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He X, Ji J, Pei Z, Luo Z, Fang S, Liu X, Lei Y, Yan H, Guo L. Anxiety and depression status in patients with idiopathic pulmonary fibrosis and outcomes of nintedanib treatment: an observational study. Ann Med 2024; 56:2323097. [PMID: 38581666 PMCID: PMC11000612 DOI: 10.1080/07853890.2024.2323097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/21/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Anxiety and depression are common comorbidities in idiopathic pulmonary fibrosis (IPF) that impair health-related quality of life. However, there is a lack of studies focusing on the mental disorder of IPF after antifibrotic treatment and their related predictive factors. METHODS Patients with an initial diagnosis of IPF were enrolled. Data on demographics, lung function, Generalized Anxiety Disorder-7 (GAD-7) Scale, Patient Health Questionnaire 9 (PHQ-9), Patient Health Questionnaire-15 (PHQ-15), and St. George's Respiratory Questionnaire total score(SGRQ-T) were collected. Changes in anxiety, depression, somatic symptoms, and quality of life scores before and after nintedanib treatment were compared, and the related predictive factors were analyzed. RESULTS A total of 56 patients with a first diagnosis of IPF were enrolled, with 42 and 35 patients suffering from anxiety and depression, respectively. The GAD-7, PHQ-9, PHQ-15, and SGRQ scores were higher in the anxiety and depression groups. SGRQ total score (SGRQ-T) [OR = 1.075, 95%CI= (1.011, 1.142)] was an independent predictor of IPF combined with anxiety (p < 0.05); SGRQ-T [OR = 1.080, 95%CI= (1.001, 1.167)] was also an independent predictor of IPF combined with depression (p < 0.05). After treatment, GAD-7, PHQ-9, PHQ-15, and SGRQ scores decreased (p < 0.05). ΔSGRQ-T significantly affected ΔGAD-7 (β = 0.376, p = 0.009) and ΔPHQ-9 (β = 0.329, p = 0.022). CONCLUSION Anxiety and depression in IPF patients are closely related to somatic symptoms, pulmonary function, and quality of life. The SGRQ-T score is of great value for assessing anxiety and depression in patients with IPF. Short-term treatment with nintedanib antifibrotic therapy can alleviate anxiety and depression in IPF patients.
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Affiliation(s)
- Xing He
- Department of Pulmonary and Critical Care Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
- Department of Pulmonary and Critical Care Medicine, Cheng Du Qing Cheng Mt. Hospital, Chongzhou City, Chengdu, Sichuan Province, China
| | - Jiaqi Ji
- Department of Pulmonary and Critical Care Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Zongmin Pei
- Department of Psychosomatic Medicine, Chengdu Seventh People's Hospital (Affiliated Cancer Hospital of Chengdu Medical College), Chengdu, Sichuan Province, China
| | - Zeli Luo
- Department of Critical Care Medicine, Wenjiang District People's Hospital, Chengdu, Sichuan Province, China
| | - Siyu Fang
- Department of Pulmonary and Critical Care Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Xiaoqin Liu
- Department of Pulmonary and Critical Care Medicine, Cheng Du Qing Cheng Mt. Hospital, Chongzhou City, Chengdu, Sichuan Province, China
| | - Yan Lei
- Department of Pulmonary and Critical Care Medicine, Cheng Du Qing Cheng Mt. Hospital, Chongzhou City, Chengdu, Sichuan Province, China
| | - Haiying Yan
- Department of Pulmonary and Critical Care Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
- Department of Pulmonary and Critical Care Medicine, Cheng Du Qing Cheng Mt. Hospital, Chongzhou City, Chengdu, Sichuan Province, China
| | - Lu Guo
- Department of Pulmonary and Critical Care Medicine, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
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Pouwer F, Perrin B, Lavender A, Najafi B, Ismail K, Vileikyte L. The quest for wellness: How to optimise self-care strategies for diabetic foot management? Diabetes Metab Res Rev 2024; 40:e3751. [PMID: 38041482 DOI: 10.1002/dmrr.3751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 12/03/2023]
Abstract
Diabetic foot ulceration (DFU) is common and highly recurrent, negatively impacting the individuals' quality of life. The 2023 guidelines of the International Working Group on the Diabetic Foot emphasise that adherence to foot self-care recommendations is one of the most important factors in DFU prevention. These guidelines also briefly mention that depression and other psychosocial problems can hamper treatment and ulcer healing. Moreover, a new clinical question was added on psychological interventions for ulcer prevention, although the evidence regarding the role of psychological and social factors is still limited. To help the field progress, this narrative overview discusses how a stronger focus on psychological factors by both researchers and clinicians could improve the care for people at high DFU risk. The review starts with a testimony of a person living with DFU, explaining that for him, the absence of shared decision-making has been a key barrier to successful foot self-care implementation. Intervention studies that address patient-reported barriers are still scarce, and are therefore urgently needed. Furthermore, the key elements of psychological interventions found to be successful in managing diabetes are yet to be implemented in DFU risk management. Importantly, research evidence indicates that commonly advocated foot self-care recommendations may be insufficient in preventing DFU recurrence, whereas digital technology appears to effectively reduce recurrent DFU. More research is therefore needed to identify determinants of patient acceptance of digital technology.
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Affiliation(s)
- Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Steno Diabetes Center Odense (SDCO), Odense, Denmark
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Byron Perrin
- La Trobe Rural Health School, La Trobe University - Bendigo Campus, Bendigo, Victoria, Australia
| | | | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Khalida Ismail
- Department of Psychological Medicine, King's College London, Weston Education Centre, London, UK
| | - Loretta Vileikyte
- Diabetes Centre, Manchester Royal Infirmary, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, UK
- Department of Endocrinology and Dermatology, University of Miami, Miami, Florida, USA
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Wilson A, Carswell C, McKeaveney C, Atkinson K, Burton S, McVeigh C, Graham-Wisener L, Jääskeläinen E, Johnston W, O'Rourke D, Reid J, Rej S, Walsh I, Noble H. Examining the acceptability and feasibility of the Compassionate Mindful Resilience (CMR) programme in adults living with chronic kidney disease: the COSMIC study findings. BMC Nephrol 2024; 25:45. [PMID: 38297189 PMCID: PMC10832231 DOI: 10.1186/s12882-024-03473-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Individuals with chronic kidney disease experience difficult physical and psychological symptoms, that impact quality of life, and are at increased risk of anxiety and depression. Access to specialist psychological support is limited. This study aimed to support a new service development project, in collaboration with Kidney Care UK, to implement the Compassionate Mindful Resilience (CMR) programme, developed by MindfulnessUK, which provides accessible mindfulness techniques and practices to enhance compassion and resilience, and explore its feasibility for people living with stage 4 or 5 kidney disease and transplant. METHODS A multi-method feasibility design was utilised. Participants over 18 years, from the UK, with stage 4 or 5 kidney disease or post-transplant, and who were not currently undergoing psychotherapy, were recruited to the four-week CMR programme. Data was collected at baseline, post-intervention and three-months post to measure anxiety, depression, self-compassion, mental wellbeing, resilience, and mindfulness. The acceptability of the intervention for a kidney disease population was explored through qualitative interviews with participants, and the Mindfulness Teacher. RESULTS In total, 75 participants were recruited to the study, with 65 completing the CMR programme. The majority were female (66.2%) and post-transplant (63.1%). Analysis of completed outcome measures at baseline and post-intervention timepoints (n = 61), and three-months post intervention (n = 45) revealed significant improvements in participant's levels of anxiety (p < .001) and depression (p < .001), self-compassion (p = .005), mental wellbeing (p < .001), resilience (p.001), and mindfulness (p < .001). Thematic analysis of interviews with participants (n = 19) and Mindfulness Teacher (n = 1) generated three themes (and nine-subthemes); experiences of the CMR programme that facilitated subjective benefit, participants lived and shared experiences, and practicalities of programme participation. All participants interviewed reported that they found programme participation to be beneficial. CONCLUSION The findings suggest that the CMR programme has the potential to improve psychological outcomes among people with chronic kidney disease. Future randomized controlled trials are required to further test its effectiveness.
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Affiliation(s)
- Anna Wilson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
| | - Claire Carswell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
- Department of Health Sciences, University of York, York, UK
| | - Clare McKeaveney
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Stephanie Burton
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Clare McVeigh
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | | | - William Johnston
- Patient and Carer Education Partnership, School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Daniel O'Rourke
- Patient and Carer Education Partnership, School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Joanne Reid
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Soham Rej
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Ian Walsh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast Northern, Ireland
- Knightsbridge Healthcare Group, Belfast, UK
- Institute of Psychosexual Medicine, London, UK
| | - Helen Noble
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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Norweg A, Hofferber B, Maguire S, Oh C, Raveis VH, Simon NM. Breathing on the mind: Treating dyspnea and anxiety symptoms with biofeedback in chronic lung disease - A qualitative analysis. Respir Med 2024; 221:107505. [PMID: 38141864 PMCID: PMC10897906 DOI: 10.1016/j.rmed.2023.107505] [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: 09/23/2023] [Revised: 11/26/2023] [Accepted: 12/17/2023] [Indexed: 12/25/2023]
Abstract
RATIONALE Chronic obstructive pulmonary disease (COPD) is characterized by dysfunctional breathing patterns that contribute to impaired lung function and symptoms of dyspnea, anxiety, and abnormal carbon dioxide (CO2) levels. OBJECTIVE The study objective was to measure the acceptability of a new mind-body intervention we developed called Capnography-Assisted, Learned Monitored (CALM) Breathing, implemented before pulmonary rehabilitation. METHODS CALM Breathing is a 4-week (8-session) intervention designed to treat dyspnea and anxiety in adults with COPD by targeting dysfunctional breathing behaviors (guided by end-tidal CO2 levels). CALM Breathing consists of ten core breathing exercises, CO2 biofeedback, and motivational interviewing. Using qualitative methods and semi-structured interviews immediately post-intervention, we evaluated the acceptability and participation process of CALM Breathing. Themes were identified using constant comparative analysis. RESULTS Sixteen participants were interviewed after receiving CALM Breathing. Three main themes of CALM Breathing were identified: (1) Process of learning self-regulated breathing, (2) Mechanisms of a mind-body intervention, (3) Clinical and implementation outcomes. CONCLUSIONS Positive themes supported the acceptability of CALM Breathing and described participants' process of learning more self-regulated breathing to manage their dyspnea and anxiety. Positive signals from qualitative participant feedback provided support for CALM Breathing as an intervention for COPD, but larger scale efficacy trials are needed.
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Affiliation(s)
- Anna Norweg
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA.
| | - Brittany Hofferber
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Sophia Maguire
- Department of Rehabilitation and Regenerative Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Cheongeun Oh
- Department of Population Health (Biostatistics), New York University Grossman School of Medicine, New York, NY, USA
| | - Victoria H Raveis
- Department of Cariology and Comprehensive Care, College of Dentistry, New York University, New York, NY, USA
| | - Naomi M Simon
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
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Cherry MG, Brown SL, Purewal R, Fisher PL. Do metacognitive beliefs predict rumination and psychological distress independently of illness representations in adults with diabetes mellitus? A prospective mediation study. Br J Health Psychol 2023; 28:814-828. [PMID: 36859760 DOI: 10.1111/bjhp.12655] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/13/2022] [Accepted: 02/06/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVE Adults with Diabetes Mellitus (DM) experience high levels of depression and anxiety that are not always effectively ameliorated by current therapeutic approaches. The Self-Regulatory Executive Function (S-REF) model, which underpins metacognitive therapy (MCT), posits that depression and anxiety become persistent when stored metacognitive beliefs guide an individual to respond to common thoughts and feelings in a certain way. We hypothesized that (i) metacognitive beliefs would predict depression and anxiety independently of participants' representations of their illness; and (ii) rumination would mediate independent prediction of depression and anxiety by metacognitive beliefs. DESIGN A prospective mediation study. METHODS Four hundred and forty-one adults with DM (Types 1 and 2) completed a two time-point survey. Metacognitive beliefs, illness representations and rumination were measured at baseline, and depression and anxiety measured at baseline and 6-months later. Data were analysed using structural equation modelling. Baseline illness representations, depression and anxiety were used as control variables. RESULTS A structural equation analysis showed potential mediation, by baseline rumination, of any effects of baseline metacognitive variables on 6-month distress in Type 1 and 2 diabetes samples. Significant standardized coefficients for relationships between the metacognitive latent variable and rumination were .67 (Type 1) and .75 (Type 2) and between rumination and distress of .36 and .43, respectively. These effects were independent of direct and independent effects of illness representation variables. CONCLUSIONS Findings are consistent with metacognitive beliefs playing a key role in depression and anxiety by increasing the likelihood of rumination in adults with DM. MCT may be an effective intervention for this population, subsequent to further longitudinal testing of the S-REF model.
