, Schermer T. Are asthma patients at increased risk of clinical depression? A longitudinal cohort study. J Asthma 2015; 53:43-9. [PMID: 26313241 DOI: 10.3109/02770903.2015.1059852] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE In this study, we assessed whether adult patients with asthma are more likely to be diagnosed with depression than diabetes patients or "healthy" controls during follow-up in primary care. METHODS Data from the Nijmegen Continuous Morbidity Registration were used to assess the risk for a first depression. Patients with asthma were compared with patients with diabetes and with two healthy controls matched on age, gender, socioeconomic status and attending general practice. With Cox proportional hazard analysis, we compared the risk of depression between these groups. These analyses were corrected for relevant covariates including a time-depending variable for multimorbidity. Explorative subgroup analyses were done for age, gender, socioeconomic status and multimorbidity. RESULTS Cumulative incidence of depression in asthma patients was 5.2%, in DM patients 4.1% and in control subjects 3.3%. The hazard ratios for a first episode of depression in the asthma patients (n = 795) compared to DM patients (n = 1033) and control subjects after correction for covariates were 1.11 (95% CI 0.60-2.04) and 1.18 (95% CI 0.78-1.79), respectively. Exploratory analyses showed that asthma patients without multimorbidity were at higher risk for a depression compared to reference groups, while asthma patients with multimorbidity were at lower risk for depression. CONCLUSION Asthma patients were not more likely to be diagnosed with a first depression compared to "healthy" control subjects or diabetes patients. The influence of multimorbidity on depression risk in asthma patients warrants further study.
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Affiliation(s)
- Lisette van den Bemt
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Hilde Luijks
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Hans Bor
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Evelien Termeer
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Peter Lucassen
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Tjard Schermer
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
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Menear M, Doré I, Cloutier AM, Perrier L, Roberge P, Duhoux A, Houle J, Fournier L. The influence of comorbid chronic physical conditions on depression recognition in primary care: a systematic review. J Psychosom Res 2015; 78:304-13. [PMID: 25676334 DOI: 10.1016/j.jpsychores.2014.11.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 11/14/2014] [Accepted: 11/16/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE People with depression often suffer from comorbid chronic physical conditions and such conditions are widely believed to interfere with primary care providers' ability to recognize their depression. We aimed to examine the evidence related to the influence of chronic physical comorbidity burden on depression recognition in routine, community-based primary care settings. METHODS We conducted a systematic review of the literature on depression recognition in primary care that featured comparisons between patient groups with higher and lower burdens of chronic physical comorbidity. Medline, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials were searched from inception to July 2013. Reference list and reverse citation searches were also performed. A narrative synthesis was conducted given clinical and methodological heterogeneity between studies. RESULTS Our search identified 5817 unique citations, out of which we identified 13 studies reporting data on the relationship between chronic physical comorbidity burden and depression recognition in primary care. Four studies provided some evidence that higher chronic physical comorbidity burden negatively affected primary care providers' ability to recognize depression. In contrast, two studies reported higher rates of recognition in patients with higher comorbidity burden and seven studies reported no differences in recognition between comorbidity groups. CONCLUSION Chronic physical comorbidity burden does not consistently affect depression recognition negatively in primary care. Instead, recognition seems to vary depending on the specific conditions or combination of conditions examined. Methodological choices of authors, such as approaches to measuring recognition and chronic medical comorbidity, also likely explain some divergent results across studies.
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Affiliation(s)
- Matthew Menear
- School of Public Health, University of Montreal, Canada; CHUM Research Centre, Canada
| | - Isabelle Doré
- School of Public Health, University of Montreal, Canada; CHUM Research Centre, Canada
| | | | - Laure Perrier
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Canada
| | - Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Sherbrooke University, Canada
| | - Arnaud Duhoux
- School of Public Health, University of Montreal, Canada; Faculty of Nursing, University of Montreal, Canada
| | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, Canada
| | - Louise Fournier
- School of Public Health, University of Montreal, Canada; CHUM Research Centre, Canada.
