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Raya-Tena A, Martín-Royo J, Bellido-Pérez M, Sauch Valmaña G, Berenguera Ossó A, Soria-García MD, Ruíz-Serrano S, Lacasta-Tintorer N, Jiménez Herrera MF. A primary care psychoeducational group intervention for patients with depression and physical comorbidity: A qualitative study with a gender perspective. Int J Nurs Pract 2023; 29:e13157. [PMID: 37127403 DOI: 10.1111/ijn.13157] [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: 05/24/2022] [Revised: 03/07/2023] [Accepted: 03/28/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To explore the experiences and emotions of individuals with depression and physical comorbidity within the context of psychoeducational group interventions led by primary care nurses in Catalunya (Spain). METHOD A psychoeducational group intervention was conducted in the first semester of 2019 with 13 primary care teams (rural/urban) and 95 participants with depression and physical comorbidity. The qualitative research and phenomenological perspective were based on 13 field diaries and 7 semi-structured interviews carried out with the observer nurses. The interviews were recorded and transcribed. Codes were identified by segmenting the text into citations/verbatim accounts and emerging categories/subcategories by regrouping the codes. The results were triangulated among the researchers to identify and compare similarities and differences. RESULTS Four major themes were found: (a) gender differences; (b) coping strategies and changes observed during the intervention; (c) functions of the group as a therapeutic element; and (d) the nurses' perceptions of the group experience. Gender differences were identified in relation to experiences and emotions. CONCLUSIONS As some patients acquired skills/behaviours during the intervention that helped them initiate changes and the nurses were satisfied with the intervention, it is important to include this information when planning effective interventions for patients with this profile.
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Affiliation(s)
- Antonia Raya-Tena
- Primary Health Care Center Raval Nord, Institut Català de la Salut, Barcelona, Spain
- Nursing Department, Faculty of Nursing, Rovira and Virgili University, Tarragona, Spain
| | - Jaume Martín-Royo
- Unitat Bàsica de Prevenció, Gerència Territorial de Barcelona, 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 (IDIAPGol), Barcelona, Spain
| | - Mercedes Bellido-Pérez
- Primary Health Care Center Esparreguera, Institut Català de la Salut, Barcelona, Spain
- Department of Nursing, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Gloria Sauch Valmaña
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Barcelona, Spain
- 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 (IDIAPGol), Barcelona, Spain
| | - Anna Berenguera Ossó
- 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 (IDIAPGol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | | | - Sonia Ruíz-Serrano
- Primary Health Care Center Adrià, Institut Català de la Salut, Barcelona, Spain
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National Trends in Prevalence of Depression in Men and Women with Chronic Obstructive Pulmonary Disease Hospitalized in Spain, 2016–2020. J Clin Med 2022; 11:jcm11216337. [PMID: 36362570 PMCID: PMC9655616 DOI: 10.3390/jcm11216337] [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: 09/22/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 11/23/2022] Open
Abstract
(1) Background: To describe trends in the prevalence of depression in men and women with COPD hospitalized in Spain (2016–2020). (2) Methods: We used a nationwide discharge database to select all patients ≥35 years with COPD. (3) Results: The prevalence of depression was 3.54-times higher in women with COPD than in men (OR 3.54; 95%CI 3.48–3.6). It decreased significantly between 2016 and 2020, although the reduction was only significant in women (12.27% in 2016 vs. 10.56% in 2020). Older age, comorbidity and the most recent years of hospital admission were associated with lower prevalence of depression in both men and women, while obesity, obstructive sleep apnea (OSA) and use of oxygen prior to admission were risk factors. In-hospital mortality (IHM) increased significantly over time. Older age, comorbidity, the use of oxygen prior to admission and having been hospitalized in 2020 increased the risk of IHM. Female sex was associated with a lower IHM in patients with depression and COPD. (4) Conclusions: The prevalence of depression has decreased over time in women with COPD while it has not changed significantly in men with this disease. IHM increased over time both in men and women with COPD and depression, with higher prevalence in the former.
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Teusen C, Hapfelmeier A, von Schrottenberg V, Gökce F, Pitschel-Walz G, Henningsen P, Gensichen J, Schneider A. Combining the GP's assessment and the PHQ-9 questionnaire leads to more reliable and clinically relevant diagnoses in primary care. PLoS One 2022; 17:e0276534. [PMID: 36269712 PMCID: PMC9586376 DOI: 10.1371/journal.pone.0276534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 10/08/2022] [Indexed: 11/07/2022] Open
Abstract
Background Screening questionnaires are not sufficient to improve diagnostic quality of depression in primary care. The additional consideration of the general practitioner’s (GP’s) assessment could improve the accuracy of depression diagnosis. The aim of this study was to examine whether the GP rating supports a reliable depression diagnosis indicated by the PHQ-9 over a period of three months. Methods We performed a secondary data analysis from a previous study. PHQ-9 scores of primary care patients were collected at the time of recruitment (t1) and during a follow-up 3 months later (t2). At t1 GPs independently made a subjective assessment whether they considered the patient depressive (yes/no). Two corresponding groups with concordant and discordant PHQ-9 and GP ratings at t1 were defined. Reliability of the PHQ-9 results at t1 and t2 was assessed within these groups and within the entire sample by Cohen’s Kappa, Pearson’s correlation coefficient and Bland-Altman plots. Results 364 consecutive patients from 12 practices in the region of Upper Bavaria/Germany participated in this longitudinal study. 279 patients (76.6%) sent back the questionnaire at t2. Concordance of GP rating and PHQ-9 at t1 led to higher replicability of PHQ-9 results between t1 and t2. The reliability of PHQ-9 was higher in the concordant subgroup (κ = 0.507) compared to the discordant subgroup (κ = 0.211) (p = 0.064). The Bland-Altman Plot showed that the deviation of PHQ-9 scores at t1 and t2 decreased by about 15% in the concordant subgroup. Pearson’s correlation coefficient between PHQ-9 scores at t1 and t2 increased significantly if the GP rating was concordant with the PHQ-9 at t1 (r = 0.671) compared to the discordant subgroup (r = 0.462) (p = 0.044). Conclusions The combination of PHQ-9 and GP rating might improve diagnostic decision making regarding depression in general practices. PHQ-9 positive results might be more reliable and accurate, when a concordant GP rating is considered.
