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Selinheimo S, Gluschkoff K, Kausto J, Turunen J, Koskinen A, Väänänen A. The association of sociodemographic characteristics with work disability trajectories during and following long-term psychotherapy: a longitudinal register study. Soc Psychiatry Psychiatr Epidemiol 2024; 59:621-630. [PMID: 37432409 PMCID: PMC10960900 DOI: 10.1007/s00127-023-02523-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/30/2023] [Indexed: 07/12/2023]
Abstract
PURPOSE This register-based study examined the trajectories of depression or anxiety disorder-related work disability during and following long-term psychotherapy and identified sociodemographic factors that indicate membership in different trajectory groups. METHODS Data were drawn from national registers (Statistics Finland, Social Insurance Institution of Finland). Participants included a random sample of Finnish working-age individuals (18-55 years) who started psychotherapy treatment between 2011 and 2014 and were followed for 5 years: 1 year before and 4 years after the onset of psychotherapy (N = 3 605 individuals; 18 025 person-observations across five time points). Group-based trajectory modeling was applied to assign individuals to work disability trajectories by the number of annual mental health-related work disability months. Multinomial logistic regression was used to examine the associations between trajectory group membership and baseline sociodemographic factors of age, gender, occupational status, and geographical area of residence. RESULTS Four mental health-related work disability trajectories were identified: stable very low (72%), decrease (11%), persistent low (9%) and persistent high (7%). Those with older age, female gender, lower occupational status, and living in sparsely populated geographical areas were more likely to belong to the most unfavorable trajectory group of persistent high work disability. The presence of multiple risk characteristics substantially increased the probability of belonging to the most adverse trajectory group. CONCLUSIONS Sociodemographic factors were associated with the course of mental health-related work disability in association with psychotherapy. Rehabilitative psychotherapy does not function as an equal support resource for work ability in all parts of the population.
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Affiliation(s)
- Sanna Selinheimo
- Finnish Institute of Occupational Health, Työterveyslaitos, PO Box 18, 00032, Helsinki, Finland.
| | - Kia Gluschkoff
- Finnish Institute of Occupational Health, Työterveyslaitos, PO Box 18, 00032, Helsinki, Finland
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Johanna Kausto
- Finnish Institute of Occupational Health, Työterveyslaitos, PO Box 18, 00032, Helsinki, Finland
| | - Jarno Turunen
- Finnish Institute of Occupational Health, Työterveyslaitos, PO Box 18, 00032, Helsinki, Finland
| | - Aki Koskinen
- Finnish Institute of Occupational Health, Työterveyslaitos, PO Box 18, 00032, Helsinki, Finland
| | - Ari Väänänen
- Finnish Institute of Occupational Health, Työterveyslaitos, PO Box 18, 00032, Helsinki, Finland
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Schaffler Y, Jesser A, Humer E, Haider K, Pieh C, Probst T, Schigl B. Process and outcome of outpatient psychotherapies under clinically representative conditions in Austria: protocol and feasibility of an ongoing study. Front Psychiatry 2024; 15:1264039. [PMID: 38510799 PMCID: PMC10951102 DOI: 10.3389/fpsyt.2024.1264039] [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: 07/20/2023] [Accepted: 02/16/2024] [Indexed: 03/22/2024] Open
Abstract
Background While most studies assessing psychotherapy efficacy are randomized-controlled trials conducted in research institutions or short clinical treatments, the understanding of psychotherapy effectiveness under regular, clinically representative conditions, particularly in outpatient practice, remains limited. Representative data examining the effectiveness of psychotherapy under real-world conditions in Austria is lacking. Aims and Methods This paper introduces a naturalistic observational combined process- and outcome study, implementing a dual-perspective approach through standardised pre- and post-treatment questionnaires and evaluating changes in the therapeutic alliance after each session. Further, semi-structured qualitative interviews aim to illuminate the personal experiences of patients and therapists. The primary objective of the presented study is to discern whether symptoms markedly decrease following therapy. A significant secondary goal is to trace the therapeutic alliance's evolution from both patient and therapist viewpoints, emphasising the alliance-outcome association and gender dynamics within the pairs. This paper discusses the project's feasibility after three years and shares key insights. Discussion Recruitment for this study has posed substantial challenges due to psychotherapists' concerns regarding data protection, extensive documentation, and philosophical reservations about the study design. Consequently, we recruited fewer participants than initially planned. Despite these hurdles, qualitative data collection has shown notable success. Given psychotherapists' busy schedules and reluctance to participate, more potent external incentives or a legal obligation may be necessary to encourage participation in future studies.