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Affiliation(s)
- Mary Gemma Cherry
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
- Clinical Health Psychology Service, Linda McCartney Centre, Liverpool University NHS Foundation Trust, Liverpool, UK
| | - Stephen L Brown
- School of Psychology, University of New England, Armidale, NSW, Australia
| | - Rebecca Purewal
- Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | - Peter L Fisher
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
- Clinical Health Psychology Service, Linda McCartney Centre, Liverpool University NHS Foundation Trust, Liverpool, UK
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Simões Cunha M, Amaral R, Pereira AM, Almeida R, Alves-Correia M, Loureiro CC, Lopes C, Carvalho J, Ribeiro C, Vidal C, Antolín-Amérigo D, Pinto D, Ferreira-Magalhães M, Vasconcelos MJ, Lozoya C, Santos N, Cardia F, Taborda-Barata L, Ferreira R, Morais Silva P, Ferreira TM, Câmara R, Silva E, Bordalo D, Guimarães C, Calix MJ, da Silva S, Marques ML, Morete A, Nunes C, Vieira C, Páscoa R, Alves A, Marques JV, Reis B, Monteiro L, Monteiro R, Cepa M, Valentim B, Coelho DS, Fernandes S, Meireles P, Aguiar MA, Mourão AR, Fonseca JA, Jácome C. Symptoms of anxiety and depression in patients with persistent asthma: a cross-sectional analysis of the INSPIRERS studies. BMJ Open 2023; 13:e068725. [PMID: 37147092 PMCID: PMC10163458 DOI: 10.1136/bmjopen-2022-068725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
OBJECTIVES Anxiety and depression are relevant comorbidities in asthma, but, in Portugal and Spain, data on this topic are scarce. We assessed, in patients with asthma, the frequency of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and the European Quality of Life Five Dimension Questionnaire (EQ-5D); the level of agreement between these questionnaires, and the factors associated with these symptoms. METHODS This is a secondary analysis of the INSPIRERS studies. A total of 614 adolescents and adults with persistent asthma (32.6±16.9 years, 64.7% female) were recruited from 30 primary care centres and 32 allergy, pulmonology and paediatric clinics. Demographic and clinical characteristics, HADS and EQ-5D were collected. A score ≥8 on Hospital Anxiety and Depression Scale-Anxiety/Hospital Anxiety and Depression Scale-Depression or a positive answer to EQ-5D item 5 indicated the presence of these symptoms. Agreement was determined by Cohen's kappa. Two multivariable logistic regressions were built. RESULTS According to HADS, 36% of the participants had symptoms of anxiety and 12% of depression. According to EQ-5D, 36% of the participants had anxiety/depression. The agreement between questionnaires in identifying anxiety/depression was moderate (k=0.55, 95% CI 0.48 to 0.62). Late asthma diagnosis, comorbidities and female gender were predictors of anxiety/depression, while better asthma control, health-related quality of life and perception of health were associated with lower odds for anxiety/depression. CONCLUSION At least 1/3 of the patients with persistent asthma experience symptoms of anxiety/depression, showing the relevance of screening these disorders in patients with asthma. EQ-5D and HADS questionnaires showed a moderate agreement in the identification of anxiety/depression symptoms. The identified associated factors need to be further investigated in long-term studies.
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Affiliation(s)
- Mafalda Simões Cunha
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rita Amaral
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiovascular and Respiratory Sciences, Porto Health School, Polytechnic Institute of Porto, Porto, Portugal
- Department of Women's and Children's Health, Paediatric Research, Uppsala University, Uppsala, Sweden
| | - Ana Margarida Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rute Almeida
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Magna Alves-Correia
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
| | - Cláudia Chaves Loureiro
- Pulmonology Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Cristina Lopes
- Basic and Clinic Immunology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Immuno-allergology, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Joana Carvalho
- Serviço de Pediatria, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Carmelita Ribeiro
- Serviço de Imunoalergologia, Hospital Universitário de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Carmen Vidal
- Servicio de Alergia, Complejo Hospitalario Universitario de Santiago, Santiago de Compostella, Spain
| | - Dario Antolín-Amérigo
- Servicio de Alergia, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Diana Pinto
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Manuel Ferreira-Magalhães
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- Serviço de Pediatria, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Maria João Vasconcelos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carlos Lozoya
- Allergy, Hospital Amato Lusitano, Unidade Local de Saúde de Castelo Branco, Castelo Branco, Portugal
| | - Natacha Santos
- Serviço de Imunoalergologia, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Francisca Cardia
- Unidade de Saúde Familiar Terras de Azurara, Agrupamento de Centros de Saúde Dão Lafões, Mangualde, Portugal
| | - Luís Taborda-Barata
- CICS-UBI Centro de Investigação em Ciências da Saúde - Health Sciences Research Centre & UBIAir - Clinical & Experimental Lung Centre, University of Beira Interior, Covilha, Portugal
- Department of Allergy & Clinical Immunology, Cova da Beira University Hospital Centre, Covilhã, Portugal
| | - Rosário Ferreira
- Departamento de Pediatria, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal
| | | | - Tania Monteiro Ferreira
- Unidade de Saúde Familiar Progresso e Saúde, Agrupamento de Centros de Saúde Baixo Mondego, Tocha, Portugal
| | - Raquel Câmara
- Serviço de Pneumologia, Hospital Nossa Senhora do Rosário, Centro Hospitalar Barreiro Montijo, Barreiro, Portugal
| | - Eurico Silva
- Unidade de Saúde Familiar João Semana, Agrupamento de Centros de Saúde de Baixo Vouga, Ovar, Portugal
| | - Diana Bordalo
- Serviço de Pediatria, Unidade Hospitalar de Famalicão, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, Portugal
| | - Cristina Guimarães
- Unidade de Cuidados de Saúde Personalizados Norte (Arnaldo Sampaio), Agrupamento de Centros de Saúde Pinhal Litoral, Monte Redondo, Portugal
| | - Maria José Calix
- Serviço de Pediatria, Hospital de São Teotónio, Centro Hospitalar Tondela Viseu, Viseu, Portugal
| | - Sofia da Silva
- Unidade de Saúde Familiar Cuidarte, Unidade Local de Saúde do Alto Minho, Portuzelo, Portugal
| | - Maria Luís Marques
- Serviço de Imunoalergologia, Hospital da Senhora da Oliveira, Guimarães, Guimaraes, Portugal
| | - Ana Morete
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
- Serviço de Imunoalergologia, Hospital Infante D Pedro, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Carlos Nunes
- Centro de Imunoalergologia do Algarve, Portimão, Portugal
| | - Cláudia Vieira
- Unidade de Saúde Familiar Corgo, Agrupamento de Centros de Saúde Douro I - Marão e Douro Norte, Vila Real, Portugal
| | - Rosália Páscoa
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto, Porto, Portugal
- Unidade de Saúde Familiar Homem do Leme, ACeS Porto Ocidental, Porto, Portugal
| | - Adelaide Alves
- Serviço de Pneumologia, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - José Varanda Marques
- Unidade de Saúde Familiar Viseu-Cidade, Agrupamento de Centros de Saúde do Dão Lafões, Viseu, Portugal
| | - Bruno Reis
- Unidade de Cuidados Saúde Personalizados Sicó, Agrupamento de Centros de Saúde Pinhal Litoral, Leiria, Portugal
| | - Luís Monteiro
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
- USF Esgueira +, ACES Baixo Vouga, Esgueira, Portugal
| | - Rosário Monteiro
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- Unidade de Saúde Familiar Homem do Leme, ACeS Porto Ocidental, Porto, Portugal
| | - Margarida Cepa
- Unidade de Saúde Familiar Marquês, ACES Pinhal Litoral, Pombal, Portugal
| | - Bruno Valentim
- Unidade de Saúde Familiar Condeixa, ACES Baixo Mondego, Condeixa-a-Nova, Portugal
| | - Daniela Sousa Coelho
- Unidade de Cuidados de Saúde Personalizados de Amarante, ACES Tâmega I - Baixo Tâmega, Amarante, Portugal
| | - Sara Fernandes
- Unidade de Saúde Familiar Bracara Augusta, ACES Cávado I, Braga, Portugal
| | - Patrícia Meireles
- Unidade de Saúde Familiar Almedina, ACES Douro II - Douro Sul, Lamego, Portugal
| | - Margarida Abreu Aguiar
- Unidade de Saúde Familiar Valongo, ACES Grande Porto III - Maia / Valongo, Valongo, Portugal
| | - Ana Rita Mourão
- Unidade de Saúde Familiar Canelas, ACES Grande Porto VIII - Espinho / Gaia, Vila Nova de Gaia, Portugal
| | - Joao A Fonseca
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
- MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal
| | - Cristina Jácome
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
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Geerlings AD, Janssen Daalen JM, Ypinga JHL, Bloem BR, Meinders MJ, Munneke M, Darweesh SKL. Case management interventions in chronic disease reduce anxiety and depressive symptoms: A systematic review and meta-analysis. PLoS One 2023; 18:e0282590. [PMID: 37058492 PMCID: PMC10104285 DOI: 10.1371/journal.pone.0282590] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/18/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND There is no systematic insight into the effect of case management on common complications of chronic diseases, including depressive symptoms and symptoms of anxiety. This is a significant knowledge gap, given that people with a chronic disease such as Parkinson Disease or Alzheimer's Disease have identified care coordination as one of their highest priorities. Furthermore, it remains unclear whether the putative beneficial effects of case management would vary by crucial patient characteristics, such as their age, gender, or disease characteristics. Such insights would shift from "one size fits all" healthcare resource allocation to personalized medicine. OBJECTIVE We systematically examined the effectiveness of case management interventions on two common complications associated PD and other chronic health conditions: Depressive symptoms and symptoms of anxiety. METHODS We identified studies published until November 2022 from PubMed and Embase databases using predefined inclusion criteria. For each study, data were extracted independently by two researchers. First, descriptive and qualitative analyses of all included studies were performed, followed by random-effects meta-analyses to assess the impact of case management interventions on anxiety and depressive symptoms. Second, meta-regression was performed to analyze potential modifying effects of demographic characteristics, disease characteristics and case management components. RESULTS 23 randomized controlled trials and four non-randomized studies reported data on the effect of case management on symptoms of anxiety (8 studies) or depressive symptoms (26 studies). Across meta-analyses, we observed a statistically significant effect of case management on reducing symptoms of anxiety (Standardized Mean Difference [SMD] = - 0.47; 95% confidence interval [CI]: -0.69, -0.32) and depressive symptoms (SMD = - 0.48; CI: -0.71, -0.25). We found large heterogeneity in effect estimates across studies, but this was not explained by patient population or intervention characteristics. CONCLUSIONS Among people with chronic health conditions, case management has beneficial effects on symptoms of depressive symptoms and symptoms of anxiety. Currently, research on case management interventions are rare. Future studies should assess the utility of case management for potentially preventative and common complications, focusing on the optimal content, frequency, and intensity of case management.
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Affiliation(s)
- Angelika D. Geerlings
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jules M. Janssen Daalen
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan H. L. Ypinga
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bastiaan R. Bloem
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marjan J. Meinders
- Scientific Center for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marten Munneke
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sirwan K. L. Darweesh
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
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Kim HK, Banik S, Husain MI, Tang V, Levitan R, Daskalakis ZJ, Kloiber S. Systematic review of structured care pathways in major depressive disorder and bipolar disorder. BMC Psychiatry 2023; 23:85. [PMID: 36732746 PMCID: PMC9893602 DOI: 10.1186/s12888-022-04379-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 11/08/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Structured care pathways (SCPs) consist of treatment algorithms that patients advance through with the goal of achieving remission or response. These SCPs facilitate the application of current evidence and adequate treatment, which potentially benefit patients with mood disorders. The aim of this systematic review was to provide an updated synthesis of SCPs for the treatment of depressive disorders and bipolar disorder (BD). METHOD PubMed, PsycINFO, and Embase were searched through June 2022 for peer-reviewed studies examining outcomes of SCPs. Eligibility criteria included being published in a peer-reviewed journal in the English language, reporting of intervention used in the SCP, and having quantitative outcomes. Studies Cochrane risk of bias tool was used to assess quality of RCTs. RESULTS Thirty-six studies including 15,032 patients were identified for qualitative synthesis. Six studies included patients with BD. The studies were highly heterogeneous in design, outcome measures, and algorithms. More than half of the studies reported superiority of SCPs over treatment as usual, suggesting that the standardized structure and consistent monitoring inherent in SCPs may be contributing to their effectiveness. We also found accumulating evidence supporting feasibility of SCPs in different settings, although dropout rates were generally higher in SCPs. The studies included were limited to being published in peer-reviewed journals in English language. The heterogeneity of studies did not allow quantitative evaluation. CONCLUSIONS The findings of our study suggest that SCPs are equally or more effective than treatment as usual in depression and BD. Further studies are required to ascertain their effectiveness, particularly for BD, and to identify factors that influence their feasibility and success.
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Affiliation(s)
- Helena Kyunghee Kim
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Suman Banik
- grid.440972.c0000 0004 0415 1244Yorkville University, Fredericton, NB Canada
| | - Muhammad Ishrat Husain
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, 100 Stokes Street, Toronto, ON M6H 1J4 Canada
| | - Victor Tang
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Robert Levitan
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, 100 Stokes Street, Toronto, ON M6H 1J4 Canada
| | - Zafiris J. Daskalakis
- grid.17063.330000 0001 2157 2938Department of Psychiatry, University of Toronto, Toronto, ON Canada ,grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, 100 Stokes Street, Toronto, ON M6H 1J4 Canada ,grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California San Diego, San Diego, USA
| | - Stefan Kloiber
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada. .,Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, 100 Stokes Street, Toronto, ON, M6H 1J4, Canada.
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Graziano S, Ullmann N, Rusciano R, Allegorico A, Boldrini F, Rosito L, Quittner AL, Cutrera R, Tabarini P. Comparison of mental health in individuals with primary ciliary dyskinesia, cystic fibrosis, and parent caregivers. Respir Med 2023; 207:107095. [PMID: 36572068 DOI: 10.1016/j.rmed.2022.107095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 12/06/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Individuals with chronic respiratory diseases and caregivers are at higher risk for depression and anxiety. Primary ciliary dyskinesia (PCD) and cystic fibrosis (CF) are both rare genetic diseases, characterized by recurrent respiratory infections. This study compared depression and anxiety in people with PCD (pwPCD) and CF (pwCF), and caregivers, using the screening tools recommended in the CF guidelines. METHODS Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) were administered to a PCD and CF sample. Given that PCD is extremely rare, they were matched on age and sex to pwCF at a 1:2 ratio. Similar procedures were performed with parents. RESULTS A total of 63 patients and 129 caregivers participated: 21 pwPCD and 42 pwCF (ages 12-34 years) plus 43 caregivers of pwPCD and 86 caregivers of pwCF. A high percentage of patients scored above the cut-off for depression (PCD: 33%; CF: 43%) and anxiety (PCD and CF both: 43%), mostly mild. Similarly, a high percentage of caregivers scored above the cut-off for depression (PCD: 42-54%; CF: 45-46%) and anxiety (PCD: 47-54%; CF: 39-56%). Suicidal ideation was endorsed by 9.5% of pwPCD, 20% of mothers and 10% of fathers and 5% of pwCF, 3% of mothers, but no fathers. CONCLUSION A large percentage of patients and caregivers reported elevated psychological distress and suicidal ideation. Addressing psychological symptoms is critical given they are associated with poor adherence, missed clinic visits, increased inflammation and worse quality of life. Mental health screening and treatment should be integrated into PCD care.