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Affiliation(s)
- Clara Teusen
- Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University of Munich, Munich, Bavaria, Germany
- * E-mail:
| | - Alexander Hapfelmeier
- Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University of Munich, Munich, Bavaria, Germany
- Institute for AI and Informatics in Medicine, TUM School of Medicine, Technical University of Munich, Munich, Bavaria, Germany
| | - Victoria von Schrottenberg
- Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University of Munich, Munich, Bavaria, Germany
| | - Feyza Gökce
- Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University of Munich, Munich, Bavaria, Germany
| | - Gabriele Pitschel-Walz
- Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University of Munich, Munich, Bavaria, Germany
| | - Peter Henningsen
- Dept. of Psychosomatic Medicine and Psychotherapy, University Hospital TU Munich, Munich, Bavaria, Germany
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital of the Ludwig-Maximilians-University of Munich, Munich, Bavaria, Germany
| | - Antonius Schneider
- Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University of Munich, Munich, Bavaria, Germany
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Agustini B, Lotfaliany M, Mohebbi M, Woods RL, McNeil JJ, Nelson MR, Shah RC, Murray AM, Reid CM, Tonkin A, Ryan J, Williams LJ, Forbes MP, Berk M. Trajectories of depressive symptoms in older adults and associated health outcomes. NATURE AGING 2022; 2:295-302. [PMID: 37117752 DOI: 10.1038/s43587-022-00203-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/10/2022] [Indexed: 04/30/2023]
Abstract
With the progressive aging of the world's population, prolongation of a healthy lifespan in old age has become a medical research priority. The presence of depressive symptoms in later life is associated with poor health prognosis and increased mortality1,2. Here we explore distinct trajectories of depressive symptoms in later life and their association with several health-related outcomes in 19,110 older individuals followed for a median of 4.7 years. Using a latent class, mixed-modeling approach we identified four distinct trajectories of depressive symptoms with scoring patterns of consistently low, moderate, emerging and persistently high. Compared to those with minimal depressive symptoms, membership of any other class was associated with specific patterns of baseline sociodemographic and medical factors. Membership of any group with depressive symptoms was associated with a higher likelihood of health events, including physical disability, cancer and major bleeding episodes. Membership of the persistently depressed class was associated with increased mortality, while a diagnosis of dementia was generally limited to the class with initially low and progressively rising symptoms. The course of depressive symptoms in older individuals can vary widely and depend on several factors. The presence of depressive symptoms, including those that do not meet criteria for major depression, can flag a poor prognosis and risk for specific health conditions. Systematic assessment of depressive symptoms may facilitate early identification of at-risk populations.
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Affiliation(s)
- Bruno Agustini
- Deakin University, iMPACT the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia.
| | - Mojtaba Lotfaliany
- Deakin University, iMPACT the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | | | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Hennepin Healthcare, Minneapolis, MN, USA
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Andrew Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lana J Williams
- Deakin University, iMPACT the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Malcolm P Forbes
- Deakin University, iMPACT the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Michael Berk
- Deakin University, iMPACT the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Psychiatry, Orygen, the National Centre of Excellence in Youth Health, and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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Qiu H, Wang L, Zeng X, Pan J. Comorbidity patterns in depression: A disease network analysis using regional hospital discharge records. J Affect Disord 2022; 296:418-427. [PMID: 34606805 DOI: 10.1016/j.jad.2021.09.100] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/31/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Depression is a psychiatric disorder with a high comorbidity burden; however, previous comorbidity studies predominately focused on a few common diseases and relied on self-reported data. We aimed to investigate the comorbid status of depression concerning the entire spectrum of chronic diseases using network analysis. METHOD Totally, 22,872 depressed inpatients and one-to-one matched controls were enrolled in the retrospective study. Hospital discharge records were aggregated to measure the comorbidities, where those with a prevalence ≥ 1% were selected for further analysis. Based on the co-occurrence frequency, sex- and age-specific comorbidity networks in depressed patients were constructed and the results were compared with the controls. Louvain algorithm was used to detect the highly interlinked communities. RESULTS Depressed patients had 4 comorbidities on average, and 84.4% had at least one comorbidity. The comorbidity network in depression cases was more complex than controls (connections of 839 vs. 369). Intricate but distinct communities appeared within the comorbidity network in depressed patients, where the largest community included cerebrovascular diseases, chronic ischaemia heart disease, atherosclerosis and osteoporosis. Sex-specific central diseases existed, and cardiovascular diseases were the major central diseases to both gender. The older the depressed patients, the more severe the central diseases in the comorbidity network. LIMITATIONS The causality of the observed interactions could not be determined. CONCLUSIONS The application of network analysis on longitudinal healthcare datasets to assess comorbidity patterns can supplement the traditional clinical study approaches. The findings would improve our understanding of depression-related comorbidities and enhance the integrated management of depression.
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Affiliation(s)
- Hang Qiu
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China; Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, China.
| | - Liya Wang
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, China
| | - Xianrong Zeng
- Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, China
| | - Jingping Pan
- Health Information Center of Sichuan Province, Chengdu, China
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Agustini B, Lotfaliany M, Woods RL, McNeil JJ, Nelson MR, Shah RC, Murray AM, Ernst ME, Reid CM, Tonkin A, Lockery JE, Williams LJ, Berk M, Mohebbi M. Patterns of Association between Depressive Symptoms and Chronic Medical Morbidities in Older Adults. J Am Geriatr Soc 2020; 68:1834-1841. [PMID: 32402115 DOI: 10.1111/jgs.16468] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/18/2020] [Accepted: 03/22/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate the association between depressive symptoms and several medical morbidities, and their combination, in a large older population. DESIGN Cross-sectional study of baseline data from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. SETTING Multicentric study conducted in Australia and the United States. PARTICIPANTS A total of 19,110 older adults (mean age = 75 years [standard deviation = ±4.5]). MEASUREMENTS Depressive symptoms were measured using the Center for Epidemiological Studies Depression (CES-D 10) scale. Medical morbidities were defined according to condition-specific methods. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) to test associations before and after accounting for possible confounders. RESULTS Depressive symptoms were significantly associated with obesity (OR = 1.19; 95% CI = 1.07-1.32), diabetes (OR = 1.22; 95% CI = 1.05-1.42), gastroesophageal reflux disease (GERD) (OR = 1.41; 95% CI = 1.28-1.57), metabolic syndrome (OR = 1.16; 95% CI = 1.03-1.29), osteoarthritis (OR = 1.41; 95% CI = 1.27-1.57), respiratory conditions (OR = 1.25; 95% CI = 1.10-1.42), history of cancer (OR = 1.19; 95% CI = 1.05-1.34), Parkinson's disease (OR = 2.56; 95% CI = 1.83-3.56), polypharmacy (OR = 1.60; 95% CI = 1.44-1.79), and multimorbidity (OR = 1.29; 95% CI = 1.12-1.49). No significant association was observed between depressive symptoms and hypertension, chronic kidney disease, dyslipidemia, and gout (P > .05). A significant dose-response relationship was evident between the number of medical comorbidities and the prevalence of depression (OR = 1.18; 95% CI = 1.13-1.22). CONCLUSION Late-life depressive symptoms are significantly associated with several medical morbidities, and there appears to be a cumulative effect of the number of somatic diseases on the prevalence of depression. These findings augment the evidence for a complex relationship between mental and physical health in an otherwise healthy older population and might guide clinicians toward early recognition of high-risk individuals. J Am Geriatr Soc 68:1834-1841, 2020.
