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Robles E, Angelone C, Ondé D, Vázquez C. Somatic symptoms in the general population of Spain: Validation and normative data of the Patient Health Questionnaire-15 (PHQ-15). J Affect Disord 2024; 362:762-771. [PMID: 39029703 DOI: 10.1016/j.jad.2024.07.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/01/2024] [Accepted: 07/14/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVE The Patient Health Questionnaire (PHQ-15) has been widely used to assess somatic symptoms. This study aimed to analyze the psychometric properties of the Spanish version of the PHQ-15, its structure and score distribution across demographic variables in a Spanish sample. In addition, we examined variations in somatic symptoms among different demographic subgroups. METHOD 1495 individuals from the Spanish population answered a series of self-reported measures, including PHQ-15. To examine the factorial structure of the PHQ-15, Confirmatory Factor Analysis (CFA) was performed. Additionally, a bifactor CFA model was examined using the Exploratory Structural Equation Modeling (ESEM) framework. RESULTS Women showed more somatic symptoms than men, and younger individuals showed more somatic symptoms than the older ones. It was also revealed positive associations between somatic symptoms and levels of depression, anxiety, and suspiciousness, while negative associations were found between somatic symptoms and perceived resilience and happiness. Regarding the factorial structure of the PHQ-15, although the one-factor and bifactor models were suitable, the bifactor model underscores the presence of a robust general factor. LIMITATIONS It is a cross-sectional study, not including non-institutionalized individuals. CONCLUSION Somatic symptoms are more frequent in women and younger individuals. Furthermore, the presence of physical symptoms is associated to other psychological aspects, such as depression or anxiety. Finally, bifactor model was the most appropriate to explain the factorial structure of the PHQ-15.
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Affiliation(s)
- Elena Robles
- School of Psychology, Complutense University, Madrid, Spain
| | - Chiara Angelone
- School of Psychology and Education, University of Bologna, Bologna, Italy
| | - Daniel Ondé
- School of Psychology, Complutense University, Madrid, Spain
| | - Carmelo Vázquez
- School of Psychology, Complutense University, Madrid, Spain.
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Seeralan T, Magaard JL, Engels A, Meister R, Kriston L, Liebherz S, König HH, Härter M. Effectiveness of a coordinated ambulatory care program for patients with mental disorders or multiple sclerosis: results of a prospective non-randomized controlled trial in South Germany. Front Psychiatry 2023; 14:1183710. [PMID: 38179252 PMCID: PMC10766382 DOI: 10.3389/fpsyt.2023.1183710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/16/2023] [Indexed: 01/06/2024] Open
Abstract
Background The Psychiatry, Neurology, Psychosomatics and Psychotherapy (PNP) program of the German statutory health insurance AOK BW promotes coordinated and evidence-based specialist care with the aim of providing individualized, guideline-based outpatient care, strengthening the collaboration between health care providers, as well as reducing care costs. The purpose of this study was to evaluate its effectiveness regarding patient-reported outcomes compared to the less specialized general practitioner program (GP) and usual care (UC). Materials and methods AOK insured patients, who were on sick leave due to a mental disorder (affective disorder, anxiety disorder, adjustment disorder, somatoform disorder, alcohol abuse disorder, schizophrenia) or multiple sclerosis were included in the prospective non-randomized controlled study. All patients either participated in the PNP program (intervention group, IG-PNP), the general practitioner program (control group, CG-GP) or usual care (control group, CG-UC). Entropy balancing was used to adjust for baseline imbalance between groups. Primary outcome was health-related quality of life, assessed by the Short-form health survey (SF-36) 12 months after diagnosis. Secondary outcomes included symptom severity, functional health, and treatment satisfaction. Results Of the 14,483 insured patients who were contacted, 1,104 patients participated at baseline and 725 at follow-up. The adjusted mean differences of SF-36 sum score did not significantly differ between groups: -1.89 (95%-CI = -4.60; 0.81, p = 0.170) between IG-PNP and CG-GP, and -1.42 (95%-CI = -4.05; 1.22, p = 0.293) between PNP and CG-UC. The adjusted mean differences of secondary outcomes did not differ between groups, except for a slightly higher increase of functional health in CG-UC. Conclusion We found no evidence that the PNP program is superior to the GP program or to usual care in terms of patient-reported outcomes or treatment satisfaction. The results are limited by the low response rate. Accordingly, future studies should strive for more representative samples. To improve the program, an integration of further collaborative care elements and guideline recommendations might be useful. Clinical trial registration DRKS (German Clinical Trials Register https://drks.de/search/en); identifier (DRKS00013114).