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Affiliation(s)
- Sonia Graziano
- Department of Neurological Sciences, Unit of Clinical Psychology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Nicola Ullmann
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Raffaela Rusciano
- Department of Neurological Sciences, Unit of Clinical Psychology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Annalisa Allegorico
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesca Boldrini
- Department of Neurological Sciences, Unit of Clinical Psychology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Lorenza Rosito
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Renato Cutrera
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paola Tabarini
- Department of Neurological Sciences, Unit of Clinical Psychology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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eHealth to Improve Psychological Functioning and Self-Management of People With Chronic Kidney Disease: A Randomized Controlled Trial. Psychosom Med 2023; 85:203-215. [PMID: 36662615 PMCID: PMC9924966 DOI: 10.1097/psy.0000000000001163] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Psychological distress is common among patients with chronic kidney disease and can interfere with disease self-management. We assessed the effectiveness of the personalized E-GOAL electronic health care pathway with screening and cognitive-behavioral therapy including self-management support, aimed to treat psychological distress and facilitate self-management among people with chronic kidney disease not on dialysis ( N = 121). METHODS Primary outcome of the open two-arm parallel randomized controlled trial in four Dutch hospitals was psychological distress at posttest directly after the intervention and at 3-month follow-up. Secondary outcomes were physical and mental health-related quality of life, self-efficacy, chronic disease self-management, and personalized outcomes, that is, perceived progress compared with the previous time point on functioning (e.g., mood or social functioning) and self-management (e.g., dietary or medication adherence) outcomes that were prioritized by each individual. RESULTS Linear mixed-effects analyses showed no significant time-by-group interaction effects for psychological distress, health-related quality of life, self-efficacy, and chronic condition self-management, whereas analyses of covariance showed significantly more perceived progress in the intervention group at posttest on personally prioritized areas of functioning ( b = 0.46, 95% confidence interval = 0.07-0.85) and self-management ( b = 0.55, 95% confidence interval = 0.16-0.95), with Cohen d values of 0.46 and 0.54 (medium effects), respectively. Effects on personalized outcomes were maintained at follow-up. CONCLUSIONS Compared with regular care only, the electronic health intervention did not reduce psychological distress, whereas personalized outcomes did improve significantly after intervention. Future studies could consider personalized outcomes that reflect individually relevant areas and treatment goals, matching person-tailored treatments. TRIAL REGISTRATION Registered at the Netherlands Trial Register with study number NTR7555 ( https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7555 ).
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Examining the Acceptability and Feasibility of the Compassionate Mindful Resilience (CMR) Programme in Adult Patients with Chronic Kidney Disease: The COSMIC Study Protocol. Healthcare (Basel) 2022; 10:healthcare10081387. [PMID: 35893209 PMCID: PMC9394402 DOI: 10.3390/healthcare10081387] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
Kidney disease is often progressive, and patients experience diminished health-related quality of life. In addition, the impact of the coronavirus (COVID-19) pandemic, and its associated restrictions, has brought many additional burdens. It is therefore essential that effective and affordable systems are explored to improve the psychological health of this group that can be delivered safely during the COVID-19 pandemic. The aim of this study is to support a new service development project in partnership with the UK’s leading patient support charity Kidney Care UK by implementing the four-session Compassionate Mindful Resilience (CMR) programme, developed by MindfulnessUK, and explore its effectiveness for patients with stage 4 or 5 chronic kidney disease or have received a kidney transplant. The study will utilise a quasi-experimental, pretest/posttest design to measure the effect of the CMR programme on anxiety, depression, self-compassion, the ability to be mindful, wellbeing, and resilience, using pre- and posttests, alongside a qualitative exploration to explore factors influencing the feasibility, acceptability, and suitability of the intervention, with patients (and the Mindfulness Teacher) and their commitment to practice. Outcomes from this study will include an evidence-based mindfulness and compassion programme for use with people with kidney disease, which is likely to have applicability across other chronic diseases.
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12
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Kappelin C, Carlsson AC, Wachtler C. Specific content for collaborative care: a systematic review of collaborative care interventions for patients with multimorbidity involving depression and/or anxiety in primary care. Fam Pract 2022; 39:725-734. [PMID: 34546354 PMCID: PMC9295603 DOI: 10.1093/fampra/cmab079] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In primary care (PC) many patients suffer from multimorbidity involving depression and/or anxiety. Collaborative care (CC) has shown promising results for patients with depression, anxiety, and multimorbidity involving depression. However, specific content in CC for patients with multimorbidity involving depression and/or anxiety is unknown. OBJECTIVE (i) To examine the effect of CC interventions in patients with multimorbidity involving depression and/or anxiety compared with usual care; (ii) to identify specific content of CC. METHODS We conducted a systematic literature review of randomized controlled trial studies evaluating CC models for adults with multimorbidity involving depression and/or anxiety in PC settings. PubMed, CINAHL, Web of Science, and PsycInfo were searched in December 2019. We conducted a qualitative synthesis using an existing framework and developed a new framework to map the content for each studied intervention. RESULTS We identified 1,447 studies. Twelve publications were included. Eleven had medium-to-high quality of CC for patients with multimorbidity involving depression. Specific content of CC in these studies is: A stepped care model, involving medication and psychotherapy delivered by a nurse or psychologist Care Manager (CM) focusing on problem-solving techniques; follow-up including monitoring of symptoms and function, and relapse prevention strategies; scheduled CM supervision. CONCLUSIONS Specific content for CC for patients with multimorbidity involving depression is identified from current research. Research gaps were found regarding CC for patients with multimorbidity and anxiety, depression and anxiety, and depression and/or anxiety and more than 2 diseases.
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Affiliation(s)
- Caroline Kappelin
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institute, Huddinge, Sweden
| | - Axel C Carlsson
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institute, Huddinge, Sweden.,Academic Primary Healthcare Centre, Stockholm, Sweden
| | - Caroline Wachtler
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institute, Huddinge, Sweden
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Cooley C, Park Y, Ajilore O, Leow A, Nyenhuis SM. Impact of interventions targeting anxiety and depression in adults with asthma. J Asthma 2022; 59:273-287. [PMID: 33176512 PMCID: PMC8221364 DOI: 10.1080/02770903.2020.1847927] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 06/01/2020] [Accepted: 07/08/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE High rates of anxiety and depression exist among asthma patient populations. This scoping review will examine the existing interventional therapies that address depression and anxiety symptoms in patients with asthma. DATA SOURCES PubMed, Cochrane, Psychinfo, CINAHL, Google Scholar and EMBASE databases were searched using the following search terms: 'anxiety asthma', 'panic disorder asthma' and 'depression asthma' with a randomized clinical trial filter and additional filters to exclude exclusion criteria. STUDY SELECTIONS Study selections included only randomized control trials with anxiety and/or depression and/or panic disorder outcomes as primary or secondary outcomes. Only full-text articles in the English language were included. RESULTS This search yielded interventions from pharmacologic (n = 3), psychological (n = 7), lifestyle medicine (n = 10) and complementary and alternative medicine (CAM; n = 1) using a range of outcomes from physiologic to psychologic. While the pharmacologic and CAM studies were inconclusive, psychologic and lifestyle interventions showed improvements in asthma (quality of life, symptoms, asthma attacks) and psychological (anxiety, panic fear, depression) outcomes. Variations in selection methods, outcome measures and diagnostic criteria hindered a direct comparison of the studies. Most studies had small sample sizes, high attrition rates and short study durations. CONCLUSION There is limited evidence on best approaches for managing co-morbid anxiety and/or depression in patients with asthma. Psychological and lifestyle medicine interventions are promising with improvements in both asthma and mental health outcomes. Well-designed randomized controlled studies with larger sample sizes, standardized outcomes and longer durations, are needed to better understand the role of depression and anxiety in adults with asthma.
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Affiliation(s)
- Caitlin Cooley
- University of Illinois at Chicago, Department of Medicine
- Co-Lead Authors
| | - Yaejin Park
- University of Illinois at Chicago, Department of Medicine
- Co-Lead Authors
| | | | - Alex Leow
- University of Illinois at Chicago, Department of Psychiatry
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Schrijver J, Lenferink A, Brusse-Keizer M, Zwerink M, van der Valk PD, van der Palen J, Effing TW. Self-management interventions for people with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2022; 1:CD002990. [PMID: 35001366 PMCID: PMC8743569 DOI: 10.1002/14651858.cd002990.pub4] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Self-management interventions help people with chronic obstructive pulmonary disease (COPD) to acquire and practise the skills they need to carry out disease-specific medical regimens, guide changes in health behaviour and provide emotional support to enable them to control their disease. Since the 2014 update of this review, several studies have been published. OBJECTIVES Primary objectives To evaluate the effectiveness of COPD self-management interventions compared to usual care in terms of health-related quality of life (HRQoL) and respiratory-related hospital admissions. To evaluate the safety of COPD self-management interventions compared to usual care in terms of respiratory-related mortality and all-cause mortality. Secondary objectives To evaluate the effectiveness of COPD self-management interventions compared to usual care in terms of other health outcomes and healthcare utilisation. To evaluate effective characteristics of COPD self-management interventions. SEARCH METHODS We searched the Cochrane Airways Trials Register, CENTRAL, MEDLINE, EMBASE, trials registries and the reference lists of included studies up until January 2020. SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster-randomised trials (CRTs) published since 1995. To be eligible for inclusion, self-management interventions had to include at least two intervention components and include an iterative process between participant and healthcare provider(s) in which goals were formulated and feedback was given on self-management actions by the participant. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, assessed trial quality and extracted data. We resolved disagreements by reaching consensus or by involving a third review author. We contacted study authors to obtain additional information and missing outcome data where possible. Primary outcomes were health-related quality of life (HRQoL), number of respiratory-related hospital admissions, respiratory-related mortality, and all-cause mortality. When appropriate, we pooled study results using random-effects modelling meta-analyses. MAIN RESULTS We included 27 studies involving 6008 participants with COPD. The follow-up time ranged from two-and-a-half to 24 months and the content of the interventions was diverse. Participants' mean age ranged from 57 to 74 years, and the proportion of male participants ranged from 33% to 98%. The post-bronchodilator forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio of participants ranged from 33.6% to 57.0%. The FEV1/FVC ratio is a measure used to diagnose COPD and to determine the severity of the disease. Studies were conducted on four different continents (Europe (n = 15), North America (n = 8), Asia (n = 1), and Oceania (n = 4); with one study conducted in both Europe and Oceania). Self-management interventions likely improve HRQoL, as measured by the St. George's Respiratory Questionnaire (SGRQ) total score (lower score represents better HRQoL) with a mean difference (MD) from usual care of -2.86 points (95% confidence interval (CI) -4.87 to -0.85; 14 studies, 2778 participants; low-quality evidence). The pooled MD of -2.86 did not reach the SGRQ minimal clinically important difference (MCID) of four points. Self-management intervention participants were also at a slightly lower risk for at least one respiratory-related hospital admission (odds ratio (OR) 0.75, 95% CI 0.57 to 0.98; 15 studies, 3263 participants; very low-quality evidence). The number needed to treat to prevent one respiratory-related hospital admission over a mean of 9.75 months' follow-up was 15 (95% CI 8 to 399) for participants with high baseline risk and 26 (95% CI 15 to 677) for participants with low baseline risk. No differences were observed in respiratory-related mortality (risk difference (RD) 0.01, 95% CI -0.02 to 0.04; 8 studies, 1572 participants ; low-quality evidence) and all-cause mortality (RD -0.01, 95% CI -0.03 to 0.01; 24 studies, 5719 participants; low-quality evidence). We graded the evidence to be of 'moderate' to 'very low' quality according to GRADE. All studies had a substantial risk of bias, because of lack of blinding of participants and personnel to the interventions, which is inherently impossible in a self-management intervention. In addition, risk of bias was noticeably increased because of insufficient information regarding a) non-protocol interventions, and b) analyses to estimate the effect of adhering to interventions. Consequently, the highest GRADE evidence score that could be obtained by studies was 'moderate'. AUTHORS' CONCLUSIONS Self-management interventions for people with COPD are associated with improvements in HRQoL, as measured with the SGRQ, and a lower probability of respiratory-related hospital admissions. No excess respiratory-related and all-cause mortality risks were observed, which strengthens the view that COPD self-management interventions are unlikely to cause harm. By using stricter inclusion criteria, we decreased heterogeneity in studies, but also reduced the number of included studies and therefore our capacity to conduct subgroup analyses. Data were therefore still insufficient to reach clear conclusions about effective (intervention) characteristics of COPD self-management interventions. As tailoring of COPD self-management interventions to individuals is desirable, heterogeneity is and will likely remain present in self-management interventions. For future studies, we would urge using only COPD self-management interventions that include iterative interactions between participants and healthcare professionals who are competent using behavioural change techniques (BCTs) to elicit participants' motivation, confidence and competence to positively adapt their health behaviour(s) and develop skills to better manage their disease. In addition, to inform further subgroup and meta-regression analyses and to provide stronger conclusions regarding effective COPD self-management interventions, there is a need for more homogeneity in outcome measures. More attention should be paid to behavioural outcome measures and to providing more detailed, uniform and transparently reported data on self-management intervention components and BCTs. Assessment of outcomes over the long term is also recommended to capture changes in people's behaviour. Finally, information regarding non-protocol interventions as well as analyses to estimate the effect of adhering to interventions should be included to increase the quality of evidence.