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Affiliation(s)
- Bruno Agustini
- School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | | | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Raj C Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy; and, Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa, Iowa, USA
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Andrew Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jessica E Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lana J Williams
- School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - Michael Berk
- School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Psychiatry, Orygen, the National Centre of Excellence in Youth Health, and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Mohammadreza Mohebbi
- School of Medicine, IMPACT the Institute for Mental and Physical Health and Clinical Translation, Barwon Health, Deakin University, Geelong, Victoria, Australia.,Biostatistics Unit, Deakin University, Geelong, Victoria, Australia
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Schonmann Y, Mansfield KE, Hayes JF, Abuabara K, Roberts A, Smeeth L, Langan SM. Atopic Eczema in Adulthood and Risk of Depression and Anxiety: A Population-Based Cohort Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2020; 8:248-257.e16. [PMID: 31479767 PMCID: PMC6947493 DOI: 10.1016/j.jaip.2019.08.030] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/16/2019] [Accepted: 08/16/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Atopic eczema is a common and debilitating condition associated with depression and anxiety, but the nature of this association remains unclear. OBJECTIVE To explore the temporal relationship between atopic eczema and new depression/anxiety. METHODS This matched cohort study used routinely collected data from the UK Clinical Practice Research Datalink, linked to hospital admissions data. We identified adults with atopic eczema (1998-2016) using a validated algorithm, and up to 5 individuals without atopic eczema matched on date of diagnosis, age, sex, and general practice. We estimated the hazard ratio (HR) for new depression/anxiety using stratified Cox regression to account for age, sex, calendar period, Index of Multiple Deprivation, glucocorticoid treatment, obesity, smoking, and harmful alcohol use. RESULTS We identified 526,808 adults with atopic eczema who were matched to 2,569,030 without. Atopic eczema was associated with increased incidence of new depression (HR, 1.14; 99% CI, 1.12-1.16) and anxiety (HR, 1.17; 99% CI, 1.14-1.19). We observed a stronger effect of atopic eczema on depression with increasing atopic eczema severity (HR [99% CI] compared with no atopic eczema: mild, 1.10 [1.08-1.13]; moderate, 1.19 [1.15-1.23]; and severe, 1.26 [1.17-1.37]). A dose-response association, however, was less apparent for new anxiety diagnosis (HR [99% CI] compared with no atopic eczema: mild, 1.14 [1.11-1.18]; moderate, 1.21 [1.17-1.26]; and severe, 1.15; [1.05-1.25]). CONCLUSIONS Adults with atopic eczema are more likely to develop new depression and anxiety. For depression, we observed a dose-response relationship with atopic eczema severity.
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Affiliation(s)
- Yochai Schonmann
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; Clalit Health Services, Department of Family Medicine, Rabin Medical Center, Petah Tikva, Israel; Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Kathryn E Mansfield
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Joseph F Hayes
- Division of Psychiatry, University College London, London, United Kingdom; Camden and Islington National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Katrina Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, Calif
| | - Amanda Roberts
- Nottingham Support Group for Carers of Children with Eczema, Nottingham, United Kingdom
| | - Liam Smeeth
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sinéad M Langan
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; St John's Institute of Dermatology, Guy's & St Thomas' Hospital National Health Service (NHS) Foundation Trust and King's College London, London, United Kingdom; Health Data Research UK, London, United Kingdom
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8
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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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Patient Engagement in ACO Practices and Patient-reported Outcomes Among Adults With Co-occurring Chronic Disease and Mental Health Conditions. Med Care 2019; 56:551-556. [PMID: 29762273 DOI: 10.1097/mlr.0000000000000927] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Accountable care organizations (ACOs) have increased their use of patient activation and engagement strategies, but it is unknown whether they achieve better outcomes for patients with comorbid chronic physical and mental health conditions. OBJECTIVES To assess the extent to which practices with patient-centered cultures, greater shared decision-making strategies, and better coordination among team members have better patient-reported outcomes (PROs) for patients with diabetes and/or cardiovascular and comorbid mental health diagnoses. RESEARCH DESIGN Sixteen practices randomly selected from top and bottom quartiles of a 39-item patient activation/engagement implementation survey of primary care team members (n=411) to assess patient-centered culture, shared decision-making, and relational coordination among team members. These data were linked to survey data on patient engagement and on emotional, physical, and social patient-reported health outcomes. SUBJECTS Adult patients (n=606) with diabetes, cardiovascular, and comorbid mental health conditions who had at least 1 visit at participating primary care practices of 2 ACOs. MEASURES Depression/anxiety, physical functioning, social functioning; patient-centered culture, patient activation/engagement implementation, relational coordination. RESULTS Patients receiving care from practices with high patient-centered cultures reported better physical functioning (0.025) and borderline better emotional functioning (0.059) compared with less patient-centered practices. More activated patients reported better PROs, with higher activation levels partially mediating the relationship of patient-centered culture and better PROs. CONCLUSIONS ACO patients with comorbid physical and mental health diagnoses report better physical functioning when practices have patient-centered cultures. More activated/engaged patients report better patient emotional, physical, and social health outcomes.