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Affiliation(s)
- Yvonne Schaffler
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, Krems, Austria
| | - Andrea Jesser
- Faculty of Psychotherapy Science, Sigmund Freud University Vienna, Vienna, Austria
| | - Elke Humer
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, Krems, Austria
- Faculty of Psychotherapy Science, Sigmund Freud University Vienna, Vienna, Austria
| | - Katja Haider
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, Krems, Austria
| | - Christoph Pieh
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, Krems, Austria
| | - Thomas Probst
- Division of Psychotherapy, Department of Psychology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Brigitte Schigl
- Department Psychology and Psychodynamics, Karl Landsteiner University of Health Sciences, Krems, Austria
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Barnett P, Oshinowo I, Cooper C, Taylor C, Smith S, Pilling S. The association between social class and the impact of treatment for mental health problems: a systematic review and narrative synthesis. Soc Psychiatry Psychiatr Epidemiol 2023; 58:581-603. [PMID: 36418643 PMCID: PMC10066076 DOI: 10.1007/s00127-022-02378-9] [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: 12/02/2021] [Accepted: 10/28/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This systematic review aimed to synthesise all quantitative literature on the association between social class and the effectiveness of interventions for mental health disorders. METHODS Systematic literature searches (inception-March 2021) were conducted across 7 databases, and all quantitative studies meeting inclusion criteria, examining the impact of social class on access to treatment, or intervention effectiveness, or the impact of treatment on social mobility, were synthesised narratively. RESULTS Evidence suggests that lower social class may be associated with reduced access to primary and secondary mental health care and increased likelihood of access via crisis services, and patients of lower social class may not benefit from all mental health interventions, with reduced effectiveness. While limited, there was some indication that psychosocial interventions could encourage increased employment rates. CONCLUSION Social class is associated with the effectiveness of psychological interventions, and should be considered when designing new interventions to prevent barriers to access and improve effectiveness.
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Affiliation(s)
- Phoebe Barnett
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB, UK.
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
| | - Iyinoluwa Oshinowo
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Christopher Cooper
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB, UK
| | - Clare Taylor
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
| | - Shubulade Smith
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Stephen Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, WC1E 7HB, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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Kausto J, Gluschkoff K, Turunen J, Selinheimo S, Peutere L, Väänänen A. Psychotherapy and change in mental health-related work disability: a prospective Finnish population-level register-based study with a quasi-experimental design. J Epidemiol Community Health 2022; 76:jech-2022-218941. [PMID: 36113989 PMCID: PMC9554072 DOI: 10.1136/jech-2022-218941] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/08/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mental disorders are a major cause of work disability among the working-age population. Psychotherapy has shown to be an effective treatment for mental disorders, but the evidence is mainly based on small-scale randomised trials with relatively short follow-ups. We used population-based register data to examine the association between statutory rehabilitative psychotherapy and change in depression or anxiety-related work disability. METHODS We drew a nationally representative sample of the working-age population (aged 18-55 in 2010). The study group comprised all those who started rehabilitative psychotherapy in 2011-2014. A total of 10 436 participants who were followed from 3 years prior to 4 years after the onset of rehabilitative psychotherapy. This resulted in 83 488 observations. The annual total number of mental health-related work disability months (0 to 12) was calculated from the total number of annual compensated sickness absence and disability pension days. A quasi-experimental interrupted time series analysis was applied. RESULTS The onset of rehabilitative psychotherapy marked a decline in work disability in comparison to the counterfactual trend. Specifically, a 20% decrease in the level (incidence rate ratio, IRR 0.80; 95% CI 0.76 to 0.85) and a 48% decrease in the slope (IRR 0.52; 95% CI 0.50 to 0.54) of work disability were detected in comparison to the counterfactual scenario. No significant gender differences were observed. The decline in work disability was the steepest in the oldest age group. CONCLUSIONS This study suggests that statutory psychotherapy may decrease work disability at the population level. However, further evidence of causal inference and the potential heterogeneity of the association is required.