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Affiliation(s)
- Jade Schrijver
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands
- Section Cognition, Data and Education, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Anke Lenferink
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands
- Section Health Technology and Services Research, Faculty of Behavioural, Management and Social sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Marjolein Brusse-Keizer
- Section Health Technology and Services Research, Faculty of Behavioural, Management and Social sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
- Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Marlies Zwerink
- Value-Based Health Care, Medisch Spectrum Twente, Enschede, Netherlands
| | | | - Job van der Palen
- Section Cognition, Data and Education, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
- Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Tanja W Effing
- College of Medicine and Public Health, School of Medicine, Flinders University, Adelaide, Australia
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
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Verkleij M, Appelman I, Altenburg J, Twisk J, Quittner AL, Haarman E. Anxiety and depression in Dutch patients with primary ciliary dyskinesia and their caregivers: associations with health-related quality of life. ERJ Open Res 2021; 7:00274-2021. [PMID: 34708110 PMCID: PMC8542938 DOI: 10.1183/23120541.00274-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/02/2021] [Indexed: 11/12/2022] Open
Abstract
Background Primary ciliary dyskinesia (PCD) might be a risk factor for the development of anxiety and depression. This study investigated the associations between anxiety, depression and health-related quality of life (HRQoL) in individuals with PCD and their caregivers. Methods Children, adolescents and adults with PCD and their caregivers were invited to participate in a mental health screening programme. During regular yearly outpatient visits, measures of anxiety (GAD-7), depression (PHQ-9), HRQoL (QOL-PCD), lung function (forced expiratory volume in 1 s (FEV1)) and body mass index (BMI)) were collected and associations of anxiety, depression and HRQoL were estimated. Results A total of 103 individuals participated in the mental health screening programme. Elevated levels of anxiety (scores ≥10 on GAD-7) were found in 6% of adults (n=33), 14% of children (n=7), 6% of adolescents (n=17) and 20% of caregivers (n=46, 52% of mothers). Elevated depression levels (scores ≥10 on PHQ-9) were found in 18% of adults, 14% of children, 6% of adolescents and 11% of caregivers. Anxiety and depression were associated with scales on the QOL-PCD. Mothers reported higher anxiety scores than fathers (30% versus 9%, p=0.03). A strong negative relationship was found between depression in caregivers and physical functioning (QOL-PCD) of the child. Anxiety and depression were not significantly associated with anxiety/depression in their child. Conclusion This is the first study investigating anxiety and depression in individuals with PCD and their caregivers. Our results revealed elevated levels of anxiety and depression, which were associated with worse HRQoL. These results suggest the need for psychological support in PCD. Individuals with PCD and their caregivers are at risk of developing symptoms of anxiety and depression, which are associated with worse HRQoL. There is an urgent need for psychological care in PCD, especially in adults with PCD and caregivers.https://bit.ly/3rmbgc9
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Affiliation(s)
- Marieke Verkleij
- Dept of Pediatric Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Iris Appelman
- Dept of Pediatric Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Josje Altenburg
- Dept of Pulmonology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Jos Twisk
- Dept of Epidemiology and Data Science, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Eric Haarman
- Dept of Pediatric Pulmonology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Vranceanu AM, Bakhshaie J, Reichman M, Doorley J, Mace RA, Jacobs C, Harris M, Archer KR, Ring D, Elwy AR. Understanding barriers and facilitators to implementation of psychosocial care within orthopedic trauma centers: a qualitative study with multidisciplinary stakeholders from geographically diverse settings. Implement Sci Commun 2021; 2:102. [PMID: 34526133 PMCID: PMC8441236 DOI: 10.1186/s43058-021-00208-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/30/2021] [Indexed: 01/15/2023] Open
Abstract
Background Psychosocial factors are pivotal in recovery after acute orthopedic traumatic injuries. Addressing psychosocial factors is an important opportunity for preventing persistent pain and disability. We aim to identify barriers and facilitators to the implementation of psychosocial care within outpatient orthopedic trauma settings using the Consolidated Framework for Implementation Research (CFIR) and Proctor’s taxonomy of implementation outcomes, and to provide implementation strategies derived from qualitative data and supplemented by the Expert Recommendations for Implementing Change. Methods We conducted live video qualitative focus groups, exit interviews and individual interviews with stakeholders within 3 geographically diverse level 1 trauma settings (N = 79; 20 attendings, 28 residents, 10 nurses, 13 medical assistants, 5 physical therapists/social workers, and 3 fellows) at 3 trauma centers in Texas, Kentucky, and Massachusetts. We used directed and conventional content analyses to derive information on barriers, facilitators, and implementation strategies within 26 CFIR constructs nested within 3 relevant Proctor outcomes of acceptability, appropriateness, and feasibility. Results Stakeholders noted that implementing psychosocial care within their practice can be acceptable, appropriate, and feasible. Many perceived integrated psychosocial care as crucial for preventing persistent pain and reducing provider burden, noting they lack the time and specialized training to address patients’ psychosocial needs. Providers suggested strategies for integrating psychosocial care within orthopedic settings, including obtaining buy-in from leadership, providing concise and data-driven education to providers, bypassing stigma, and flexibly adapting to fast-paced clinics. Conclusions Results provide a blueprint for successful implementation of psychosocial care in orthopedic trauma settings, with important implications for prevention of persistent pain and disability. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00208-8.
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Affiliation(s)
- Ana-Maria Vranceanu
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 1st Floor, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Jafar Bakhshaie
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 1st Floor, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Mira Reichman
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 1st Floor, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - James Doorley
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 1st Floor, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Ryan A Mace
- Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 1st Floor, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Cale Jacobs
- Department of Orthopaedic Surgery & Sports Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Mitchel Harris
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Kristin R Archer
- Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - A Rani Elwy
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA.,Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
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Felix SN, Agondi RC, Aun MV, Olivo CR, de Almeida FM, Amorim TS, Cezario JC, Giavina-Bianchi P, Tiberio IDFLC, de Martins MDA, Romanholo BMS. Clinical, functional and inflammatory evaluation in asthmatic patients after a simple short-term educational program: a randomized trial. Sci Rep 2021; 11:18267. [PMID: 34521963 PMCID: PMC8440547 DOI: 10.1038/s41598-021-97846-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/10/2021] [Indexed: 02/08/2023] Open
Abstract
This study aimed to evaluate the clinical evolution, functional parameters and inflammatory activity of asthma in patients who submitted to an educational intervention. 58 adult patients over 18 years of age with partly controlled and uncontrolled asthma were randomized into an intervention group (IG) (N = 32) and a control group (CG) (N = 26) and evaluated for 12 weeks. The Asthma Control Test (ACT), Asthma Control Questionnaire (ACQ), Asthma Quality Life Questionnaire (AQLQ) and Beck Depression Inventory (BDI) questionnaires were applied. Spirometry, exhaled nitric oxide (NO), exhaled breath condensate (EBC) and induced sputum (IS), measurement of the peak flow and symptoms were performed. The IG patients received an educational activity for 30 min applied by a nurse. Statistical analysis: analysis of variance with repeated intragroup measures. IG presented a decreased number of eosinophils in IS and IL-17A in EBC, an increase in the percentage of FEV1 before and after bronchodilator and an improvement in quality of life compared to the CG. There was an improvement in depression levels and a decrease in IL-4 and IL-5 in the IS and in the EBC in both groups. Our results suggest that an educational intervention can bring benefits concerning the control of inflammation, lung function alterations, quality of life and levels of depression in asthmatic patients. Registration: ClinicalTrials.gov; NCT03655392.
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Affiliation(s)
- Soraia Nogueira Felix
- Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Sao Paulo, SP, Brazil.
| | - Rosana Câmara Agondi
- Serviço de Imunologia Clínica e Alergia, HCFMUSP, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Marcelo Vivolo Aun
- Serviço de Imunologia Clínica e Alergia, HCFMUSP, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Clarice Rosa Olivo
- Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Sao Paulo, SP, Brazil
- Universidade Cidade de Sao Paulo (UNICID), Sao Paulo, SP, Brazil
- Laboratório de Terapêutica Experimental (LIM-20), Faculdade de Medicina da USP (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Francine Maria de Almeida
- Laboratório de Terapêutica Experimental (LIM-20), Faculdade de Medicina da USP (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | | | - Pedro Giavina-Bianchi
- Serviço de Imunologia Clínica e Alergia, HCFMUSP, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | | | - Milton de Arruda de Martins
- Laboratório de Terapêutica Experimental (LIM-20), Faculdade de Medicina da USP (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Beatriz Mangueira Saraiva Romanholo
- Instituto de Assistência Médica Ao Servidor Público Estadual (IAMSPE), Sao Paulo, SP, Brazil.
- Universidade Cidade de Sao Paulo (UNICID), Sao Paulo, SP, Brazil.
- Laboratório de Terapêutica Experimental (LIM-20), Faculdade de Medicina da USP (FMUSP), Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
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18
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van Dijk SEM, Pols AD, Adriaanse MC, van Marwijk HWJ, van Tulder MW, Bosmans JE. Cost-effectiveness of a stepped care program to prevent depression among primary care patients with diabetes mellitus type 2 and/or coronary heart disease and subthreshold depression in comparison with usual care. BMC Psychiatry 2021; 21:402. [PMID: 34389017 PMCID: PMC8361858 DOI: 10.1186/s12888-021-03367-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patients with diabetes mellitus type 2 (DM2) and/or coronary heart disease (CHD) are at high risk to develop major depression. Preventing incident major depression may be an important tool in reducing the personal and societal burden of depression. The aim of the current study was to assess the cost-effectiveness of a stepped care program to prevent major depression (Step-Dep) in diabetes mellitus type 2 and/or coronary heart disease patients with subthreshold depression in comparison with usual care. METHODS An economic evaluation with 12 months follow-up was conducted alongside a pragmatic cluster-randomized controlled trial from a societal perspective. Participants received care as usual (n = 140) or Step-Dep (n = 96) which consisted of four sequential treatment steps: watchful waiting, guided self-help, problem solving treatment and referral to a general practitioner. Primary outcomes were quality-adjusted life years (QALYs) and cumulative incidence of major depression. Costs were measured every 3 months. Missing data was imputed using multiple imputation. Uncertainty around cost-effectiveness outcomes was estimated using bootstrapping and presented in cost-effectiveness planes and acceptability curves. RESULTS There were no significant differences in QALYs or depression incidence between treatment groups. Secondary care costs (mean difference €1644, 95% CI €344; €3370) and informal care costs (mean difference €1930, 95% CI €528; €4089) were significantly higher in the Step-Dep group than in the usual care group. The difference in total societal costs (€1001, 95% CI €-3975; €6409) was not statistically significant. The probability of the Step-Dep intervention being cost-effective was low, with a maximum of 0.41 at a ceiling ratio of €30,000 per QALY gained and 0.32 at a ceiling ratio of €0 per prevented case of major depression. CONCLUSIONS The Step-Dep intervention is not cost-effective compared to usual care in a population of patients with DM2/CHD and subthreshold depression. Therefore, widespread implementation cannot be recommended. TRIAL REGISTRATION The trial was registered in the Netherlands Trial Register ( NTR3715 ).
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Affiliation(s)
- S. E. M. van Dijk
- grid.16872.3a0000 0004 0435 165XDepartment of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
| | - A. D. Pols
- grid.16872.3a0000 0004 0435 165XDepartment of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands ,grid.16872.3a0000 0004 0435 165XDepartment of General Practice and Elderly Medicine and the Amsterdam Public Health research institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - M. C. Adriaanse
- grid.16872.3a0000 0004 0435 165XDepartment of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
| | - H. W. J. van Marwijk
- grid.16872.3a0000 0004 0435 165XDepartment of General Practice and Elderly Medicine and the Amsterdam Public Health research institute, VU University Medical Centre, Amsterdam, The Netherlands ,Department of Primary Care and Public Health Medicine, Brighton, UK ,Sussex Medical School, Brighton, UK
| | - M. W. van Tulder
- grid.16872.3a0000 0004 0435 165XDepartment of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
| | - J. E. Bosmans
- grid.16872.3a0000 0004 0435 165XDepartment of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, De Boelelaan 1085, 1081 HV Amsterdam, the Netherlands
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19
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Luckett T, Roberts M, Swami V, Smith T, Cho JG, Klimkeit E, Wheatley JR. Maintenance of non-pharmacological strategies 6 months after patients with chronic obstructive pulmonary disease (COPD) attend a breathlessness service: a qualitative study. BMJ Open 2021; 11:e050149. [PMID: 33986071 PMCID: PMC8126310 DOI: 10.1136/bmjopen-2021-050149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES This study aimed to explore the degree to which non-pharmacological strategies for chronic breathlessness are sustained 6 months after completing a breathlessness service in patients with chronic obstructive pulmonary disease (COPD), and patient perceptions regarding the need for ongoing support. DESIGN A qualitative approach was taken using semistructured telephone interviews. Thematic analysis used an integrative approach. SETTING The Westmead Breathlessness Service (WBS) trains patients with COPD to self-manage chronic breathlessness over an 8-week programme with multidisciplinary input and home visits. PARTICIPANTS Patients with moderate to very severe COPD who had completed the WBS programme 6 months earlier. RESULTS Thirty-two participants were interviewed. One or more breathlessness self-management strategies were sustained by most participants, including breathing techniques (n=22; 69%), the hand-held fan (n=17; 53%), planning/pacing and exercise (n=14 for each; 44%) and strategic use of a four-wheeled walker (n=8; 25%). However, almost a third of participants appeared to be struggling psychologically, including some who had refused psychological intervention. A 'chaos narrative' appeared to be prevalent, and many participants had poor recall of the programme. CONCLUSIONS Self-management strategies taught by breathlessness services to patients with moderate to very severe COPD have potential to be sustained 6 months later. However, psychological coping may be more challenging to maintain. Research is needed on ways to improve resilience to set-backs and uptake of psychological interventions, as well as to understand and address the implications of poor recall for self-management. TRIAL REGISTRATION NUMBER ACTRN12617000499381.