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Li H, Ge S, Greene B, Dunbar-Jacob J. Depression in the context of chronic diseases in the United States and China. Int J Nurs Sci 2019; 6:117-122. [PMID: 31406877 PMCID: PMC6608796 DOI: 10.1016/j.ijnss.2018.11.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/14/2018] [Accepted: 11/28/2018] [Indexed: 02/07/2023] Open
Abstract
Depression is not only a major global public health concern, but also a common comorbidity among patients who experience chronic diseases, such as cancer, stroke, heart disease, diabetes, and chronic obstructive pulmonary disease. Yet the recognition and treatment varies widely around the world. This study (1) provides an integrated review of the literature on the prevalence of depression among patients with chronic diseases in China and the United States and its relationship to poorer health outcomes and (2) compares the differences in the percentages of patients receiving treatments for depression between the United States and China. Given the current situation, we recommended that primary care and specialty providers should be knowledgeable and alert regarding the signs of depression. Efforts should be directed to further implement integrated care based interventions to manage depression and improve quality of life among patients suffering chronic diseases in both China and the United States.
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Affiliation(s)
- Hongjin Li
- University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA
| | - Song Ge
- University of Houston Downtown, Department of Natural Science, Houston, TX, USA
| | - Brian Greene
- University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA
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11
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Castellani B, Griffiths F, Rajaram R, Gunn J. Exploring comorbid depression and physical health trajectories: A case-based computational modelling approach. J Eval Clin Pract 2018; 24:1293-1309. [PMID: 30277297 DOI: 10.1111/jep.13042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/27/2018] [Accepted: 08/20/2018] [Indexed: 11/30/2022]
Abstract
While comorbid depression/physical health is a major clinical concern, the conventional methods of medicine make it difficult to model the complexities of this relationship. Such challenges include cataloguing multiple trends, developing multiple complex aetiological explanations, and modelling the collective large-scale dynamics of these trends. Using a case-based complexity approach, this study engaged in a richly described case study to demonstrate the utility of computational modelling for primary care research. N = 259 people were subsampled from the Diamond database, one of the largest primary care depression cohort studies worldwide. A global measure of depressive symptoms (PHQ-9) and physical health (PCS-12) were assessed at 3, 6, 9, and 12 months and then annually for a total of 7 years. Eleven trajectories and 2 large-scale collective dynamics were identified, revealing that while depression is comorbid with poor physical health, chronic illness is often low dynamic and not always linked to depression. Also, some of the cases in the unhealthy and oscillator trends remain ill without much chance of improvement. Finally, childhood abuse, partner violence, and negative life events are greater amongst unhealthy trends. Computational modelling offers a major advance for health researchers to account for the diversity of primary care patients and for developing better prognostic models for team-based interdisciplinary care.
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Affiliation(s)
- Brian Castellani
- Department of Sociology, Durham University, Durham, UK.,Department of Psychiatry, Northeastern Ohio Medical University, Rootstown, OH, USA
| | - Frances Griffiths
- Division of Health Sciences, University of Warwick, Coventry, UK.,University of the Witwatersrand, Johannesburg, South Africa
| | - Rajeev Rajaram
- Department of Mathematics, Kent State University, Kent, OH, USA
| | - Jane Gunn
- Department of General Practice, University of Melbourne, Melbourne, Australia
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12
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Palmos AB, Breen G, Goodwin L, Frissa S, Hatch SL, Hotopf M, Thuret S, Lewis CM, Powell TR. Genetic Risk for Psychiatric Disorders and Telomere Length. Front Genet 2018; 9:468. [PMID: 30459805 PMCID: PMC6232668 DOI: 10.3389/fgene.2018.00468] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 09/24/2018] [Indexed: 01/07/2023] Open
Abstract
Background: Previous studies have revealed associations between psychiatric disorder diagnosis and shorter telomere length. Here, we attempt to discern whether genetic risk for psychiatric disorders, or use of pharmacological treatments (i.e., antidepressants), predict shorter telomere length and risk for aging-related disease in a United Kingdom population sample. Methods: DNA samples from blood were available from 351 participants who were recruited as part of the South East London Community Health (SELCoH) Study, and for which whole-genome genotype data was available. Leukocyte telomere length was characterized using quantitative polymerase chain reactions. Individualized polygenic risk scores for major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia (SCZ) were calculated using Psychiatric Genomics Consortium summary statistics. We subsequently performed linear models, to discern the impact polygenic risk for psychiatric disorders (an etiological risk factor) and antidepressant use (common pharmacological treatment) have on telomere length, whilst accounting for other lifestyle/health factors (e.g., BMI, smoking). Results: There were no significant associations between polygenic risk for any of the psychiatric disorders tested and telomere length (p > 0.05). Antidepressant use was significantly associated with shorter telomere length and this was independent from a depression diagnosis or current depression severity (p ≤ 0.01). Antidepressant use was also associated with a significantly higher risk of aging-related disease, which was independent from depression diagnosis (p ≤ 0.05). Conclusion: Genetic risk for psychiatric disorders is not associated with shorter telomere length. Further studies are now needed to prospectively characterize if antidepressant use increases risk for aging-related disease and telomere shortening, or whether people who age faster and have aging-related diseases are just more likely to be prescribed antidepressants.
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Affiliation(s)
- Alish B Palmos
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Gerome Breen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,National Institute for Health Research Biomedical Research Centre for Mental Health, Institute of Psychiatry, Psychology and Neuroscience, Maudsley Hospital, King's College London, London, United Kingdom
| | - Laura Goodwin
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Souci Frissa
- Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Stephani L Hatch
- Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Matthew Hotopf
- National Institute for Health Research Biomedical Research Centre for Mental Health, Institute of Psychiatry, Psychology and Neuroscience, Maudsley Hospital, King's College London, London, United Kingdom.,Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Sandrine Thuret
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Cathryn M Lewis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,National Institute for Health Research Biomedical Research Centre for Mental Health, Institute of Psychiatry, Psychology and Neuroscience, Maudsley Hospital, King's College London, London, United Kingdom
| | - Timothy R Powell
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Dodd S, Mitchell PB, Bauer M, Yatham L, Young AH, Kennedy SH, Williams L, Suppes T, Lopez Jaramillo C, Trivedi MH, Fava M, Rush AJ, McIntyre RS, Thase ME, Lam RW, Severus E, Kasper S, Berk M. Monitoring for antidepressant-associated adverse events in the treatment of patients with major depressive disorder: An international consensus statement. World J Biol Psychiatry 2018; 19:330-348. [PMID: 28984491 DOI: 10.1080/15622975.2017.1379609] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES These recommendations were designed to ensure safety for patients with major depressive disorder (MDD) and to aid monitoring and management of adverse effects during treatment with approved antidepressant medications. The recommendations aim to inform prescribers about both the risks associated with these treatments and approaches for mitigating such risks. METHODS Expert contributors were sought internationally by contacting representatives of key stakeholder professional societies in the treatment of MDD (ASBDD, CANMAT, WFSBP and ISAD). The manuscript was drafted through iterative editing to ensure consensus. RESULTS Adequate risk assessment prior to commencing pharmacotherapy, and safety monitoring during pharmacotherapy are essential to mitigate adverse events, optimise the benefits of treatment, and detect and assess adverse events when they occur. Risk factors for pharmacotherapy vary with individual patient characteristics and medication regimens. Risk factors for each patient need to be carefully assessed prior to initiating pharmacotherapy, and appropriate individualised treatment choices need to be selected. Some antidepressants are associated with specific safety concerns which were addressed. CONCLUSIONS Risks of adverse outcomes with antidepressant treatment can be managed through appropriate assessment and monitoring to improve the risk benefit ratio and improve clinical outcomes.