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Affiliation(s)
- Johanna Kausto
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Kia Gluschkoff
- Finnish Institute of Occupational Health, Helsinki, Finland
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Jarno Turunen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | - Laura Peutere
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Ari Väänänen
- Finnish Institute of Occupational Health, Helsinki, Finland
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Abstract
In this chapter, I address the topic of tinnitus in the context of the patient's trajectory of care, with special attention to psychological comorbidities. Although most patients will cope with tinnitus and need no more than information and reassurance from professionals, a proportion of patients will need more supportive management. Assessment of psychological comorbidities is important to determine how urgent they should be seen in the clinic and their specific needs. The most frequent complaints are stress, depression, and anxiety. Although the direction of this relationship is still unclear (are comorbidities at the origin of tinnitus or are they a consequence of it), it is evident that the more serious comorbidities are at the onset of tinnitus, the worse the prognosis. Therefore, an assessment at the initial visit in the clinic is of utmost importance. There are valid and reliable psychometric tools to quickly draw a portrait of the psychological state of patients that can be used by audiologists, psychologists, or doctors. Therapeutic avenues can then be discussed with the patients to ensure them the best support possible.
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Supported self-help to prevent relapse or recurrence of depression: Who benefits most? J Affect Disord 2019; 257:180-186. [PMID: 31301621 DOI: 10.1016/j.jad.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND This study aimed to identify subgroups for whom supported self-help preventive cognitive therapy (S-PCT) is more (cost)effective than treatment as usual (TAU) in preventing relapse and recurrence of major depression. METHODS We conducted a randomized controlled trial in which 248 remitted, recurrently depressed participants were randomized to S-PCT (n = 124) or TAU (n = 124). Clinical outcome was relapse or recurrence of major depressive disorder (SCID-I). We tested the moderating effects on relapse or recurrence of age, gender, education level, residual depressive symptoms, number of previous episodes, age of onset, antidepressant medication, somatization, and self-efficacy with logistic regression analyses adjusted for baseline values of depressive symptoms. We examined moderating effects on costs using linear regression analyses adjusted for baseline costs. A stratified cost-effectiveness analysis was performed to tease out differences in cost-effectiveness between subgroups. RESULTS We found no moderating effect on relapse or recurrence for any of the potential moderators. For costs, the number of previous depressive episodes was identified as a moderator. At a willingness-to-pay of 16,000€, the probability that S-PCT was cost-effective compared to TAU was 95% for participants with 2-3 episodes and 11% for participants with ≥4 episodes. LIMITATIONS Participants and counselors were not blinded. The study was primarily designed to assess the (cost)effectiveness of S-PCT and not to conduct moderation analyses. CONCLUSIONS S-PCT was effective in preventing relapse or recurrence of depressive disorders in a broad range of participants, but is more likely to be cost-effective in participants with 2-3 episodes than ≥4 episodes. This indicates that S-PCT can best be offered to participants with fewer previous depressive episodes.
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Finegan M, Firth N, Wojnarowski C, Delgadillo J. Associations between socioeconomic status and psychological therapy outcomes: A systematic review and meta-analysis. Depress Anxiety 2018; 35:560-573. [PMID: 29697880 DOI: 10.1002/da.22765] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/16/2018] [Accepted: 03/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Socioeconomic deprivation is associated with higher prevalence of mental health problems; however, the influence of socioeconomic status (SES) on psychological therapy outcomes is as yet unclear. AIM To review published evidence on the association between indicators of SES (income, education, employment, neighborhood deprivation, social position) and the outcomes of psychological interventions for depression and anxiety. METHODS Systematic review and meta-analysis of outcomes research studies published in the last 10 years. RESULTS Seventeen studies including 165,574 patients measured at least one indicator of SES and its relationship with psychological therapy outcomes. Twelve of these studies found significant relationships between SES measures and mental health outcomes. Six studies focusing on employment status offered sufficient quantitative information to conduct meta-analysis. The overall effect of employment was not significant (-0.66, confidence of interval (CI) -1.33, 0.02). A sensitivity analysis (k = 5) showed a small effect (-0.22, CI -0.36, -0.09) of employment on treatment outcomes. CONCLUSIONS There is some evidence to indicate that socioeconomic deprivation is associated with poorer treatment outcomes, although limitations of the available data warrant treating this as a preliminary conclusion.