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Affiliation(s)
- Tim Luckett
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Mary Roberts
- Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, New South Wales, Australia
- The University of Sydney at Westmead Hospital, Westmead, NSW, Australia
| | - Vinita Swami
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Tracy Smith
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, New South Wales, Australia
- The University of Sydney at Westmead Hospital, Westmead, NSW, Australia
| | - Jin-Gun Cho
- Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, New South Wales, Australia
- The University of Sydney at Westmead Hospital, Westmead, NSW, Australia
| | - Ester Klimkeit
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - John R Wheatley
- Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, Westmead, New South Wales, Australia
- Department of Respiratory and Sleep Medicine, Westmead Hospital, Westmead, New South Wales, Australia
- The University of Sydney at Westmead Hospital, Westmead, NSW, Australia
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20
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Fletcher S, Spittal MJ, Chondros P, Palmer VJ, Chatterton ML, Densley K, Potiriadis M, Harris M, Bassilios B, Burgess P, Mihalopoulos C, Pirkis J, Gunn J. Clinical efficacy of a Decision Support Tool (Link-me) to guide intensity of mental health care in primary practice: a pragmatic stratified randomised controlled trial. Lancet Psychiatry 2021; 8:202-214. [PMID: 33571453 DOI: 10.1016/s2215-0366(20)30517-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The volume and heterogeneity of mental health problems that primary care patients present with is a substantial challenge for health systems, and both undertreatment and overtreatment are common. We developed Link-me, a patient-completed Decision Support Tool, to predict severity of depression or anxiety, identify priorities, and recommend interventions. In this study, we aimed to examine if Link-me reduces psychological distress among individuals predicted to have minimal/mild or severe symptoms of anxiety or depression. METHODS In this pragmatic stratified randomised controlled trial, adults aged 18-75 years reporting depressive or anxiety symptoms or use of mental health medication were recruited from 23 general practices in Australia. Participants completed the Decision Support Tool and were classified into three prognostic groups (minimal/mild, moderate, severe), and those in the minimal/mild and severe groups were eligible for inclusion. Participants were individually and randomly assigned (1:1) by a computer-generated allocation sequence to receive either prognosis-matched care (intervention group) or usual care plus attention control (control group). Participants were not blinded but intervention providers were only notified of those allocated to the intervention group. Outcome assessment was blinded. The primary outcome was the difference in the change in scores between the intervention and control group, and within prognostic groups, on the 10-item Kessler Psychological Distress Scale at 6 months post randomisation. The trial was registered on the Australian and New Zealand Clinical Trials Registry, ACTRN12617001333303. OUTCOMES Between Nov 21, 2017, and Oct 31, 2018, 24 616 patients were invited to complete the eligibility screening survey. 1671 of these patients were included and randomly assigned to either the intervention group (n=834) or the control group (n=837). Prognosis-matched care was associated with greater reductions in psychological distress than usual care plus attention control at 6 months (p=0·03), with a standardised mean difference (SMD) of -0·09 (95% CI -0·17 to -0·01). This reduction was also seen in the severe prognostic group (p=0·003), with a SMD of -0·26 (-0·43 to -0·09), but not in the minimal/mild group (p=0·73), with a SMD of 0·04 (-0·17 to 0·24). In the complier average causal effect analysis in the severe prognostic group, differences were larger among those who received some or all aspects of the intervention (SMD range -0·58 to -1·15). No serious adverse effects were recorded. INTERPRETATION Prognosis-based matching of interventions reduces psychological distress in patients with anxiety or depressive symptoms, particularly in those with severe symptoms, and is associated with better outcomes when patients access the recommended treatment. Optimisation of the Link-me approach and implementation into routine practice could help reduce the burden of disease associated with common mental health conditions such as anxiety and depression. FUNDING Australian Government Department of Health.
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Affiliation(s)
- Susan Fletcher
- Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia
| | - Matthew J Spittal
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Patty Chondros
- Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia
| | - Victoria J Palmer
- Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia
| | - Mary Lou Chatterton
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Konstancja Densley
- Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia
| | - Maria Potiriadis
- Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia
| | - Meredith Harris
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Bridget Bassilios
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Philip Burgess
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Cathrine Mihalopoulos
- School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Jane Pirkis
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jane Gunn
- Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia
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21
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van der Feltz‐Cornelis C, Allen SF, Holt RIG, Roberts R, Nouwen A, Sartorius N. Treatment for comorbid depressive disorder or subthreshold depression in diabetes mellitus: Systematic review and meta-analysis. Brain Behav 2021; 11:e01981. [PMID: 33274609 PMCID: PMC7882189 DOI: 10.1002/brb3.1981] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/02/2020] [Accepted: 11/16/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To provide an estimate of the effect of interventions on comorbid depressive disorder (MDD) or subthreshold depression in type 1 and type 2 diabetes. METHODS Systematic review and meta-analysis. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomized controlled trials evaluating the outcome of depression treatments in diabetes and comorbid MDD or subthreshold symptoms published before August 2019 compared to care as usual (CAU), placebo, waiting list (WL), or active comparator treatment as in a comparative effectiveness trial (CET). Primary outcomes were depressive symptom severity and glycemic control. Cohen's d is reported. RESULTS Forty-three randomized controlled trials (RCTs) were selected, and 32 RCTs comprising 3,543 patients were included in the meta-analysis. Our meta-analysis showed that, compared to CAU, placebo or WL, all interventions showed a significant effect on combined outcome 0,485 (95% CI 0.360; 0.609). All interventions showed a significant effect on depression. Pharmacological treatment, group therapy, psychotherapy, and collaborative care had a significant effect on glycemic control. High baseline depression score was associated with a greater reduction in HbA1 c and depressive outcome. High baseline HbA1 c was associated with a greater reduction in HbA1 c. CONCLUSION All treatments are effective for comorbid depression in type 1 diabetes and type 2 diabetes. Over the last decade, new interventions with large effect sizes have been introduced, such as group-based therapy, online treatment, and exercise. Although all interventions were effective for depression, not all treatments were effective for glycemic control. Effective interventions in comorbid depressive disorder may not be as effective in comorbid subthreshold depression. Baseline depression and HbA1 c scores modify the treatment effect. Based on the findings, we provide guidance for treatment depending on patient profile and desired outcome, and discuss possible avenues for further research.
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Affiliation(s)
| | - Sarah F. Allen
- Department of Health SciencesHull York Medical SchoolUniversity of YorkYorkUK
| | - Richard I. G. Holt
- Human Development and HealthFaculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Richard Roberts
- Department of Family Medicine & Community HealthUniversity of WisconsinMadisonWIUSA
| | - Arie Nouwen
- Department of PsychologyMiddlesex UniversityLondonUK
| | - Norman Sartorius
- Association for the Improvement of Mental Health ProgrammesGenevaSwitzerland
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22
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Fletcher S, Chondros P, Densley K, Murray E, Dowrick C, Coe A, Hegarty K, Davidson S, Wachtler C, Mihalopoulos C, Lee YY, Chatterton ML, Palmer VJ, Gunn J. Matching depression management to severity prognosis in primary care: results of the Target-D randomised controlled trial. Br J Gen Pract 2021; 71:e85-e94. [PMID: 33431380 PMCID: PMC7846356 DOI: 10.3399/bjgp.2020.0783] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/11/2020] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Mental health treatment rates are increasing, but the burden of disease has not reduced. Tools to support efficient resource distribution are required. AIM To investigate whether a person-centred e-health (Target-D) platform matching depression care to symptom severity prognosis can improve depressive symptoms relative to usual care. DESIGN AND SETTING Stratified individually randomised controlled trial in 14 general practices in Melbourne, Australia, from April 2016 to February 2019. In total, 1868 participants aged 18-65 years who had current depressive symptoms; internet access; no recent change to antidepressant; no current antipsychotic medication; and no current psychological therapy were randomised (1:1) via computer-generated allocation to intervention or usual care. METHOD The intervention was an e-health platform accessed in the GP waiting room, comprising symptom feedback, priority-setting, and prognosis-matched management options (online self-help, online guided psychological therapy, or nurse-led collaborative care). Management options were flexible, neither participants nor staff were blinded, and there were no substantive protocol deviations. The primary outcome was depressive symptom severity (9-item Patient Health Questionnaire [PHQ-9]) at 3 months. RESULTS In intention to treat analysis, estimated between- arm difference in mean PHQ-9 scores at 3 months was -0.88 (95% confidence interval [CI] = -1.45 to -0.31) favouring the intervention, and -0.59 at 12 months (95% CI = -1.18 to 0.01); standardised effect sizes of -0.16 (95% CI = -0.26 to -0.05) and -0.10 (95% CI = -0.21 to 0.002), respectively. No serious adverse events were reported. CONCLUSION Matching management to prognosis using a person-centred e-health platform improves depressive symptoms at 3 months compared to usual care and could feasibly be implemented at scale. Scope exists to enhance the uptake of management options.
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Affiliation(s)
- Susan Fletcher
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Patty Chondros
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Konstancja Densley
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Elizabeth Murray
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Australia; professor of eHealth and primary care, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Christopher Dowrick
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Australia; professor of primary medical care, Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Amy Coe
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Kelsey Hegarty
- Department of General Practice, Melbourne Medical School, University of Melbourne; director, Centre for Family Violence Prevention, The Royal Women's Hospital, Melbourne, Australia
| | - Sandra Davidson
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Caroline Wachtler
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Australia; family medicine resident, Department of General Practice and Primary Care, Karolinska Institutet, Solna, Sweden
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Yong Yi Lee
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong; honorary fellow, School of Public Health, University of Queensland, Brisbane; health economist, Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Mary Lou Chatterton
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Victoria J Palmer
- Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Jane Gunn
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne; chair of primary care research, Department of General Practice, Melbourne Medical School, University of Melbourne, Melbourne, Australia
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23
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Han W, Peng X, Qu D, Yang Y, Li K. Heavy shackles: The experience of symptom distress and coping behaviors of Chinese patients with chronic obstructive pulmonary disease. Nurs Health Sci 2020; 22:1177-1185. [PMID: 33118687 DOI: 10.1111/nhs.12790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/14/2020] [Accepted: 10/26/2020] [Indexed: 11/27/2022]
Abstract
People with chronic obstructive pulmonary disease exhibit various symptoms, some of which can negatively affect their daily lives. Thus, they may adopt coping behaviors to improve their condition. This qualitative descriptive study investigated symptom distress and coping behaviors among 19 Chinese patients with chronic obstructive pulmonary disease using individual, semi-structured, face-to-face interviews. We identified the following three themes for the patients' symptom distress: distressing symptoms, inescapable imprisonment, and no choice other than being a burden to the family. The various coping behaviors of the patients were categorized into the following three themes: struggle during the medical treatment process, careful maintenance of daily life, and coping with negative emotions. Although all patients experienced physical and psychological distress, they displayed a strong desire to improve their lives and health. By recognizing the patients' symptom distress and coping behaviors, tailored interventions could be developed to improve the quality of their lives.
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Affiliation(s)
- Wenwen Han
- School of Nursing, Jilin University, Changchun, China.,The First Hospital of Jilin University, Changchun, China
| | - Xin Peng
- School of Nursing, Jilin University, Changchun, China
| | - Danhua Qu
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China
| | - Yuhang Yang
- School of Nursing, Jilin University, Changchun, China.,The First Hospital of Jilin University, Changchun, China
| | - Kun Li
- School of Nursing, Jilin University, Changchun, China
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Nefs G, Hendrieckx C, Reddy P, Browne JL, Bot M, Dixon J, Kyrios M, Speight J, Pouwer F. Comorbid elevated symptoms of anxiety and depression in adults with type 1 or type 2 diabetes: Results from the International Diabetes MILES Study. J Diabetes Complications 2019; 33:523-529. [PMID: 31129003 DOI: 10.1016/j.jdiacomp.2019.04.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/05/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022]
Abstract
AIMS We examined: (a) the prevalence of comorbid elevated symptoms of anxiety/depression; (b) its demographic/clinical correlates; (c) associations with self-care behaviors, by diabetes type. METHODS Cross-sectional self-report data of 6590 adults with diabetes (42% type 1; 58% type 2) from the Australian and Dutch Diabetes MILES studies were used. Elevated symptoms of anxiety/depression were defined as GAD-7 ≥ 10/PHQ-9 ≥ 10. RESULTS In both diabetes types, comorbid elevated symptoms of anxiety/depression were present in 9% and symptoms of anxiety alone in 2%; symptoms of depression alone were present in 8% of adults with type 1 diabetes and 11% with type 2 diabetes. Shorter diabetes duration (type 1 only) was the only characteristic that distinguished those with comorbid elevated symptoms of anxiety/depression but not those with symptoms of anxiety/depression alone from the reference group (no/minimal symptoms of anxiety/depression). Those with comorbid elevated symptoms of anxiety/depression had increased odds of sub-optimal diabetes self-care behaviors compared with the reference group, with higher odds than those with symptoms of anxiety or depression alone. CONCLUSIONS Comorbid elevated symptoms of anxiety/depression affected one in ten respondents, who also had increased odds of suboptimal diabetes self-care. Those with shorter type 1 diabetes duration may be at increased risk.
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Affiliation(s)
- Giesje Nefs
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Medical Psychology, Nijmegen, the Netherlands; Tilburg University, Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg, the Netherlands; Diabeter, National treatment and research center for children, adolescents and young adults with type 1 diabetes, Rotterdam, the Netherlands.
| | - Christel Hendrieckx
- Deakin University, School of Psychology, Geelong, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Prasuna Reddy
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; University of Technology Sydney, Australia; Swinburne University of Technology, Hawthorn, Australia
| | | | - Mariska Bot
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health, Amsterdam, the Netherlands
| | - John Dixon
- Human Neurotransmitters, Baker Heart and Diabetes Institute, Melbourne, Australia; Primary Care Research, Monash University, Melbourne, Australia
| | - Michael Kyrios
- College of Education, Psychology and Social Work, Flinders University, Australia
| | - Jane Speight
- Deakin University, School of Psychology, Geelong, Australia; The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia; AHP Research, Hornchurch, United Kingdom; Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - François Pouwer
- Deakin University, School of Psychology, Geelong, Australia; Department of Psychology, University of Southern Denmark, Odense, Denmark; STENO Diabetes Center Odense
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Alhaboby ZA, Barnes J, Evans H, Short E. Cyber-Victimization of People With Chronic Conditions and Disabilities: A Systematic Review of Scope and Impact. TRAUMA, VIOLENCE & ABUSE 2019; 20:398-415. [PMID: 29333943 DOI: 10.1177/1524838017717743] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The victimization of individuals with chronic conditions or disabilities is prevalent with severe impact at psychological and physiological levels. With the increasing use of technology these experiences were further reshaped. This systematic review aimed at scoping the experiences of cyber-victimization of people living with chronic conditions or disabilities and examine the documented impact on them. Following a four-stage search strategy in several databases including MEDLINE, Embase, PsychINFO, CINAHL, Cochrane and snowballing of references, a total of 2,922 studies were scanned and 10 studies were eventually included. Quality assessment was done in two phases using tools specific to observational studies and cyber-victimization research. A narrative synthesis of reported results covered a total of 3,070 people. Sample size ranged between 42 and 823 participants, and the age range was 6-71 years with a majority of White ethnic backgrounds. Most studies (n=9) were cross sectional. The prevalence range of cyber-victimization was 2%-41.7% based on variable definitions, duration and methods. Targeted conditions included physical impairments, intellectual disabilities and specific chronic diseases. The most common documented impact was psychological/psychiatric, mainly depression followed by anxiety and distress. Somatic health complaints and self-harm were also reported. We concluded that people with chronic conditions and disabilities were consistently at higher risk of victimization with devastating health complications. Research gaps were identified such as the need to address more conditions and acknowledge differences between heterogeneous health conditions. Other recommendations include allowing flexibility and accountability to patients/victims in research design, education on victimization and health consequences, and improving primary care.