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Sinnema H, Majo MC, Volker D, Hoogendoorn A, Terluin B, Wensing M, van Balkom A. Effectiveness of a tailored implementation programme to improve recognition, diagnosis and treatment of anxiety and depression in general practice: a cluster randomised controlled trial. Implement Sci 2015; 10:33. [PMID: 25884819 PMCID: PMC4360947 DOI: 10.1186/s13012-015-0210-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 01/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anxiety and depression are not always diagnosed and treated in primary care as has been recommended. A tailored implementation programme, which addresses key barriers for change by targeted interventions, may help to remedy this. METHODS The effectiveness of an individually tailored implementation programme, additional to standardised training and feedback on the recognition and treatment of patients with anxiety or depression in general practice, was examined in a cluster randomised controlled trial. Participants were 46 general practitioners (GPs) from 23 general practices (12 intervention, 11 control) and 444 patients aged 18 years or older (198 intervention, 246 control) who screened positive on the extended Kessler 10. In the control group, GPs received a 1-day training in guidelines for recognition and stepped treatment for anxiety and depression. Ten months after the training session, GPs received feedback on their performance over the preceding 6 months. In the intervention group, GPs received the same training and feedback as those in the control condition; in addition, they were offered support, tailored to perceived local barriers to change. The support was delivered in the format of peer group supervisions and personalised telephone consultations. Data were based on an audit of patient records and patient surveys at baseline and after 3 and 6 months. RESULTS The tailored implementation programme led to recognition of a higher proportion of patients presenting with anxiety and depression (42% versus 31%; odds ratio (OR) = 1.60; 95% CI: 1.01-2.53), more consultations after recognition (IRR = 1.78; 95% CI: 1.14-2.78) and did not lead to more prescription of antidepressants (OR = 1.07; 95% CI: 0.52-2.19) or referral to specialist mental health services (OR = 1.62; 95% CI: 0.72-3.64). Patients in the intervention group reported better accessibility of care (effect size (ES) = 0.4; p < 0.05) and provision of information and advice (ES = 0.5; p < 0.05). CONCLUSIONS A tailored implementation programme may enhance the recognition and treatment of patients with anxiety or depression. Further development and evaluation of the programme is warranted to determine its cost-effectiveness. TRAIL REGISTRATION Dutch Trial Register identifier NTR1912 .
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Affiliation(s)
- Henny Sinnema
- Netherlands Institute of Mental Health and Addiction, Trimbos Institute, 3500 AS, Utrecht, The Netherlands.
| | - Maria Cristina Majo
- Netherlands Institute of Mental Health and Addiction, Trimbos Institute, 3500 AS, Utrecht, The Netherlands.
| | - Daniëlle Volker
- Netherlands Institute of Mental Health and Addiction, Trimbos Institute, 3500 AS, Utrecht, The Netherlands.
| | - Adriaan Hoogendoorn
- Department of Psychiatry, VU University Medical Centre and GGZinGeest, 1081 HL, Amsterdam, The Netherlands.
| | - Berend Terluin
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, 1000 SN, Amsterdam, The Netherlands.
| | - Michel Wensing
- Radboud University Medical Centre, Scientific Institute for Quality, 6500 HB, Nijmegen, The Netherlands.
| | - Anton van Balkom
- Department of Psychiatry, VU University Medical Centre and GGZinGeest, 1081 HL, Amsterdam, The Netherlands.
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van Straten A, Hill J, Richards DA, Cuijpers P. Stepped care treatment delivery for depression: a systematic review and meta-analysis. Psychol Med 2015; 45:231-246. [PMID: 25065653 DOI: 10.1017/s0033291714000701] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In stepped care models patients typically start with a low-intensity evidence-based treatment. Progress is monitored systematically and those patients who do not respond adequately step up to a subsequent treatment of higher intensity. Despite the fact that many guidelines have endorsed this stepped care principle it is not clear if stepped care really delivers similar or better patient outcomes against lower costs compared with other systems. We performed a systematic review and meta-analysis of all randomized trials on stepped care for depression. METHOD We carried out a comprehensive literature search. Selection of studies, evaluation of study quality and extraction of data were performed independently by two authors. RESULTS A total of 14 studies were included and 10 were used in the meta-analyses (4580 patients). All studies used screening to identify possible patients and care as usual as a comparator. Study quality was relatively high. Stepped care had a moderate effect on depression (pooled 6-month between-group effect size Cohen's d was 0.34; 95% confidence interval 0.20-0.48). The stepped care interventions varied greatly in number and duration of treatment steps, treatments offered, professionals involved, and criteria to step up. CONCLUSIONS There is currently only limited evidence to suggest that stepped care should be the dominant model of treatment organization. Evidence on (cost-) effectiveness compared with high-intensity psychological therapy alone, as well as with matched care, is required.