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Affiliation(s)
- Seetal Dodd
- a School of Medicine, Barwon Health , Deakin University, IMPACT SRC (Innovation in Mental and Physical Health and Clinical Treatment - Strategic Research Centre) , Geelong , Australia.,b Department of Psychiatry , University of Melbourne , Melbourne , Australia.,c Mental Health Drug and Alcohol Services , University Hospital Geelong, Barwon Health , Geelong , Australia.,d Orygen The National Centre of Excellence in Youth Mental Health , Parkville , Australia
| | - Philip B Mitchell
- f School of Psychiatry , University of New South Wales, and Black Dog Institute , Sydney , Australia
| | - Michael Bauer
- g Department of Psychiatry and Psychotherapy , University Hospital Carl Gustav Carus, Technische, Universität Dresden , Dresden , Germany
| | - Lakshmi Yatham
- h Department of Psychiatry , University of British Columbia , British Columbia , BC , Canada
| | - Allan H Young
- i Department of Psychological Medicine , Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK & South London and Maudsley NHS Foundation Trust , London , UK
| | - Sidney H Kennedy
- j Department of Psychiatry , University of Toronto , Toronto , ON , Canada
| | - Lana Williams
- a School of Medicine, Barwon Health , Deakin University, IMPACT SRC (Innovation in Mental and Physical Health and Clinical Treatment - Strategic Research Centre) , Geelong , Australia
| | - Trisha Suppes
- k Department of Psychiatry & Behavioral Sciences , School of Medicine, Stanford University , Stanford , CA , USA
| | | | - Madhukar H Trivedi
- m Department of Psychiatry , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Maurizio Fava
- n Division of Clinical Research , Massachusetts General Hospital and Harvard Medical School , Boston , MA , USA
| | - A John Rush
- o Duke-National University of Singapore Medical School , Singapore , Singapore
| | - Roger S McIntyre
- j Department of Psychiatry , University of Toronto , Toronto , ON , Canada.,p Mood Disorders Psychopharmacology Unit, University of Toronto , Toronto , ON , Canada.,q Brain and Cognition Discovery Foundation , Toronto , ON , Canada
| | - Michael E Thase
- r Department of Psychiatry, Perelman School of Medicine , University of Pennsylvania , Pennsylvania , PA , USA
| | - Raymond W Lam
- h Department of Psychiatry , University of British Columbia , British Columbia , BC , Canada
| | - Emanuel Severus
- g Department of Psychiatry and Psychotherapy , University Hospital Carl Gustav Carus, Technische, Universität Dresden , Dresden , Germany
| | - Siegfried Kasper
- s Department of Psychiatry and Psychotherapy , Medical University of Vienna , Wien , Austria
| | - Michael Berk
- a School of Medicine, Barwon Health , Deakin University, IMPACT SRC (Innovation in Mental and Physical Health and Clinical Treatment - Strategic Research Centre) , Geelong , Australia.,b Department of Psychiatry , University of Melbourne , Melbourne , Australia.,c Mental Health Drug and Alcohol Services , University Hospital Geelong, Barwon Health , Geelong , Australia.,d Orygen The National Centre of Excellence in Youth Mental Health , Parkville , Australia.,e The Florey Institute of Neuroscience and Mental Health , Parkville , Australia
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14
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Araya R, Zitko P, Markkula N, Rai D, Jones K. Determinants of access to health care for depression in 49 countries: A multilevel analysis. J Affect Disord 2018. [PMID: 29524750 DOI: 10.1016/j.jad.2018.02.092] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The relative importance of individual and country-level factors influencing access to diagnosis and treatment for depression across the world is fairly unknown. METHODS We analysed cross-national data from the WHO World Health Surveys. Depression diagnosis and access to health care were ascertained using a structured interview. Logistic Bayesian Multilevel analyses were performed to establish individual and country level factors associated with: (1) receiving a diagnosis and (2) accessing treatment for depression if a diagnosis was ascertained. RESULTS The sample included 7870 individuals from 49 countries who met ICD-10 criteria for depressive episode in the past 12 months. A third (32%) of these individuals had ever been diagnosed with depression in their lifetime. Among those diagnosed with depression, 66% reported to have ever received treatment for depression. Although individual factors were more important determinants of access to treatment for depression, country-level factors explained 27.6% of the variance in access to diagnosis and 24.1% in access to treatment. Access to treatment for depression improved with increasing country income. Female gender, better education, the presence of physical co-morbidity, more material assets, and living in urban areas were individual level determinants of better access. LIMITATIONS Data on other contextual factors was not available. Unmet need was likely underestimated, since only lifetime treatment data was available. CONCLUSION This study highlights major inequalities in access to a diagnosis and treatment of depression. Unlike the prevalence of depression, where contextual factors have shown to have less importance, a significant proportion of the variance in access to depression care was explained by country-level income.