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Affiliation(s)
- Zhraa A Alhaboby
- 1 Institute for Health Research, University of Bedfordshire, Bedfordshire, United Kingdom
| | - James Barnes
- 2 National Centre for Cyberstalking Research, University of Bedfordshire, Bedfordshire, United Kingdom
| | - Hala Evans
- 1 Institute for Health Research, University of Bedfordshire, Bedfordshire, United Kingdom
| | - Emma Short
- 2 National Centre for Cyberstalking Research, University of Bedfordshire, Bedfordshire, United Kingdom
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Lin F, Yeh M, Lai Y, Lin K, Yu C, Chang J. Two‐month breathing‐based walking improves anxiety, depression, dyspnoea and quality of life in chronic obstructive pulmonary disease: A randomised controlled study. J Clin Nurs 2019; 28:3632-3640. [DOI: 10.1111/jocn.14960] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/03/2019] [Accepted: 05/03/2019] [Indexed: 01/27/2023]
Affiliation(s)
- Feng‐Lien Lin
- Department of Nursing National Taiwan University Hospital Taipei Taiwan, ROC
| | - Mei‐Ling Yeh
- Department of Nursing National Taipei University of Nursing and Health Sciences Taipei Taiwan, ROC
| | - Yeur‐Hur Lai
- School of Nursing National Taiwan University Taipei Taiwan, ROC
- Department of Nursing National Taiwan University Cancer Center Taipei Taiwan, ROC
| | - Kuan‐Chia Lin
- Institute of Hospital and Health Care Administration National Yang Ming University Taipei Taiwan, ROC
| | - Chong‐Jen Yu
- National Taiwan University Hospital Taipei Taiwan, ROC
- Department of Internal Medicine, College of Medicine National Taiwan University Taipei Taiwan, ROC
| | - Jung‐San Chang
- Department of Renal Care Kaohsiung Medical University Kaohsiung Taiwan, ROC
- Department of Internal Medicine Kaohsiung Medical University Hospital Kaohsiung Taiwan, ROC
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Casañas R, Martín Royo J, Fernandez-San-Martín MI, Raya Tena A, Mendioroz J, Sauch Valmaña G, Masa-Font R, Casajuana-Closas M, Fernandez Linares EM, Cols-Sagarra C, Gonzalez Tejón S, Foguet-Boreu Q, Martín Lopez LM. Effectiveness of a psychoeducation group intervention conducted by primary healthcare nurses in patients with depression and physical comorbidity: study protocol for a randomized, controlled trial. BMC Health Serv Res 2019; 19:427. [PMID: 31242892 PMCID: PMC6595681 DOI: 10.1186/s12913-019-4198-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depressive disorders are the third leading cause of consultation in primary care, mainly in patients with chronic physical illnesses. Studies have shown the effectiveness of group psychoeducation in reducing symptoms in depressive individuals. Our primary aim is to evaluate the effectiveness of an intervention based on a psychoeducational program, carried out by primary care nurses, to improve the remission/response rate of depression in patients with chronic physical illness. Secondarily, to assess the cost-effectiveness of the intervention, its impact on improving control of the physical pathology and quality of life, and intervention feasibility. METHODS/DESIGN A multicenter, randomized, clinical trial, with two groups and one-year follow-up evaluation. Economic evaluation study. SUBJECTS We will assess 504 patients (252 in each group) aged > 50 years assigned to 25 primary healthcare centers (PHC) from Catalonia (urban, semi-urban, and rural). Participants suffer from major depression (Beck depression inventory: BDI-II 13-28) and at least one of the following: type 2 diabetes mellitus, chronic obstructive pulmonary disease, asthma, and/or ischemic cardiopathy. Patients with moderate/severe suicide risk or severe mental disorders are excluded. Participants will be distributed randomly into the intervention group (IG) and control (CG). INTERVENTION The IG will participate in the psychoeducational intervention: 12 sessions of 90 min, once a week led by two Primary Care (PC) nurses. The sessions will consist of health education regarding chronic physical illness and depressive symptoms. MAIN MEASUREMENTS Clinical remission of depression and/or response to intervention (BDI-II). SECONDARY MEASUREMENTS Improvement in control of chronic diseases (blood test and physical parameters), drug compliance (Morinsky-Green test and number of containers returned), quality of life (EQ-5D), medical service utilization (appointments and hospital admissions due to complications), and feasibility of the intervention (satisfaction and compliance). Evaluations will be blinded, and conducted at baseline, post-intervention, and 12 months follow-up. DISCUSSION Results could be informative for efforts to prevent depression in patients with a chronic physical illness. TRIAL REGISTRATION NCT03243799 (registration date August 9, 2017).
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Affiliation(s)
- Rocío Casañas
- Research Department, Associació Centre Higiene Mental Les Corts, Barcelona, Spain. .,Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
| | - Jaume Martín Royo
- Centre d'Urgències d'Atenció Primària (CUAP) Casernes, Institut Català de la Salut, Barcelona, Spain.,Unitat de Suport a la Recerca Barcelona Ciutat, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Maria Isabel Fernandez-San-Martín
- Unitat de Suport a la Recerca Barcelona Ciutat, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Unitat Docent Multiprofesional Gerència Territorial Barcelona, Institut Català de la Salut, Barcelona, Spain
| | - Antonia Raya Tena
- Centre d'Atenció Primària Raval Nord, Institut Català de la Salut, Barcelona, Spain
| | - Jacobo Mendioroz
- Unitat de Suport a la Recerca Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Health Promotion in Rural Areas Research Group (PRoSaARu), Gerència Territorial de la Catalunya Central, Catalan Health Institute, Sant Fruitós de Bages, Barcelona, Spain
| | - Glòria Sauch Valmaña
- Unitat de Suport a la Recerca Catalunya Central, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Health Promotion in Rural Areas Research Group (PRoSaARu), Gerència Territorial de la Catalunya Central, Catalan Health Institute, Sant Fruitós de Bages, Barcelona, Spain
| | - Roser Masa-Font
- Centre d'Atenció Primària Besos, Institut Català de la Salut, Barcelona, Spain
| | - Marc Casajuana-Closas
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autónoma de Barcelona, Bellaterra, Cerdanyola del Valles, Spain
| | | | - Cèlia Cols-Sagarra
- Centre d'Atenció Primària Martorell Rural, Institut Català de la Salut, Barcelona, Martorell, Spain
| | | | - Quintí Foguet-Boreu
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Luis Miguel Martín Lopez
- Instituto de Neuropsiquiatria y Adicciones del Parc de Salut del Mar (INAD), Consorci Parc de Salut Mar, Barcelona, Spain.,Universitat Autónoma de Barcelona, Bellaterra, Cerdanyola del Valles, Spain
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Pollok J, van Agteren JEM, Esterman AJ, Carson‐Chahhoud KV. Psychological therapies for the treatment of depression in chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2019; 3:CD012347. [PMID: 30838649 PMCID: PMC6400788 DOI: 10.1002/14651858.cd012347.pub2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) has been recognised as a global health concern, and one of the leading causes of morbidity and mortality worldwide. Projections of the World Health Organization (WHO) indicate that prevalence rates of COPD continue to increase, and by 2030, it will become the world's third leading cause of death. Depression is a major comorbidity amongst patients with COPD, with an estimate prevalence of up to 80% in severe stages of COPD. Prevalence studies show that patients who have COPD are four times as likely to develop depression compared to those without COPD. Regrettably, they rarely receive appropriate treatment for COPD-related depression. Available findings from trials indicate that untreated depression is associated with worse compliance with medical treatment, poor quality of life, increased mortality rates, increased hospital admissions and readmissions, prolonged length of hospital stay, and subsequently, increased costs to the healthcare system. Given the burden and high prevalence of untreated depression, it is important to evaluate and update existing experimental evidence using rigorous methodology, and to identify effective psychological therapies for patients with COPD-related depression. OBJECTIVES To assess the effectiveness of psychological therapies for the treatment of depression in patients with chronic obstructive pulmonary disease. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2018, Issue 11), and Ovid MEDLINE, Embase and PsycINFO from June 2016 to 26 November 2018. Previously these databases were searched via the Cochrane Airways and Common Mental Disorders Groups' Specialised Trials Registers (all years to June 2016). We searched ClinicalTrials.gov, the ISRCTN registry, and the World Health Organization International Clinical Trials Registry Platform (ICTRP) to 26 November 2018 to identify unpublished or ongoing trials. Additionally, the grey literature databases and the reference lists of studies initially identified for full-text screening were also searched. SELECTION CRITERIA Eligible for inclusion were randomised controlled trials that compared the use of psychological therapies with either no intervention, education, or combined with a co-intervention and compared with the same co-intervention in a population of patients with COPD whose depressive symptoms were measured before or at baseline assessment. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the titles and abstracts identified by the search to determine which studies satisfied the inclusion criteria. We assessed two primary outcomes: depressive symptoms and adverse events; and the following secondary outcomes: quality of life, dyspnoea, forced expiratory volume in one second (FEV1), exercise tolerance, hospital length of stay or readmission rate, and cost-effectiveness. Potentially eligible full-text articles were also independently assessed by two review authors. A PRISMA flow diagram was prepared to demonstrate the decision process in detail. We used the Cochrane 'Risk of bias' evaluation tool to examine the risk of bias, and assessed the quality of evidence using the GRADE framework. All outcomes were continuous, therefore, we calculated the pooled standardised mean difference (SMD) or mean difference (MD) with a corresponding 95% confidence interval (CI). We used a random-effects model to calculate treatment effects. MAIN RESULTS The findings are based on 13 randomised controlled trials (RCTs), with a total of 1500 participants. In some of the included studies, the investigators did not recruit participants with clinically confirmed depression but applied screening criteria after randomisation. Hence, across the studies, baseline scores for depressive symptoms varied from no symptoms to severe depression. The severity of COPD across the studies was moderate to severe.Primary outcomesThere was a small effect showing the effectiveness of psychological therapies in improving depressive symptoms when compared to no intervention (SMD 0.19, 95% CI 0.05 to 0.33; P = 0.009; 6 studies, 764 participants), or to education (SMD 0.23, 95% CI 0.06 to 0.41; P = 0.010; 3 studies, 507 participants).Two studies compared psychological therapies plus a co-intervention versus the co-intervention alone (i.e. pulmonary rehabilitation (PR)). The results suggest that a psychological therapy combined with a PR programme can reduce depressive symptoms more than a PR programme alone (SMD 0.37, 95% CI -0.00 to 0.74; P = 0.05; 2 studies, 112 participants).We rated the quality of evidence as very low. Owing to the nature of psychological therapies, blinding of participants, personnel, and outcome assessment was a concern.None of the included studies measured adverse events.Secondary outcomesQuality of life was measured in four studies in the comparison with no intervention, and in three studies in the comparison with education. We found inconclusive results for improving quality of life. However, when we pooled data from two studies using the same measure, the result suggested that psychological therapy improved quality of life better than no intervention. One study measured hospital admission rates and cost-effectiveness and showed significant reductions in the intervention group compared to the education group. We rated the quality of evidence as very low for the secondary outcomes. AUTHORS' CONCLUSIONS The findings from this review indicate that psychological therapies (using a CBT-based approach) may be effective for treating COPD-related depression, but the evidence is limited. Depressive symptoms improved more in the intervention groups compared to: 1) no intervention (attention placebo or standard care), 2) educational interventions, and 3) a co-intervention (pulmonary rehabilitation). However, the effect sizes were small and quality of the evidence very low due to clinical heterogeneity and risk of bias. This means that more experimental studies with larger numbers of participants are needed, to confirm the potential beneficial effects of therapies with a CBT approach for COPD-related depression.New trials should also address the gap in knowledge related to limited data on adverse effects, and the secondary outcomes of quality of life, dyspnoea, forced expiratory volume in one second (FEV1), exercise tolerance, hospital length of stay and frequency of readmissions, and cost-effectiveness. Also, new research studies need to adhere to robust methodology to produce higher quality evidence.
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Affiliation(s)
- Justyna Pollok
- The University of AdelaideFaculty of Health and Medical SciencesNorth TerraceAdelaideSouth AustraliaAustralia5005
- The University of AdelaideAdelaideAustralia
| | - Joep EM van Agteren
- Flinders UniversityCollege of Medicine and Public HealthAdelaideAustralia
- South Australian Health and Medical Research InstituteWellbeing and Resilience CentreAdelaideAustralia
| | - Adrian J Esterman
- University of South AustraliaDivision of Health SciencesAdelaideAustralia
- James Cook UniversityAustralian Institute of Tropical Health and MedicineCairnsAustralia
| | - Kristin V Carson‐Chahhoud
- University of South AustraliaSchool of Health SciencesCity East Campus, Frome RoadAdelaideAustralia5001
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Candlish J, Teare MD, Cohen J, Bywater T. Statistical design and analysis in trials of proportionate interventions: a systematic review. Trials 2019; 20:151. [PMID: 30819224 PMCID: PMC6396459 DOI: 10.1186/s13063-019-3206-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 01/17/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In proportionate or adaptive interventions, the dose or intensity can be adjusted based on individual need at predefined decision stages during the delivery of the intervention. The development of such interventions may require an evaluation of the effectiveness of the individual stages in addition to the whole intervention. However, evaluating individual stages of an intervention has various challenges, particularly the statistical design and analysis. This review aimed to identify the use of trials of proportionate interventions and how they are being designed and analysed in current practice. METHODS We searched MEDLINE, Web of Science and PsycINFO for articles published between 2010 and 2015 inclusive. We considered trials of proportionate interventions in all fields of research. For each trial, its aims, design and analysis were extracted. The data synthesis was conducted using summary statistics and a narrative format. RESULTS Our review identified 44 proportionate intervention trials, comprising 28 trial results, 13 protocols and three secondary analyses. These were mostly described as stepped care (n=37) and mainly focussed on mental health research (n=30). The other studies were aimed at finding an optimal adaptive treatment strategy (n=7) in a variety of therapeutic areas. Further terminology used included adaptive intervention, staged intervention, sequentially multiple assignment trial or a two-phase design. The median number of decision stages in the interventions was two and only one study explicitly evaluated the effect of the individual stages. CONCLUSIONS Trials of proportionate staged interventions are being used predominantly within the mental health field. However, few studies consider the different stages of the interventions, either at the design or the analysis phase, and how they may interact with one another. There is a need for further guidance on the design, analyses and reporting across trials of proportionate interventions. TRIAL REGISTRATION Prospero, CRD42016033781. Registered on 2 February 2016.