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Affiliation(s)
- A van Straten
- Mood Disorders Centre,University of Exeter,Exeter,UK
| | - J Hill
- Mood Disorders Centre,University of Exeter,Exeter,UK
| | - D A Richards
- University of Exeter Medical School, University of Exeter,Exeter,UK
| | - P Cuijpers
- Department of Clinical Psychology,VU University,Amsterdam,The Netherlands
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Abstract
The diagnosis of dysthymic disorder was created in DSM-III and maintained in DSM-IV to describe a depressive syndrome of mild to moderate severity of at least two years' duration that did not meet criteria for major depressive disorder. The prevalence of dysthymic disorder is approximately 2% in the elderly population where subsyndromal depressions of lesser severity are more common. Dysthymic disorder was replaced in DSM-V by the diagnosis of "persistent depressive disorder" that includes chronic major depression and dysthymic disorder. In older adults, epidemiological and clinical evidence supports the use of the term "dysthymic disorder." In contrast to young adults with dysthymic disorder, older adults with dysthymic disorder commonly present with late age of onset, without major depression and other psychiatric disorders, and with a low rate of family history of mood disorders. They often have stressors such as loss of social support and bereavement, and some have cerebrovascular or neurodegenerative pathology. A minority has chronic depression dating from youth with psychiatric comorbidity similar to young adults with dysthymic disorder. In older adults, both dysthymic disorder and subsyndromal depression increase disability and lead to poor medical outcomes. Elderly patients with dysthymic disorder are seen mainly in primary care where identification and treatment are often inadequate. Treatment with antidepressant medication shows marginal superiority over placebo in controlled trials, and problem-solving therapy shows similar efficacy. Combined treatment and collaborative care models show slightly better results, but cost effectiveness is a concern. Further work is needed to clarify optimal approaches to the treatment of dysthymic disorder in elderly patients.
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Bet PM, Hugtenburg JG, Penninx BWJH, Balkom AV, Nolen WA, Hoogendijk WJG. Treatment inadequacy in primary and specialized care patients with depressive and/or anxiety disorders. Psychiatry Res 2013; 210:594-600. [PMID: 23850429 DOI: 10.1016/j.psychres.2013.06.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 06/10/2013] [Accepted: 06/12/2013] [Indexed: 11/18/2022]
Abstract
All guidelines on major depressive disorder (MDD) and anxiety disorders recommend pharmacotherapy and/or psychological treatment for moderate to severe disease. The aim of this cross-sectional study was to investigate treatment inadequacy, both pharmacological and psychological, in a large naturalistic cohort of subjects with MDD and anxiety disorders from the Netherlands Study of Depression and Anxiety. All subjects with a current 6-month diagnosis were included (n=1662). Demographic data, clinical features and actual medication use were assessed in face-to-face interviews. In moderate to severe MDD, 43% of the subjects were not treated sufficiently with antidepressants or psychological treatment. In primary health care patients, this undertreatment was 70%. In moderate to severe anxiety disorders, 44% of the subjects were not treated sufficiently with antidepressants, benzodiazepines or psychological treatment. Among antidepressant users with moderate to severe MDD, 21% of the pharmacotherapy was inadequate with respect to drug choice, dose and every day use. Undertreatment and pharmacotherapeutic inadequacy are common in moderate to severe MDD and anxiety disorders. Both are more pronounced in primary care than in specialized care. This may be partly due to differences in disease recognition and help seeking behaviour.
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Affiliation(s)
- Pierre M Bet
- Department of Clinical Pharmacology and Pharmacy, VU University Medical Centre, Amsterdam, The Netherlands; Neuroscience Campus Amsterdam, VU University, Amsterdam, The Netherlands.
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Moayedoddin B, Rubovszky G, Mammana L, Jeannot E, Sartori M, Garin N, Andreoli A, Canuto A, Perrier A. Prevalence and clinical characteristics of the DSM IV major depression among general internal medicine patients. Eur J Intern Med 2013; 24:763-6. [PMID: 23816277 DOI: 10.1016/j.ejim.2013.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 05/26/2013] [Accepted: 05/27/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the prevalence and clinical characteristics of the DSM IV major depressive disorder (MDD) among patients admitted to the General Internal Medicine Service of the Geneva University Hospital. METHOD 557 patients admitted to the IM of the Geneva University Hospital aged 18 to 70 were investigated. Each subject was assessed by a clinical psychologist using the SCID (Structured Clinical Interview Depression for DSM-IV) questionnaire. RESULTS 69 patients (12.4%) met diagnostic criteria for MDD (men: 8.8%, women: 16.9%, p=.004). Among subjects with major depression, depressed mood (97%), fatigue (91%), and diminished interest and pleasure (81%) were the most prevalent symptoms. Recurrent thoughts of death were present in 48% of depressed patients. CONCLUSIONS This study raises further evidence that an elevated proportion of patients admitted to an acute care general internal medicine facility meet DSM IV criteria for MDD with nearly half of depressed patients suffering from recurrent thoughts of death. It emphasizes the necessity of a targeted, continuous, and active support given by the psychiatry liaison service in the internal medicine setting.
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Affiliation(s)
- Babak Moayedoddin
- Liaison Psychiatry and Crisis Intervention Service, Department of Psychiatry, University Hospitals of Geneva (HUG), Hôpitaux Universitaires de Genève, Rue Gabrielle-Perret-Gentil 4, 1211 Genève 14, Switzerland.