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Affiliation(s)
- Tharanya Seeralan
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia L. Magaard
- Evangelisches Krankenhaus Ginsterhof GmbH, Psychosomatic Clinic, Rosengarten, Germany
| | - Alexander Engels
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ramona Meister
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Liebherz
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Mamo N, van de Klundert M, Tak L, Hartman TO, Hanssen D, Rosmalen J. Characteristics of collaborative care networks in functional disorders: A systematic review. J Psychosom Res 2023; 172:111357. [PMID: 37392482 DOI: 10.1016/j.jpsychores.2023.111357] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE Functional disorders (FD) are complex conditions, for which multidisciplinary involvement is often recommended. Collaborative care networks (CCN) may unlock the potential of the multidisciplinary team (MDT) in FD care. To understand what characteristics should be part of CCNs in FD, we studied the composition and characteristics of existing CCNs in FD. METHODS We performed a systematic review following PRISMA guidelines. A search of PubMed, WebofScience, PsycInfo, SocINDEX, AMED and CINAHL was undertaken to select studies describing CCNs in FD. Two reviewers extracted characteristics of the different CCNs. Characteristics were classified as relating to structure and processes of networks. RESULTS A total of 62 studies were identified representing 39 CCNs across 11 countries. Regarding structural characteristics, we found that most networks are outpatient, secondary-care based, with teams of between two and 19 members. Medical specialists were most commonly involved and the typical team leads as well as main patient contacts were general practitioners (GPs) or nurses. Regarding processes, collaboration was demonstrated mostly during assessment, management and patient education, less often during rehabilitation and follow-up, mostly using MDT meetings. CCNs provided a wide range of treatment modalities, reflecting a biopsychosocial approach, including psychological therapies, physiotherapy and social and occupational therapy. CONCLUSION CCNs for FD are heterogeneous, showing a wide variety of structures as well as processes. The heterogeneity of results provides a broad framework, demonstrating considerable variation in how this framework is applied in different contexts. Better development of network evaluation, as well as professional collaboration and education processes is needed.
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Affiliation(s)
- Nick Mamo
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, Netherlands; Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands.
| | - Manouk van de Klundert
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Lineke Tak
- Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands
| | - Tim Olde Hartman
- Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Denise Hanssen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, Netherlands
| | - Judith Rosmalen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, Netherlands; Dimence Institute for Specialized Mental Health Care, Alkura Specialist Center Persistent Somatic Symptoms, Deventer, Netherlands; University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, Netherlands
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Berezowski L, Ludwig L, Martin A, Löwe B, Shedden-Mora MC. Early Psychological Interventions for Somatic Symptom Disorder and Functional Somatic Syndromes: A Systematic Review and Meta-Analysis. Psychosom Med 2022; 84:325-338. [PMID: 34524264 PMCID: PMC8983947 DOI: 10.1097/psy.0000000000001011] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/20/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Psychological treatments for somatic symptom disorder and functional somatic syndromes (SSD/FSS) achieve moderate effects only, potentially because of the high chronicity in these patients. Therefore, we aimed to evaluate whether early treatment, that is, treatment in populations at risk or with recent onset, improves outcome. METHODS We conducted a systematic review and meta-analysis of (cluster-)randomized controlled trials evaluating early psychological interventions in the prevention and treatment of SSD/FSS in adults compared with inactive control conditions, standard care, or placebo. Individuals at risk for SSD/FSS, suffering from subthreshold symptoms or new onsets of SSD/FSS, or presenting with SSD/FSS for the first time were included. RESULTS We identified 30 eligible studies, mostly examining pain-related conditions. Interventions were diverse, ranging from bibliotherapy to cognitive-behavioral therapy. We found positive effects on depression post-treatment (Hedges' g = 0.12 [95% confidence interval = 0.03-0.2], k = 5) as well as on somatic symptom severity (g = 0.25 [0.096-0.41], k = 17) and health care utilization (g = 0.31 [0.18-0.44], k = 3) at follow-up. However, because of a high risk of bias, sensitivity to corrections for meta-bias, and missing outcome data, findings should be interpreted cautiously. CONCLUSIONS Our review shows that targeting SSD/FSS at an early stage represents a conceptual and practical challenge. Readily accessible interventions addressing transsymptomatic processes of SSD/FSS development and consolidation are highly needed. Future studies are needed to evaluate individuals with diverse symptoms, examine symptom history thoroughly, use placebo controls, and report outcomes completely to determine the efficacy of early psychological interventions for SSD/FSS.PROSPERO Registration:CRD42020140122.