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Affiliation(s)
- Ricardo Araya
- Health Service & Population Research Department, IoPPN, King's College, London, UK.
| | - Pedro Zitko
- Health Service & Population Research Department, IoPPN, King's College, London, UK; Department of Public Health, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Unit of Healthcare Studies, Complejo Asistencial Barros Luco, Santiago, Chile
| | - Niina Markkula
- Faculty of Medicine Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; Mental Health Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Dheeraj Rai
- Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK; Avon and Wiltshire Mental Health Partnership NHS Trust, UK
| | - Kelvyn Jones
- Centre for Multilevel Modelling and School of Geographical Sciences, University of Bristol, UK
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15
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Dalgard FJ, Svensson Å, Gieler U, Tomas-Aragones L, Lien L, Poot F, Jemec GBE, Misery L, Szabo C, Linder D, Sampogna F, Evers AWM, Halvorsen JA, Balieva F, Szepietowski J, Lvov A, Marron SE, Alturnay IK, Finlay AY, Salek SS, Kupfer J. Dermatologists across Europe underestimate depression and anxiety: results from 3635 dermatological consultations. Br J Dermatol 2018; 179:464-470. [PMID: 29247454 DOI: 10.1111/bjd.16250] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND It was recently demonstrated that a significant number of patients with common skin diseases across Europe are clinically depressed and anxious. Studies have shown that physicians not trained as psychiatrists underdiagnose depression. This has not been explored among dermatologists. OBJECTIVES To estimate the concordance between clinical assessment of depression and anxiety by a dermatologist and assessment with the Hospital Anxiety and Depression Scale (HADS). METHODS The study was an observational cross-sectional multicentre study of prevalent cases of skin diseases in 13 countries in Europe. Consecutive patients were recruited in outpatient clinics and filled in questionnaires prior to clinical examination by a dermatologist who reported any diagnosis of skin disease and signs of mood disorders. RESULTS Analysis of the 3635 consultations showed that the agreement between dermatologist and HADS was poor to fair (lower than 0·4) for all diagnosis categories. The true-positive rate (represented by the percentage of dermatologists recognizing signs of depression or anxiety in patients with depression or anxiety as defined by a HADS value ≥ 11) was 44·0% for depression and 35·6% for anxiety. The true negative rate (represented by the percentage of dermatologists not detecting signs of depression or anxiety in non-depressed or non-anxious patients defined by HADS-value < 11) was 88.8% for depression and 85.7% for anxiety. CONCLUSIONS Dermatologists in Europe tend to underestimate mood disorders. The results suggest that further training for dermatologists to improve their skills in diagnosing depression and anxiety might be appropriate. When present, the psychological suffering of patients with dermatological conditions needs to be addressed.
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Affiliation(s)
- F J Dalgard
- Department of Dermatology and Venereology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Å Svensson
- Department of Dermatology and Venereology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - U Gieler
- Department of Dermatology, Justus Liebig University, Giessen, Germany
| | | | - L Lien
- National Centre for Dual Diagnosis, Innlandet Hospital Trust, Brumunddal, Norway
| | - F Poot
- Department of Dermatology, Universite libre de Bruxelles, Brussels, Belgium
| | - G B E Jemec
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - L Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - C Szabo
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - D Linder
- Section of Biostatistics, University of Oslo, Oslo, Norway
| | - F Sampogna
- Clinical Epidemiology Unit, Istituto Dermopatico dell'Immacolata, Rome, Italy
| | - A W M Evers
- Department of Health, Medical and Neuropsychology, Faculty of Social and Behavioral Science, the Netherlands
| | | | - F Balieva
- Department of Dermatology, Stavanger University Hospital, Stavanger, Norway
| | - J Szepietowski
- Department of Dermatology, Wroclav Medical University, Wroclav, Poland
| | - A Lvov
- Moscow Scientific and Practical Centre of Dermatovenereology and Cosmetology, Moscow, Russia
| | - S E Marron
- Department of Dermatology, Royo Villanova Hospital, Zaragoza, Spain
| | - I K Alturnay
- University of Health Science, Istanbul Sisli Hamidiye Efdal Health Training and Research Centre, Istanbul, Turkey
| | - A Y Finlay
- Department of Dermatology, Cardiff University School of Medicine, Cardiff, U.K
| | - S S Salek
- School of Life and Medical Sciences, University of Herdfordshire, Hatfield, U.K
| | - J Kupfer
- Institute of Medical Psychology, Justus Liebig University, Giessen, Germany
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16
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Seo MS, Hwang IC, Shim JY, Ahn HY, Kim S. The relationship between pulmonary function and suicidal ideation in Korean adults: a nationwide survey. PSYCHOL HEALTH MED 2018; 23:1037-1045. [PMID: 29678118 DOI: 10.1080/13548506.2018.1467020] [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: 10/17/2022]
Abstract
Controversy surrounds the association between lung function and mental health in the general population, and previous reported results were confounded by the effect of other chronic illnesses. This study aimed to investigate whether reduced lung function was related to mental health issues, taking into consideration the relevant potential confounders. We used data from the 2008-2013 Korean National Health and Nutrition Examination Survey to examine the relationship between lung function and three mental issues (recognized stress, depressive mood, and suicidal ideation) among 22,068 Korean adults. A multiple logistic regression with adjustment for potential covariates including chronic illnesses revealed that a .5-L decrement of forced vital capacity increased the risk for suicidal ideation in both genders, but there was no significant association with recognized stress or depressive mood. We found an inverse relationship between lung function and suicidal ideation in the Korean general population.
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Affiliation(s)
- Min-Seok Seo
- a Department of Family Medicine , Incheon St. Mary's Hospital , Incheon , Republic of Korea.,b Yonsei University Graduate School of Medicine , Seoul , Republic of Korea
| | - In Cheol Hwang
- c Department of Family Medicine , Gachon University Gil Medical Center , Incheon , Republic of Korea
| | - Jae-Yong Shim
- b Yonsei University Graduate School of Medicine , Seoul , Republic of Korea
| | - Hong Yup Ahn
- d Department of Statistics , Dongguk University , Seoul , Republic of Korea
| | - Sewan Kim
- e Shingil Yonsei Clinic , Seoul , Republic of Korea
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17
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The Mini-International Neuropsychiatric Interview is useful and well accepted as part of the clinical assessment for depression and anxiety in primary care: a mixed-methods study. BMC FAMILY PRACTICE 2018; 19:19. [PMID: 29368585 PMCID: PMC5781342 DOI: 10.1186/s12875-017-0674-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 11/28/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Psychiatric complaints are common among primary care patients, with depression and anxiety being the most frequent. Diagnosis of anxiety and depression can be difficult, potentially leading to over- as well as under-diagnosis. The diagnostic process can be facilitated by incorporating structured interviews as part of the assessment. One such instrument, the Mini-International Neuropsychiatric Interview (MINI), has been established and accepted in psychiatric care. The purpose of this study was to explore the experiences and perceptions of the paper-and-pen version of MINI version 6.0 among patients and staff in primary care centers in Sweden. METHODS The MINI was introduced at three primary care centers and was conducted by either therapists or general practitioners. Patients presented with symptoms that could suggest depression or anxiety disorders. The duration of the interview was recorded. The experiences and perceptions of 125 patients and their interviewers were collected using a structured questionnaire. Global satisfaction was measured with a visual-analog scale (0-100). Semi-structured interviews were conducted with 24 patients and three therapists, and focus groups were held with 17 general practitioners. Qualitative content analysis was used for the interviews and focus groups. The findings across the groups were triangulated with results from the questionnaires. RESULTS The median global satisfaction with the MINI was 80 for patients and 86 for interviewers. General practitioners appreciated that the MINI identified comorbidities, as one-third of the patients had at least two psychiatric diagnoses. The MINI helped general practitioners attain a more accurate diagnosis. Patients appreciated that the MINI helped them recognize and verbalize their problems and did not find it intrusive. Patients and interviewers had mixed experiences with the yes-no format of the MINI, and the risk of subjective interpretations was acknowledged. Patients, general practitioners and therapists stated that the MINI contributed to appropriate treatment. The MINI assessment lasted 26 min on average (range 12 to 60 min). CONCLUSIONS The paper-and-pen version of the MINI could be useful in primary care as part of the clinical assessment of patients with problems suggestive of depression or anxiety disorders. The MINI was well accepted by patients, general practitioners and therapists.