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Affiliation(s)
- Jane Candlish
- ScHARR, University of Sheffield, 30 Regent Court, Sheffield, S1 4DA, UK.
| | - M Dawn Teare
- ScHARR, University of Sheffield, 30 Regent Court, Sheffield, S1 4DA, UK
| | - Judith Cohen
- ScHARR, University of Sheffield, 30 Regent Court, Sheffield, S1 4DA, UK
- Hull Health Trials Unit, University of Hull/Hull York Medical School, York, UK
| | - Tracey Bywater
- Department of Health Sciences, University of York, Area 2, Seebohm, Rowntree Building, York, Y010 5DD, UK
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30
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Arnold EM, Swendeman D, Harris D, Fournier J, Kozina L, Abdalian S, Rotheram MJ. The Stepped Care Intervention to Suppress Viral Load in Youth Living With HIV: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e10791. [PMID: 30810536 PMCID: PMC6414817 DOI: 10.2196/10791] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/30/2018] [Accepted: 12/13/2018] [Indexed: 12/16/2022] Open
Abstract
Background Among youth living with HIV (YLH) aged 12-24 years who have health care in the United States, only 30% to 40% are virally suppressed. YLH must achieve viral suppression in order to reduce the probability of infecting others as well as increasing the length and quality of their own life. Objective This randomized controlled trial aimed to evaluate the efficacy of an Enhanced Standard Care condition (n=110) compared to an Enhanced Stepped Care intervention condition (n=110) to increase viral suppression among YLH aged 12-24 years with established infection (not acutely infected). Methods YLH (N=220) who are not virally suppressed will be identified at homeless shelters, health clinics, and gay-identified community-based organizations in Los Angeles, CA, and New Orleans, LA. Informed consent will be obtained from all participants. YLH will be randomly assigned to one of two study conditions: Enhanced Standard Care, which includes standard clinical care plus an automated messaging and monitoring intervention (AMMI), or an Enhanced Stepped Care, which includes three levels of intervention (AMMI, Peer Support via social media plus AMMI, or Coaching plus Peer Support and AMMI). The primary outcome is viral suppression of HIV, and YLH will be assessed at 4-month intervals for 24 months. For the Enhanced Stepped Care intervention group, those who do not achieve viral suppression (via blood draw, viral load<200 copies/mL) at any 4-month assessment will “step up” to the next level of intervention. Secondary outcomes will be retention in care, antiretroviral therapy adherence, alcohol use, substance use, sexual behavior, and mental health symptoms. Results Recruitment for this study began in June 2017 and is ongoing. We estimate data collection to be completed by the end of 2020. Conclusions This is the first known application of an Enhanced Stepped Care intervention model for YLH. By providing the lowest level of intervention needed to achieve viral suppression, this model has the potential to be a cost-effective method of helping YLH achieve viral suppression and improve their quality of life. Trial Registration ClinicalTrials.gov NCT03109431; https://clinicaltrials.gov/ct2/show/NCT03109431 International Registered Report Identifier (IRRID) DERR1-10.2196/10791
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Affiliation(s)
- Elizabeth Mayfield Arnold
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Dallas Swendeman
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Danielle Harris
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jasmine Fournier
- Section of Adolescent Medicine, Department of Pediatrics, Tulane University, New Orleans, LA, United States
| | - Leslie Kozina
- Section of Adolescent Medicine, Department of Pediatrics, Tulane University, New Orleans, LA, United States
| | - Susan Abdalian
- Section of Adolescent Medicine, Department of Pediatrics, Tulane University, New Orleans, LA, United States
| | - Mary Jane Rotheram
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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Maehder K, Löwe B, Härter M, Heddaeus D, Scherer M, Weigel A. Management of comorbid mental and somatic disorders in stepped care approaches in primary care: a systematic review. Fam Pract 2019; 36:38-52. [PMID: 30535053 DOI: 10.1093/fampra/cmy122] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Stepped care models comprise a graded treatment intensity and a systematic monitoring. For an effective implementation, stepped care models have to account for the high rates of mental and somatic comorbidity in primary care. OBJECTIVES The aim of the systematic review was to take stock of whether present stepped care models take comorbidities into consideration. A further aim was to give an overview on treatment components and involved health care professionals. METHODS A systematic literature search was performed using the databases PubMed, PsycINFO, Cochrane Library and Web of Science. Selection criteria were a randomized controlled trial of a primary-care-based stepped care intervention, adult samples, publication between 2000 and 2017 and English or German language. RESULTS Of 1009 search results, 39 studies were eligible. One-third of the trials were conceived for depressive disorders only, one-third for depression and further somatic and/or mental comorbidity and one-third for conditions other than depression. In 39% of the studies comorbidities were explicitly integrated in treatment, mainly via transdiagnostic self-management support, interprofessional collaboration and digital approaches for treatment, monitoring and communication. Most care teams were composed of a primary care physician, a care manager and a psychiatrist and/or psychologist. Due to the heterogeneity of the addressed disorders, no meta-analysis was performed. CONCLUSIONS Several stepped care models in primary care already account for comorbidities, with depression being the predominant target disorder. To determine their efficacy, the identified strategies to account for comorbidities should be investigated within stepped care models for a broader range of disorders.
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Affiliation(s)
- Kerstin Maehder
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany
| | - Daniela Heddaeus
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany
| | - Martin Scherer
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Germany
| | - Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
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Rotheram MJ, Fernandez MI, Lee SJ, Abdalian SE, Kozina L, Koussa M, Comulada WS, Klausner JD, Mayfield Arnold E, Ocasio MA, Swendeman D. Strategies to Treat and Prevent HIV in the United States for Adolescents and Young Adults: Protocol for a Mixed-Methods Study. JMIR Res Protoc 2019; 8:e10759. [PMID: 30664482 PMCID: PMC6360384 DOI: 10.2196/10759] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 10/24/2018] [Accepted: 11/08/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Over 20% of HIV diagnoses in the United States are among youth aged 12-24 years. Furthermore, youth have the lowest rates of uptake and adherence to antiretroviral (ARV) medications and are least aware of their HIV status. OBJECTIVE Our objective was to design a set of interrelated studies to promote completion of each step of the HIV Prevention Continuum by uninfected youth at high risk (YHR), as well as completion of steps in the Treatment Continuum by youth living with HIV (YLH). METHODS Gay, bisexual, and transgender youth; homeless youth; substance-abusing youth; youth with criminal justice contact; and youth with significant mental health challenges, particularly black and Latino individuals, are being recruited from 13 community-based organizations, clinics, drop-in centers, and shelters in Los Angeles and New Orleans. Youth are screened on the basis of self-reports and rapid diagnostic tests for HIV, drug use, and sexually transmitted infections and, then, triaged into one of 3 studies: (1) an observational cohort of YLH who have never received ARV medications and are then treated-half initially are in the acute infection period (n=36) and half with established HIV infection (n=36); (2) a randomized controlled trial (RCT) for YLH (N=220); and (3) an RCT for YHR (N=1340). Each study contrasts efficacy and costs of 3 interventions: an automated messaging and weekly monitoring program delivered via text messages (short message service, SMS); a peer support intervention delivered via social media forums; and coaching, delivered via text message (SMS), phone, and in-person or telehealth contacts. The primary outcomes are assessing youths' uptake and retention of and adherence to the HIV Prevention or Treatment Continua. Repeat assessments are conducted every 4 months over 24 months to engage and retain youth and to monitor their status. RESULTS The project is funded from September 2016 through May 2021. Recruitment began in May 2017 and is expected to be completed by June 2019. We expect to submit the first results for publication by fall 2019. CONCLUSIONS Using similar, flexible, and adaptable intervention approaches for YLH and YHR, this set of studies may provide a roadmap for communities to broadly address HIV risk among youth. We will evaluate whether the interventions are cost-efficient strategies that can be leveraged to help youth adhere to the actions in the HIV Prevention and Treatment Continua. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/10759.
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Affiliation(s)
- Mary Jane Rotheram
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Maria Isabel Fernandez
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Sung-Jae Lee
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Sue Ellen Abdalian
- Department of Pediatrics, School of Medicine, Tulane University, New Orleans, LA, United States
| | - Leslie Kozina
- Department of Pediatrics, School of Medicine, Tulane University, New Orleans, LA, United States
| | - Maryann Koussa
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Warren Scott Comulada
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
| | - Jeffrey D Klausner
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | | | - Manuel A Ocasio
- Department of Pediatrics, School of Medicine, Tulane University, New Orleans, LA, United States
| | - Dallas Swendeman
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, United States
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Ivziku D, Clari M, Piredda M, De Marinis MG, Matarese M. Anxiety, depression and quality of life in chronic obstructive pulmonary disease patients and caregivers: an actor-partner interdependence model analysis. Qual Life Res 2018; 28:461-472. [PMID: 30341578 DOI: 10.1007/s11136-018-2024-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE We aimed to assess the influence of anxiety and depression on the physical and mental quality of life (QoL) in patient with chronic obstructive pulmonary disease (COPD) and caregiver dyads, detect the simultaneous effect of anxiety and depression of each partner on the other's QoL and determine the dyadic patterns. METHODS A cross-sectional descriptive design was used. The actor-partner interdependence model estimated by structural equation modeling was used for the dyadic analysis. Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and 12-Item Short-Form Health Survey (SF-12) were used to measure depression, anxiety and QoL, respectively. RESULTS Eighty COPD dyads were enrolled in the study. Patients presented higher depression symptoms and poorer physical and mental QoL than their caregivers, whereas comparable levels of anxiety were found in patients and caregivers. The model exploring the effects of depression and anxiety on mental QoL found that patients' depressive symptoms negatively influence their mental QoL, and caregivers' anxiety and depression symptoms negatively impact their mental QoL. The model exploring the effects of anxiety and depression on physical QoL detected one statistically significant actor effect with patients' depressive symptoms negatively influencing their physical QoL, and two partner effects with caregivers' anxiety worsening patients' physical QoL and caregivers' depression improving patients' physical QoL. CONCLUSIONS The results suggest that caregivers' psychological distress influences caregivers' mental QoL and patients' physical QoL. Therefore, health-care professionals should assess and treat anxiety and depression in both members of the COPD dyad to improve their QoL.
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Affiliation(s)
- Dhurata Ivziku
- Department of Biomedicine and Prevention, University of Rome 'Tor Vergata', Via Montpellier 1, 00133, Rome, Italy. .,, Rome, Italy.
| | - Marco Clari
- Department of Biomedicine and Prevention, University of Rome 'Tor Vergata', Via Montpellier 1, 00133, Rome, Italy
| | - Michela Piredda
- Research Unit of Nursing Science, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Maria Grazia De Marinis
- Research Unit of Nursing Science, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
| | - Maria Matarese
- Research Unit of Nursing Science, Campus Bio-Medico University of Rome, Via Alvaro del Portillo 21, 00128, Rome, Italy
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KhalediSardashti F, Ghazavi Z, Keshani F, Smaeilzadeh M. Effect of Hope Therapy on the Mood Status of Patients with Diabetes. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2018; 23:281-286. [PMID: 30034488 PMCID: PMC6034523 DOI: 10.4103/ijnmr.ijnmr_36_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background: Diabetes mellitus (DM) is a chronic disease which imposes high costs on patients and society and results in complications in patients. One of these complications includes issues related to mood. Thus, the present study was conducted with the aim to determine the effect of hope therapy on the mood status of patients with DM. Materials and Methods: This quasi-experimental study was performed with two groups in three stages in the summer of 2015 on 38 individuals. The study population consisted of all individuals with DM who referred to and had a medical record at Shahid Asghar Shabani Clinic (Isfahan, Iran) affiliated with the social security organization. From among the 350 individuals with medical records at the clinic, 38 who had the inclusion criteria were selected through simple random sampling. Participants were randomly assigned to control (n = 19) and experimental (n = 19) groups. The Zung Self-Rating Depression Scale was completed by both groups before, after, and 1 month after the intervention. Results: There was a significant difference in the mean scores of depression in the intervention group before (F = 19.48, p = 0.001), immediately after (t = 3.30, p = 0.002), and 1 month after the intervention (t = 3.09, p = 0.004), whereas there was no significant difference in the mean scores of depression before, immediately after, and 1 month after the intervention in the control group. Conclusions: The obtained results showed that hope therapy can reduce depression in patients with DM.
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Affiliation(s)
- Firouz KhalediSardashti
- Department of Nursing, School of Nursing, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Zahra Ghazavi
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farshad Keshani
- Student of Artificial Intelligent, Isfahan University, Isfahan, Iran
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Schuler M, Strohmayer M, Mühlig S, Schwaighofer B, Wittmann M, Faller H, Schultz K. Assessment of depression before and after inpatient rehabilitation in COPD patients: Psychometric properties of the German version of the Patient Health Questionnaire (PHQ-9/PHQ-2). J Affect Disord 2018; 232:268-275. [PMID: 29499510 DOI: 10.1016/j.jad.2018.02.037] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/05/2018] [Accepted: 02/16/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Depression is a frequent comorbidity of COPD and leads to worse clinical COPD-outcomes. PHQ-9 and PHQ-2 are two widely used brief instruments to assess depression. However, psychometric properties in COPD patients are unknown. This study examines factorial validity, measurement invariance and composite reliability (CR) of PHQ-9/PHQ-2, respectively, and concordance between both tools. METHODS This is a secondary analysis of N = 561 COPD patients who filled out the PHQ-9 at the begin (T0), the end (T1) and 3/6/9/12 (T2/T3/T4/T5) months after pulmonary inpatient rehabilitation. Structural equation modeling was used to examine factorial validity and measurement invariance between gender, GOLD disease severity groups and over time. Concordance was assessed using Cohen's Kappa, Yules Y, positive and negative agreement. RESULTS A one-factor model (with one freed residual covariance) showed best model fit. At least partial scalar invariance could be established. Concordance between both instruments was substantial. 31.7% (26.2%) COPD patients showed clinically relevant depression according to PHQ-9 (PHQ-2) at T0. At T0-T2, PHQ-9 classified more patients as depressed than did PHQ-2. According to both measures, depression rates declined after rehabilitation. Reliability was high for both PHQ-9 (CR = 0.94) and PHQ-2 (CR = 0.89). LIMITATIONS No gold-standard (clinical interview) to assess depression was used. Therefore, diagnostic accuracy for PHQ-9/PHQ-2 remains unclear. CONCLUSIONS PHQ-9 and PHQ-2 fulfill important psychometric criteria (factorial validity, invariance, reliability) for measuring depression in COPD. The results support their use in clinical practice to assess severity of depression. Diagnostic accuracy to identify major/minor depression of both instruments should be examined in future studies.