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Affiliation(s)
- Lukas Berezowski
- From the Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences (Berezowski, Ludwig), University of Hamburg, Hamburg; Department of Clinical Psychology and Psychotherapy (Martin), University of Wuppertal, Wuppertal; Department of Psychosomatic Medicine and Psychotherapy (Löwe, Shedden-Mora), University Medical Center Hamburg-Eppendorf; and Department of Psychology (Shedden-Mora), University Medical Center Hamburg-Eppendorf & Medical School Hamburg, Hamburg, Germany
| | - Lea Ludwig
- From the Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences (Berezowski, Ludwig), University of Hamburg, Hamburg; Department of Clinical Psychology and Psychotherapy (Martin), University of Wuppertal, Wuppertal; Department of Psychosomatic Medicine and Psychotherapy (Löwe, Shedden-Mora), University Medical Center Hamburg-Eppendorf; and Department of Psychology (Shedden-Mora), University Medical Center Hamburg-Eppendorf & Medical School Hamburg, Hamburg, Germany
| | - Alexandra Martin
- From the Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences (Berezowski, Ludwig), University of Hamburg, Hamburg; Department of Clinical Psychology and Psychotherapy (Martin), University of Wuppertal, Wuppertal; Department of Psychosomatic Medicine and Psychotherapy (Löwe, Shedden-Mora), University Medical Center Hamburg-Eppendorf; and Department of Psychology (Shedden-Mora), University Medical Center Hamburg-Eppendorf & Medical School Hamburg, Hamburg, Germany
| | - Bernd Löwe
- From the Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences (Berezowski, Ludwig), University of Hamburg, Hamburg; Department of Clinical Psychology and Psychotherapy (Martin), University of Wuppertal, Wuppertal; Department of Psychosomatic Medicine and Psychotherapy (Löwe, Shedden-Mora), University Medical Center Hamburg-Eppendorf; and Department of Psychology (Shedden-Mora), University Medical Center Hamburg-Eppendorf & Medical School Hamburg, Hamburg, Germany
| | - Meike C. Shedden-Mora
- From the Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences (Berezowski, Ludwig), University of Hamburg, Hamburg; Department of Clinical Psychology and Psychotherapy (Martin), University of Wuppertal, Wuppertal; Department of Psychosomatic Medicine and Psychotherapy (Löwe, Shedden-Mora), University Medical Center Hamburg-Eppendorf; and Department of Psychology (Shedden-Mora), University Medical Center Hamburg-Eppendorf & Medical School Hamburg, Hamburg, Germany
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Stieler M, Pockney P, Campbell C, Thirugnanasundralingam V, Gan L, Spittal MJ, Carter G. OUP accepted manuscript. BJS Open 2022; 6:6633165. [PMID: 35796068 PMCID: PMC9260183 DOI: 10.1093/bjsopen/zrac046] [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: 11/26/2021] [Revised: 02/26/2022] [Accepted: 03/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background Somatic syndromes are present in 30 per cent of primary healthcare populations and are associated with increased health service use and health costs. Less is known about secondary care surgical inpatient populations. Methods This was a prospective longitudinal cohort study (n = 465) of consecutive adult admissions with an episode of non-traumatic abdominal pain, to the Acute General Surgical Unit at a tertiary hospital in New South Wales, Australia. Somatic symptom severity (SSS) was dichotomized using the Patient Health Questionnaire (PHQ)-15 with a cut-off point of 10 or higher (medium–high SSS) and compared pre-admission and during admission. Total healthcare utilization and direct costs were stratified by a PHQ-15 score of 10 or higher. Linear regression was used to examine differences in costs, and a multivariable linear regression was used to examine the relationship of PHQ-15 scores of 10 or higher to total costs, reported as mean total costs of care and percentage difference (95 per cent confidence intervals). Results Fifty-two per cent (n = 242) of participants had a medium–high SSS with greater pre-admission and admission interval health service costs. Mean total direct costs of care were 25 per cent (95 per cent c.i. 8 to 44 per cent) higher in the PHQ-15 score of 10 or higher group: mean difference €1401.93 (95 per cent c.i. €512.19 to €2273.67). The multivariable model showed a significant association of PHQ-15 scores of 10 or higher (2.1 per cent; 0.2–4.1 per cent greater for each one-point increase in score) with total hospital costs, although the strongest contributions to cost were older age, operative management, and lower socioeconomic level. There was a linear relationship between PHQ scores and total healthcare costs. Conclusions Medium to high levels of somatic symptoms are common in surgical inpatients with abdominal pain and are independently associated with greater healthcare utilization.