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18
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Restoring function in major depressive disorder: A systematic review. J Affect Disord 2017; 215:299-313. [PMID: 28364701 DOI: 10.1016/j.jad.2017.02.029] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 02/22/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Functional impairment contributes to significant disability and economic burden in major depressive disorder (MDD). Treatment response is measured by improvement in depressive symptoms, but functional improvement often lags behind symptomatic improvement. Residual deficits are associated with relapse of depressive symptoms. METHODS A literature search was conducted using the following terms: "major depressive disorder," "functional impairment," "functional outcomes," "recovery of function," "treatment outcome," "outcome assessment," "social functioning," "presenteeism," "absenteeism," "psychiatric status rating scales," and "quality of life." Search limits included publication date (January 1, 1995 to August 31, 2016), English language, and human clinical trials. Controlled, acute-phase, nonrecurrent MDD treatment studies in adults were included if a functional outcome was measured at baseline and endpoint. RESULTS The qualitative analysis included 35 controlled studies. The Sheehan Disability Scale was the most commonly used functional assessment. Antidepressant treatments significantly improved functional outcomes. Early treatment response predicted functional improvement, while baseline disease severity did not. LIMITATIONS Clinical studies utilized various methodologies and assessments for functional impairment, and were not standardized or adequately powered. CONCLUSIONS The lack of synchronicity between symptomatic and functional improvement highlights an unmet need for MDD. Treatment guided by routine monitoring of symptoms and functionality may minimize residual functional impairments.
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19
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Gender and age group differences in suicide risk associated with co-morbid physical and psychiatric disorders in older adults. Int Psychogeriatr 2017; 29:249-257. [PMID: 27605541 DOI: 10.1017/s1041610216001290] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND It is unclear whether health service use influences the association between psychiatric and physical co-morbidity and suicide risk in older adults. METHODS Controls were older adults (n = 2,494) participating in a longitudinal study on the health of the elderly carried out between 2004 and 2007, in Quebec. The cases were all suicide decedents (n = 493) between 2004 and 2007, confirmed by the Quebec Coroner's office. Multivariate analyses were carried out to test the association between suicide and the presence of psychiatric and physical illnesses controlling for health service use and socio-demographic factors by gender and age group. Interaction terms were also tested between suicide and co-morbidity on outpatient service use. RESULTS The presence of physical illnesses only, was associated with a reduced risk of suicide across all sex and age groups. The presence of a mental disorder only was associated with an increased risk of suicide overall and specifically in females and those aged 70 to 84 years of age. Suicide risk was lower in those with a psychiatric and physical co-morbidity and consulting mental health services. CONCLUSIONS Increased mental health follow-up in older adults with psychiatric illnesses is needed for the detection of suicidal behavior and reducing suicide risk in males. Further research should focus on the mitigating effect of the presence of physical illnesses on stigma and health service use and the presence of social support in the elderly.
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20
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Markkula N, Marola N, Nieminen T, Koskinen S, Saarni SI, Härkänen T, Suvisaari J. Predictors of new-onset depressive disorders - Results from the longitudinal Finnish Health 2011 Study. J Affect Disord 2017; 208:255-264. [PMID: 27792971 DOI: 10.1016/j.jad.2016.08.051] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/23/2016] [Accepted: 08/27/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND Identifying risk factors for depression is important for understanding etiological mechanisms and targeting preventive efforts. No prior studies have compared risk factors of dysthymia and major depressive disorder (MDD) in a longitudinal setting. METHODS Predictors of new-onset MDD and dysthymia were examined in a longitudinal general population study (Health 2000 and 2011 Surveys, BRIF8901). 4057 persons free of depressive disorders at baseline were followed up for 11 years. DSM-IV MDD and dysthymia were diagnosed with the Composite International Diagnostic Interview. RESULTS 126 persons (4.4%, 95%CI 3.6-5.2) were diagnosed with MDD or dysthymia at follow-up. Predictors of new-onset depressive disorders were younger age (adjusted OR 0.97, 95%CI 0.95-0.99 per year), female gender (aOR 1.46, 95%CI 1.01-2.12), multiple childhood adversities (aOR 1.76, 95%CI 1.10-2.83), low trust dimension of social capital (aOR 0.58, 95%CI 0.36-0.96 for high trust), baseline anxiety disorder (aOR 2.75, 95%CI 1.36-5.56), and baseline depressive symptoms (aOR 1.65, 95%CI 1.04-2.61 for moderate and aOR 2.49, 95%CI 1.20-5.17 for severe symptoms). Risk factors for MDD were younger age, female gender, anxiety disorder and depressive symptoms, whereas younger age, multiple childhood adversities, low trust, and having 1-2 somatic diseases predicted dysthymia. LIMITATIONS We only had one follow-up point at eleven years, and did not collect information on the subjects' health during the follow-up period. CONCLUSIONS Persons with subclinical depressive symptoms, anxiety disorders, low trust, and multiple childhood adversities have a higher risk of depressive disorders. Predictors of MDD and dysthymia appear to differ. This information can be used to target preventive efforts and guide social policies.