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Affiliation(s)
- Michael Schuler
- University of Würzburg, Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, Würzburg, Germany.
| | - Miriam Strohmayer
- University of Würzburg, Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, Würzburg, Germany
| | - Stephan Mühlig
- Chemnitz University of Technology, Clinical Psychology and Psychotherapy, Chemnitz, Germany
| | - Birgit Schwaighofer
- Bad Reichenhall Clinic, Centre for Rehabilitation, Pneumology and Orthopedics, Bad Reichenhall, Germany
| | - Michael Wittmann
- Bad Reichenhall Clinic, Centre for Rehabilitation, Pneumology and Orthopedics, Bad Reichenhall, Germany
| | - Hermann Faller
- University of Würzburg, Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, Würzburg, Germany
| | - Konrad Schultz
- Bad Reichenhall Clinic, Centre for Rehabilitation, Pneumology and Orthopedics, Bad Reichenhall, Germany
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Purewal R, Fisher PL. The contribution of illness perceptions and metacognitive beliefs to anxiety and depression in adults with diabetes. Diabetes Res Clin Pract 2018; 136:16-22. [PMID: 29203257 DOI: 10.1016/j.diabres.2017.11.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/04/2017] [Accepted: 11/28/2017] [Indexed: 12/17/2022]
Abstract
AIMS Anxiety and depression are highly prevalent in people with diabetes (PwD). The most widely used psychological model to explain anxiety and depression in PwD is the Common-Sense Model, which gives a central role to illness perceptions. The Self-Regulatory Executive Function (S-REF) model proposes metacognitive beliefs are key to understanding the development and maintenance of emotional disorders. To test the potential utility of the S-REF model in PwD, the study explored if metacognitive beliefs explained additional variance in anxiety and depression after controlling for demographic and illness perceptions. METHODS 614 adults with either Type 1 (n = 335) or Type 2 (n = 279) diabetes participated in a cross sectional online survey. All participants completed questionnaires on anxiety, depression, illness perceptions and metacognitive beliefs. RESULTS Regression analyses showed that metacognitive beliefs were associated with anxiety and depression in PwD and explained additional variance in both anxiety and depression after controlling for demographics and illness perceptions. CONCLUSIONS This is the first study to demonstrate that metacognitive beliefs are associated with anxiety and depression in PwD. The clinical implications of the study are illustrated.
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Affiliation(s)
- Rebecca Purewal
- Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Peter L Fisher
- Psychological Sciences, University of Liverpool, Liverpool, United Kingdom; Nidaros DPS, Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway.
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Sleep disturbance as a predictor of time to drug and alcohol use treatment in primary care. Sleep Med 2018; 42:31-37. [PMID: 29458743 DOI: 10.1016/j.sleep.2017.12.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Sleep Disturbances (SDs) are a symptom common to mental health disorders (MHD) and substance use disorders (SUD). We aimed to identify the value of SD as a predictor for subsequent treatment of illicit drug and alcohol use disorders (SUDs) in primary care and relative to the predictive value of mental health disorders (MHDs). METHODS We used electronic health records data from ambulatory primary care in a safety net Boston area healthcare system from 2013 to 2015 (n = 83,920). SUD (separated into illicit drug use disorder and alcohol use disorder) and MHD were identified through ICD-9 codes and medical record documentation. We estimated Cox proportional hazard models to examine the risk of SUD across four comparison groups (SD only, SD and MHD, MHD only, and neither SD nor MHD). RESULTS Compared to patients with no sleep or MHD, patients with SD had a greater risk for subsequent SUD treatment. Approximately one-fifth of patients with SD were treated for an illicit drug use disorder and approximately 12% were treated for alcohol use disorder. Risk for SUD treatment, estimated at over 30% by the end of the study, was greatest for patients with a MHD, either alone or comorbid with SD. Risk was greater for older patients and men, and lower for minority patients. CONCLUSIONS SD and MHD, individually and comorbid, significantly predict subsequent treatment of illicit drug and alcohol use disorder in primary care. Screening and evaluation for SD should be a routine practice in primary care to help with identifying potential SUD risk.
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Robbins SR, Melo LRS, Urban H, Deveza LA, Asher R, Johnson VL, Hunter DJ. Stepped care approach for medial tibiofemoral osteoarthritis (STrEAMline): protocol for a randomised controlled trial. BMJ Open 2017; 7:e018495. [PMID: 29282267 PMCID: PMC5770832 DOI: 10.1136/bmjopen-2017-018495] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Current guidelines recommend tailored interventions to optimise knee osteoarthritis (OA) management. However, models of care still have a 'one size fits all' approach, which is suboptimal as it ignores patient heterogeneity. This study aims to compare a stepped care strategy with standard care for overweight and obese persons with medial tibiofemoral OA. METHODS AND ANALYSIS Participants will be randomised into two groups (85 each). The intervention will receive a diet and exercise programme for 18 weeks in the first step of the study. Disease remission will then be assessed using the Patient Acceptable Symptom State (PASS). PASS is defined as the highest level of symptom beyond which patients consider themselves well and takes into account pain intensity, patient's global assessment of disease activity and degree of functional impairment. In the second step, participants in remission will continue with diet and exercise. If remission is not achieved, participants will be assigned in a hierarchical order to cognitive behavioural therapy, knee brace or muscle strengthening for 12 weeks. The intervention will be decided based on their clinical presentation for symptoms of depression and varus malalignment. Participants without depression or varus malalignment will undertake a muscle strengthening programme. The control group will receive educational material related to OA management. Main inclusion criteria are age ≥50 years, radiographic medial tibiofemoral OA, body mass index (BMI) ≥28 kg/m2, knee pain ≥40 (Visual Analogue Scale, 0-100), PASS (0-100) >32 for pain and global assessment, and 31 for functional impairment. Outcomes will be measured at 20-week and 32-week visits. The primary outcome is disease remission at 32 weeks. Other outcomes include functional mobility; patient-reported outcomes; BMI; waist-hip ratio; quadriceps strength; symptoms of depression, anxiety and stress; and knee range of motion. The analysis will be performed according to the intention-to-treat principle. ETHICS AND DISSEMINATION The local ethics committee approved this protocol (HREC/14/HAWKE/381). Dissemination will occur through presentations at international conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12615000227594.
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Affiliation(s)
- Sarah Rubia Robbins
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Sydney, Australia
- Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, Australia
| | - Luciano Ricardo S Melo
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Sydney, Australia
- Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, Australia
| | - Hema Urban
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Sydney, Australia
- Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, Australia
| | - Leticia A Deveza
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Sydney, Australia
- Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, Australia
| | - Rebecca Asher
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Victoria L Johnson
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Sydney, Australia
- Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, Australia
| | - David J Hunter
- Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney, Sydney, Australia
- Department of Rheumatology, Royal North Shore Hospital and Northern Clinical School, University of Sydney, Sydney, Australia
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Pascoe MC, Thompson DR, Castle DJ, Jenkins ZM, Ski CF. Psychosocial Interventions and Wellbeing in Individuals with Diabetes Mellitus: A Systematic Review and Meta-Analysis. Front Psychol 2017; 8:2063. [PMID: 29259563 PMCID: PMC5723413 DOI: 10.3389/fpsyg.2017.02063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/13/2017] [Indexed: 12/12/2022] Open
Abstract
Purpose: A number of studies, including systematic reviews, show beneficial effects of psychosocial interventions for people with diabetes mellitus; however, they have not been assessed using meta-analysis. The purpose of this meta-analysis of randomized controlled trials is to investigate the effects of psychosocial interventions on depressive and anxiety symptoms, quality of life and self-efficacy in individuals with diabetes mellitus. Methods: The databases Pubmed, MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science and SocINDEX were searched with no year restriction. Eligible studies were randomized controlled trials published in English that included individuals diagnosed with diabetes mellitus, aged 18 years or above, who engaged in a psychosocial intervention, with outcome measures addressing depressive or anxiety symptomology, quality of life or self-efficacy. Eligible studies needed to compare the intervention to usual care. Study selection was completed using Covidence and meta-analysis was undertaken using Comprehensive Meta-Analysis software. Results: Seven studies were included in the meta-analysis. Five studies investigated the effects of psychosocial interventions and showed a medium to large benefit for depressive symptoms (SMD: −0.70; CI: −1.27, −0.13) which persisted at follow up (SMD: −1.54, CI: −2.97, −0.12). Similar results were not seen immediately post-intervention in the three studies that assessed anxiety symptoms (SMD: −0.30; CI: −0.69, 0.10); however, a medium beneficial effect was seen at follow up (SMD = −0.61, CI = −0.92 to −0.31). Small benefits were seen in the three studies assessing quality of life outcomes (SMD: 0.30, CI: 0.06, 0.55). No benefit was seen in the two studies assessing self-efficacy (SMD: 0.23, CI: −0.11, 0.57). Conclusions: The results of the current study provide preliminary evidence that psychosocial interventions, compared to usual care, reduce depressive symptoms, and may improve quality of life in individuals with diabetes. However, only a few studies were included and the clinical significance of these findings is unknown.
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Affiliation(s)
- Michaela C Pascoe
- Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia.,Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - David R Thompson
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - David J Castle
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.,Mental Health Service, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Zoe M Jenkins
- Mental Health Service, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Chantal F Ski
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.,Mental Health Service, St. Vincent's Hospital, Melbourne, VIC, Australia
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Stoop CH, Nefs G, Pop VJ, Pouwer F. Screening for and subsequent participation in a trial for depression and anxiety in people with type 2 diabetes treated in primary care: Who do we reach? Prim Care Diabetes 2017; 11:273-280. [PMID: 28330680 DOI: 10.1016/j.pcd.2017.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 02/26/2017] [Indexed: 01/28/2023]
Abstract
AIMS This study investigated (factors related to) (a) the response to a screening procedure for depression and anxiety in people with type 2 diabetes in primary care, and (b) participation in a subsequent randomised controlled trial targeting depressive or anxiety symptoms. METHODS People with type 2 diabetes (n=1837) received a screening questionnaire assessing depressive symptoms (PHQ-9) and anxiety symptoms (GAD-7). Eligible persons who scored above the cut-off score (PHQ-9≥7 or GAD-7≥8) were offered to participate in the trial. RESULTS In total, 798 people (43%) returned the screening questionnaire. Non-responders were more often female (53% vs 44%, p<0.001), had higher LDL cholesterol levels (Cohen's d=0.17, p=0.001) and a higher albumin/creatinine ratio (Cohen's d=0.08, p=0.01). In total, 130 people (18%) reported elevated depressive or anxiety symptoms. Twenty-seven persons agreed to participate in the trial. Factors related to participation were a high education level, a higher level of diabetes distress and a history of psychological problems. CONCLUSIONS Using screening as recruitment resulted in a small number of participants in a treatment trial for anxiety and depression. Research is needed to investigate whether screening is also followed by a low uptake of treatment in primary care outside a RCT setting.
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Affiliation(s)
- Corinne H Stoop
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands; PoZoB, PO Box 312, 5500 AH Veldhoven, The Netherlands
| | - Giesje Nefs
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands.
| | - Victor J Pop
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
| | - François Pouwer
- Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands
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Long-term predictors of anxiety and depression in adult patients with asthma. Wien Klin Wochenschr 2017; 129:665-673. [PMID: 28421345 DOI: 10.1007/s00508-017-1203-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 03/27/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND It is well established that anxiety and depression are associated with asthma, but there is limited evidence about the persistence of anxiety/depression in asthma. The aim of our study was to assess the long-term predictors of anxiety and depression in adult asthmatic patients. METHODS A total of 90 adult asthma patients (63 women, age 18-50 years) with different levels of disease control (28 uncontrolled and 34 partially controlled) were assessed at baseline and at follow-up after 7 years for anxiety, depression and asthma control. The same work-up on both occasions included: demographics, living conditions, medical history (e.g. comorbidities, adherence and exacerbations), Hospital Anxiety and Depression Scale (HADS), Asthma Quality of Life Questionnaire (AQLQ), disease control and lung function. Persistence was defined as the HADS scores for anxiety and depression present at baseline and follow-up. RESULTS The HADS results at follow-up visit showed 36 (40%) asthma patients with anxiety and 13 (14%) with depression, with the persistence of anxiety in 17 (19%) and of depression in 7 (8%) patients. Significant predictors of anxiety at follow-up were HADS and AQLQ results at baseline and several parameters of asthma control at follow-up (area under the curve AUC 0.917, 95% confidence interval CI 0.829-0.969, p < 0.001) and for depression AQLQ mood disorder domain, asthma control and lung function (AUC 0.947, 95% CI 0.870-0.986, p < 0.001). CONCLUSION Anxiety and depression persist over years in some patients with asthma. The association between mood disorders and asthma suggests potential mutual treatability.
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Kennedy GJ, Castro J, Chang M, Chauhan-James J, Fishman M. Psychiatric and Medical Comorbidity in the Primary Care Geriatric Patient-An Update. Curr Psychiatry Rep 2016; 18:62. [PMID: 27222136 DOI: 10.1007/s11920-016-0700-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The mental health needs of older primary care patients are now widely recognized if not widely addressed. The range of behavioral health approaches including co-locating psychiatrists and integrating mental health professionals as care managers into primary care sites is extensive and growing. Nonetheless the primary care provider remains the first line of defense against mental disorders, most commonly depression and anxiety that accompany and exacerbate common physical conditions. The excess, potentially avoidable disability that results from comorbidity makes it imperative that early recognition and evidence based intervention occur. Multi-morbidity and polypharmacy make intervention a challenge. Psychotherapy can help overcome comorbidity depression however the most accessible intervention would be an antidepressant FDA approved for both anxiety and depressive disorders. For all these reasons, a focus on physical conditions most commonly associated with mental disorders can foster early recognition before the older patient's care becomes overwhelmingly complicated.
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Affiliation(s)
- Gary J Kennedy
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA. .,Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
| | - Jack Castro
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Mason Chang
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Jaimini Chauhan-James
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, 111 East 210th Street, Bronx, NY, 10467, USA
| | - Manuel Fishman
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
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