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Affiliation(s)
| | - Peter Pockney
- College of Health, Medicine and Wellbeing, School of Medicine and Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - Cassidy Campbell
- Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | | | - Lachlan Gan
- Department of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Matthew J Spittal
- Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Gregory Carter
- College of Health, Medicine and Wellbeing, School of Medicine and Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
- Department of Consultation-Liaison Psychiatry, Calvary Mater Newcastle, Waratah, New South Wales, Australia
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Seesing A, Löwe B, Shedden-Mora M. [Mental and Somatic Health Care Use in Persistent Somatic Symptoms: 4-Year Follow Up of the Network for Somatoform and Functional Disorders (Sofu-Net)]. Psychother Psychosom Med Psychol 2021; 72:179-188. [PMID: 34820822 DOI: 10.1055/a-1663-6647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The stepped, coordinated, interdisciplinary Health Network for Somatoform and Functional Disorders (Sofu-Net) was developed to provide guideline-based care for patients with somatoform and functional disorders. This controlled cluster cohort study evaluated patients' mental and somatic health care use, clinical outcomes, and their predictors at 4-years follow-up. METHOD 219 patients at risk for somatoform disorders from Sofu-Net practices (n=119) and control practices (n=100) were resurveyed after 4 years using structured interviews. Outcomes were mental and somatic health care use, somatic symptom burden and depressive symptoms. RESULTS 127 patients (n=74 Sofu-Net, n=53 controls) were followed up. Compared with the control group, Sofu-Net patients were significantly more likely to be referred to psychotherapy (55.4 vs. 35.8%). Younger age and more frequent GP consultations on the occasion of psychosocial problems predicted mental health care use. No difference was found between the two groups in the severity of clinical symptoms or in the extent of somatic health care use. Significant predictors were the number of somatic diseases, increased fear of illness, female gender, increased depressive symptomatology, low physical and mental quality of life. DISCUSSION In the long term, the coordinated and interdisciplinary network structure succeeded in more successfully referring high-risk patients to psychotherapy. The role of the primary care physician proved to be important. However, this was not accompanied by an improvement in the patients' clinical condition or a decrease in outpatient physician utilization.
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Affiliation(s)
- Alexandra Seesing
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Bernd Löwe
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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Martin A, Van den Bergh O. Medically Unexplained Symptoms and Bodily Distress. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1027/2151-2604/a000399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Alexandra Martin
- Department of Clinical Psychology and Psychotherapy, School of Human and Social Sciences, University of Wuppertal, Germany
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Shedden-Mora MC, Kuby A, Tönnies J, Piontek K, Löwe B. Stepped, Collaborative, Coordinated Care for Somatic Symptom and Related Disorders (Sofu-Net). ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1027/2151-2604/a000405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abstract. To improve early detection and adequate treatment for patients with somatic symptom and related disorders (SSRD), we implemented Sofu-Net, a stepped, collaborative, and coordinated health care network. This mixed-methods study aimed to evaluate Sofu-Net from the health care professionals’ perspective. Network partners (primary care physicians (PCPs), psychotherapists, inpatient mental health clinics) completed an evaluation survey. Following, qualitative analysis of focus groups explored facilitating factors and barriers of Sofu-Net. Of 66 network partners who completed the survey (response 83.5%), the majority was satisfied with Sofu-Net, and perceived improvements regarding management, early detection, and referral to mental health care. Both survey and focus groups identified interdisciplinary collaboration and diagnostic screening as most relevant facilitating factors. Important barriers to implementation included challenges in patient referral and structural factors. Necessary prerequisites for future stepped collaborative care for SSRD include structures facilitating diagnosis, inter-professional collaboration and referral, availability of mental health care, inclusion of comorbidities, and adequate reimbursement.