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Affiliation(s)
- Megan Finegan
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Nick Firth
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | | | - Jaime Delgadillo
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, United Kingdom
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Bastos AG, Guimarães LS, Trentini CM. Predictors of response in the treatment of moderate depression. ACTA ACUST UNITED AC 2016; 39:12-20. [PMID: 27901214 PMCID: PMC7112736 DOI: 10.1590/1516-4446-2016-1976] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/27/2016] [Indexed: 12/29/2022]
Abstract
Objective: To identify neurocognitive and sociodemographic variables that could be associated with clinical response to three modalities of treatment for depression, as well as variables that predicted superior response to one treatment over the others. Method: The present study derives from a research project in which depressed patients (n=272) received one of three treatments – long-term psychodynamic psychotherapy (n=90), fluoxetine therapy (n=91), or a combination thereof (n=91) – over a 24-month period. Results: Sociodemographic variables were not found to be predictive. Six predictive neurocognitive variables were identified: three prognostic variables related to working memory and abstract reasoning; one prescriptive variable related to working memory; and two variables found to be moderators. Conclusions: The results of this study indicate subgroups of patients who might benefit from specific therapeutic strategies and subgroups that seem to respond well to long-term psychodynamic psychotherapy and combined therapy. The moderators found suggest that abstract reasoning and processing speed may influence the magnitude and/or direction of clinical improvement.
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Affiliation(s)
- Andre G Bastos
- Programa de Pós-Graduação em Psicologia, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Luciano S Guimarães
- Unidade de Epidemiologia e Bioestatística, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
| | - Clarissa M Trentini
- Departamento de Psicologia, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Schneider RL, Arch JJ, Wolitzky-Taylor KB. The state of personalized treatment for anxiety disorders: A systematic review of treatment moderators. Clin Psychol Rev 2015; 38:39-54. [DOI: 10.1016/j.cpr.2015.02.004] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 02/11/2015] [Accepted: 02/13/2015] [Indexed: 11/26/2022]
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Nyklíček I, Schalken P, Meertens S. The role of emotional intelligence in symptom reduction after psychotherapy in a heterogeneous psychiatric sample. Compr Psychiatry 2015; 57:65-72. [PMID: 25511325 DOI: 10.1016/j.comppsych.2014.11.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 11/21/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Emotional intelligence of the patient has been claimed to potentially be an important factor in psychotherapy. Empirical studies are largely lacking. The purpose of this study was to examine if (i) pre-intervention emotional intelligence predicts outcome of psychotherapy and (ii) change in emotional intelligence during psychotherapy is associated with change in symptoms in a patient sample with heterogeneous psychiatric symptoms. METHODS Participants were 166 patients with different diagnoses who were hospitalized at the Center for Psychological Recovery. Before, after hospitalization and 6months after hospitalization they were asked to complete the BarOn-EQi for emotional intelligence and the Symptom Checklist-90. RESULTS Level of emotional intelligence at the start of hospitalization largely did not predict psychological symptoms at post-intervention or at 6month follow-up. However, an increase in the level of emotional intelligence over the course of the intervention was associated with lower levels of psychological symptoms, both immediately post-intervention and at 6-month follow-up. CONCLUSIONS The results suggest that while the pre-intervention level of emotional intelligence has no substantial effect on treatment outcome, an increase in emotional intelligence may have a positive effect on symptom decrease and on the preservation of treatment results.
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Affiliation(s)
- Ivan Nyklíček
- Center for Research in Psychology in Somatic Disease (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
| | - Pierre Schalken
- Center for Psychological Recovery, Berlicumseweg 8, 5248 NT Rosmalen, Netherlands
| | - Stephanie Meertens
- Center for Psychological Recovery, Berlicumseweg 8, 5248 NT Rosmalen, Netherlands
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