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24
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Gerrits MMJG, van Marwijk HWJ, van Oppen P, van der Horst H, Penninx BWJH. The role of somatic health problems in the recognition of depressive and anxiety disorders by general practitioners. J Affect Disord 2013; 151:1025-32. [PMID: 24119920 DOI: 10.1016/j.jad.2013.08.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/07/2013] [Accepted: 08/29/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recognition of depression and anxiety by general practitioners (GPs) is suboptimal and there is uncertainty as to whether particular somatic health problems hinder or facilitate GP recognition. The objective of this study was to investigate the associations between somatic health problems and GP recognition of depression and anxiety. METHODS We studied primary care patients with a DSM-IV based psychiatric diagnosis of depressive or anxiety disorder during a face-to-face interview (n=778). GPs' registrations of depression and anxiety diagnoses, based on medical file extractions, were compared with the DSM-IV based psychiatric diagnoses as reference standard. Somatic health problems were based on self-report of several chronic somatic diseases and pain symptoms, using the Chronic Pain Grade (CPG), during the interview. RESULTS Depression and anxiety was recognized in sixty percent of the patients. None of the health problems were negatively associated with recognition. Greater severity of pain symptoms (OR=1.18, p=.02), and chest pain (OR=1.56, p=.02), in particular, were associated with more GP recognition of depression and anxiety. Mediation analyses showed that depression and anxiety in these patients were better recognized through the presence of more severe psychiatric symptoms. LIMITATIONS Some specific chronic diseases had low prevalence. CONCLUSIONS This study shows that the presence of particular chronic diseases does not influence GP recognition of depression and anxiety. GPs tend to recognize depression and anxiety better in patients with pain symptoms, partly due to more severe psychiatric symptoms among those with pain.
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Affiliation(s)
- Marloes M J G Gerrits
- Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center and Academic Outpatient Clinic for Affective Disorders, GGZ inGeest, Amsterdam, The Netherlands; Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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A Direct Method of Assessing Underlying Cognitive Risk for Adolescent Depression. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2013; 41:1279-88. [DOI: 10.1007/s10802-013-9760-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hinrichs S, Owens M, Dunn V, Goodyer I. General practitioner experience and perception of Child and Adolescent Mental Health Services (CAMHS) care pathways: a multimethod research study. BMJ Open 2012; 2:e001573. [PMID: 23148343 PMCID: PMC3533003 DOI: 10.1136/bmjopen-2012-001573] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 09/27/2012] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This is a pilot study with the objective of investigating general practitioner (GP) perceptions and experiences in the referral of mentally ill and behaviourally disturbed children and adolescents. DESIGN Quantitative analyses on patient databases were used to ascertain the source of referrals into Child and Adolescent Mental Health Services (CAMHS) and identify the relative contribution from GP practices. Qualitative semistructured interviews were then used to explore challenges faced by GPs in referring to CAMHS. SETTING GPs were chosen from the five localities that deliver CAMHS within the local Trust (Peterborough City, Fenland, Huntingdon, Cambridge City and South Cambridgeshire). PARTICIPANTS For the quantitative portion, data involving 19 466 separate referrals were used. Seven GPs took part in the qualitative interviews. RESULTS The likelihood of a referral from GPs being rejected by CAMHS was over three times higher compared to all other referral sources combined within the Cambridge and Peterborough NHS Foundation Trust. Interviews showed that detecting the signs and symptoms of mental illness in young people is a challenge for GPs. Communication with referral agencies varies and depends on individual relationships. GPs determine whether to refer on a mixture of the presenting conditions and their perceived likelihood of acceptance by CAMHS; the criteria for the latter were poorly understood by the interviewed GPs. CONCLUSIONS There are longstanding structural weaknesses in the services for children and young people in general, reflected in poor multiagency cooperation at the primary care level. GP-friendly guidelines and standards are required that will aid in decision-making and help with understanding the referrals process. We look to managers of both commissioning and providing organisations, as well as future research, to drive forward the development of tools, protocols, and health service structures to help aid the recognition and treatment of mental illness in young people.
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Affiliation(s)
- Saba Hinrichs
- Department of Engineering, Engineering Design Centre, University of Cambridge, Cambridge, UK
| | - Matthew Owens
- Department of Psychiatry, Developmental Psychiatry, University of Cambridge, Cambridge, UK
| | - Valerie Dunn
- Department of Psychiatry, Developmental Psychiatry, University of Cambridge, Cambridge, UK
| | - Ian Goodyer
- Department of Psychiatry, Developmental Psychiatry, University of Cambridge, Cambridge, UK
- Cambridge and Peterborough NHS Foundation Trust, Cambridge, UK
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