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Affiliation(s)
- Niina Markkula
- National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Helsinki, Finland; Universidad del Desarrollo, Santiago, Chile.
| | - Niko Marola
- National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Helsinki, Finland
| | | | - Seppo Koskinen
- National Institute for Health and Welfare, Department of Health, Functional Capacity and Welfare, Helsinki, Finland
| | - Samuli I Saarni
- Turku University Hospital and the University of Turku, Turku, Finland
| | - Tommi Härkänen
- National Institute for Health and Welfare, Department of Health, Functional Capacity and Welfare, Helsinki, Finland
| | - Jaana Suvisaari
- National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Helsinki, Finland
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21
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Roberge P, Hudon C, Pavilanis A, Beaulieu MC, Benoit A, Brouillet H, Boulianne I, De Pauw A, Frigon S, Gaboury I, Gaudreault M, Girard A, Giroux M, Grégoire É, Langlois L, Lemieux M, Loignon C, Vanasse A. A qualitative study of perceived needs and factors associated with the quality of care for common mental disorders in patients with chronic diseases: the perspective of primary care clinicians and patients. BMC FAMILY PRACTICE 2016; 17:134. [PMID: 27620166 PMCID: PMC5020556 DOI: 10.1186/s12875-016-0531-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 09/01/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND The prevalence of comorbid anxiety and depressive disorders is high among patients with chronic diseases in primary care, and is associated with increased morbidity and mortality rates. The detection and treatment of common mental disorders in patients with chronic diseases can be challenging in the primary care setting. This study aims to explore the perceived needs, barriers and facilitators for the delivery of mental health care for patients with coexisting common mental disorders and chronic diseases in primary care from the clinician and patient perspectives. METHODS In this qualitative descriptive study, we conducted semi-structured interviews with clinicians (family physician, nurse, psychologist, social worker; n = 18) and patients (n = 10) from three primary care clinics in Quebec, Canada. The themes explored included clinician factors (e.g., attitudes, perception of roles, collaboration, management of clinical priorities) and patient factors (e.g., needs, preferences, access to care, communication with health professionals) associated with the delivery of care. Qualitative data analysis was conducted based on an interactive cyclical process of data reduction, data display and conclusion drawing and verification. RESULTS Clinician interviews highlighted a number of needs, barriers and enablers in the provision of patient services, which related to inter-professional collaboration, access to psychotherapy, polypharmacy as well as communication and coordination of services within the primary care clinic and the local network. Two specific facilitators associated with optimal mental health care were the broadening of nurses' functions in mental health care and the active integration of consulting psychiatrists. Patients corroborated the issues raised by the clinicians, particularly in the domains of whole-person care, service accessibility and care management. CONCLUSIONS The results of this project will contribute to the development of quality improvement interventions to increase the uptake of organizational and clinical evidence-based practices for patients with chronic diseases and concurrent common mental disorders, in priority areas including collaborative care, access to psychotherapy and linkages with specialized mental health care.
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Affiliation(s)
- Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
- Université de Sherbrooke - Campus de la santé, Groupe de recherche PRIMUS, 3001, 12e avenue nord, Sherbrooke, QC J1H 5N4 Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
- Université de Sherbrooke - Campus de la santé, Groupe de recherche PRIMUS, 3001, 12e avenue nord, Sherbrooke, QC J1H 5N4 Canada
| | - Alan Pavilanis
- St. Mary’s Hospital Center, 3830 Lacombe Avenue, Montreal, QC Canada
| | - Marie-Claude Beaulieu
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
| | - Annie Benoit
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
| | - Hélène Brouillet
- CISSS de la Montérégie-Est, 90 Sainte-Foy Boulevard, Longueuil, QC Canada
| | - Isabelle Boulianne
- Université de Sherbrooke, UMF Chicoutimi, 305, St-Vallier, Chicoutimi, QC Canada
| | - Anna De Pauw
- St. Mary’s Hospital Center, 3830 Lacombe Avenue, Montreal, QC Canada
| | - Serge Frigon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
| | - Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
- Université de Sherbrooke - Campus de la santé, Groupe de recherche PRIMUS, 3001, 12e avenue nord, Sherbrooke, QC J1H 5N4 Canada
| | - Martine Gaudreault
- Université de Sherbrooke, UMF Chicoutimi, 305, St-Vallier, Chicoutimi, QC Canada
| | - Ariane Girard
- Université du Québec à Chicoutimi, 555, Boulevard de l’Université, Chicoutimi, QC Canada
| | - Marie Giroux
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
| | - Élyse Grégoire
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
| | - Line Langlois
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
| | - Martin Lemieux
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
| | - Christine Loignon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
| | - Alain Vanasse
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
- Université de Sherbrooke - Campus de la santé, Groupe de recherche PRIMUS, 3001, 12e avenue nord, Sherbrooke, QC J1H 5N4 Canada
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Chronic physical comorbidity burden and the quality of depression treatment in primary care: a systematic review. J Psychosom Res 2015; 78:314-23. [PMID: 25649274 DOI: 10.1016/j.jpsychores.2015.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 01/02/2015] [Accepted: 01/03/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We examined whether the treatment and follow-up care for depression in routine primary care differs between adults with higher chronic physical comorbidity burden compared to adults with lower chronic physical comorbidity burden and explored factors leading to divergent results across studies. METHODS We conducted a systematic review of English and French articles using Medline, Embase, PsycINFO, CINAHL and Cochrane Controlled Trials Register from inception to July 2013. Reference list and reverse citation searches were also conducted. Search terms included depression, primary care, general practitioner, chronic disease and comorbidity. Study eligibility required inclusion of relevant quality indicators and data contrasting participants with higher and lower chronic physical comorbidity burden. Study selection and quality appraisal were carried out independently by two review authors. A narrative synthesis of results was performed. RESULTS Our search yielded 5817 unique citations and 46 studies met inclusion criteria. Studies provided data on quality of pharmacotherapy (n=28), psychotherapy (n=4), combined measures of treatment quality (n=14), and follow-up care (n=9). Across studies, evidence that higher chronic physical comorbidity burden was associated with lower depression treatment or follow-up care quality was reported in 13 studies whereas evidence for the opposite relationship was reported in 15 studies. Four studies reported mixed results and 14 studies observed no relationships between comorbidity burden and depression treatment or follow-up care quality. CONCLUSION Review findings suggest that chronic physical comorbidity does not consistently lead to lower quality of depression treatment or follow-up care in primary care.
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