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Affiliation(s)
- Meike C. Shedden-Mora
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Amina Kuby
- Department of Nursing and Management, Hamburg University of Applied Sciences, Hamburg, Germany
| | - Justus Tönnies
- Clinic for General Internal Medicine and Psychosomatics, University Medical Center Heidelberg, Germany
| | - Katharina Piontek
- Institute for Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Heddaeus D, Dirmaier J, Brettschneider C, Daubmann A, Grochtdreis T, von dem Knesebeck O, König HH, Löwe B, Maehder K, Porzelt S, Rosenkranz M, Schäfer I, Scherer M, Schulte B, Wegscheider K, Weigel A, Werner S, Zimmermann T, Härter M. Study protocol for the COMET study: a cluster-randomised, prospective, parallel-group, superiority trial to compare the effectiveness of a collaborative and stepped care model versus treatment as usual in patients with mental disorders in primary care. BMJ Open 2019; 9:e032408. [PMID: 31767595 PMCID: PMC6887029 DOI: 10.1136/bmjopen-2019-032408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/10/2019] [Accepted: 10/10/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Mental healthcare is one of the biggest challenges for healthcare systems. Comorbidities between different mental disorders are common, and patients suffer from a high burden of disease. While the effectiveness of collaborative and stepped care models has been shown for single disorders, comorbid mental disorders have rarely been addressed in such care models. The aim of the present study is to evaluate the effectiveness of a collaborative and stepped care model for depressive, anxiety, somatoform and alcohol use disorders within a multiprofessional network compared with treatment as usual. METHODS AND ANALYSIS In a cluster-randomised, prospective, parallel-group superiority trial, n=570 patients will be recruited from primary care practices (n=19 practices per group). The intervention is a newly developed collaborative and stepped care model in which patients will be treated using treatment options of various intensities within an integrated network of outpatient general practitioners, psychiatrists, psychotherapists and inpatient institutions. It will be compared with treatment as usual with regard to effectiveness, cost-effectiveness and feasibility, with the primary outcome being a change in mental health-related quality of life from baseline to 6 months. Patients in both groups will undergo an assessment at baseline, 3, 6 and 12 months after study inclusion. ETHICS AND DISSEMINATION The study has been approved by the ethics committee of the Hamburg Medical Association (No. PV5595) and will be carried out in accordance with the principles of the Declaration of Helsinki. For dissemination, the results will be published in peer-reviewed journals and presented at conferences. Within the superordinate research project Hamburg Network for Health Services Research, the results will be communicated to relevant stakeholders in mental healthcare. TRIAL REGISTRATION NUMBER NCT03226743.
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Affiliation(s)
- Daniela Heddaeus
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Brettschneider
- Institute of Health Economics and Health Care Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Daubmann
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Grochtdreis
- Institute of Health Economics and Health Care Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Institute of Health Economics and Health Care Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kerstin Maehder
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Porzelt
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Moritz Rosenkranz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Schulte
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angelika Weigel
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Werner
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Zimmermann
- Department of General Practice / Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Lehmann M, Jonas C, Pohontsch NJ, Zimmermann T, Scherer M, Löwe B. General practitioners' views on the diagnostic innovations in DSM-5 somatic symptom disorder - A focus group study. J Psychosom Res 2019; 123:109734. [PMID: 31376875 DOI: 10.1016/j.jpsychores.2019.109734] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 05/29/2019] [Accepted: 05/31/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The innovations concerning the new diagnosis somatic symptom disorder (SSD) in the DSM-5 include the introduction of psychological diagnostic criteria and the elimination of the need to exclude all potential somatic causes of the symptoms. Thus far, it is unknown how general practitioners (GPs) evaluate the innovations conceptually and regarding their applicability in primary care. METHOD We performed six focus groups with GPs. A semi-structured interview-guideline included a presentation of the innovations of SSD and questions about the innovations and their potential (dis-)advantages from the GPs' points of view. The material was analyzed using structuring qualitative content analysis. RESULTS A total of 41 GPs participated (mean (sd) age = 51 (8.5) years, female = 17, male = 24). The GPs assessed that the diagnostic innovations could help them to focus on symptom-related concerns and anxiety as core aspects of the patients' complaints. However, the meaning of the term excessive in the psychological diagnostic criteria (i.e., excessive worries, anxiety, time and energy) was ambiguous for the GPs. The GPs appreciated that a mental disorder can be assigned in addition to a severe physical disease. The GPs found it unlikely that diagnostic workup of somatic symptoms would be cut short if the diagnostic criteria of SSD were fulfilled in a given patient. CONCLUSION Altogether, for the GPs, the advantages of the new diagnostic criteria for SSD outweighed the disadvantages. In particular, the newly included psychological criteria were seen as an important advancement in comparison to the previous need of merely excluding a physical disease.
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Affiliation(s)
- Marco Lehmann
- Department of Psychosomatic Medicine and Psychotherapy, Center for Internal Medicine, University Medical Center, Hamburg-Eppendorf, Germany.
| | - Christina Jonas
- Department of Psychosomatic Medicine and Psychotherapy, Center for Internal Medicine, University Medical Center, Hamburg-Eppendorf, Germany.
| | - Nadine Janis Pohontsch
- Department of General Practice/Primary Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Germany.
| | - Thomas Zimmermann
- Department of General Practice/Primary Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Germany.
| | - Martin Scherer
- Department of General Practice/Primary Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Germany.
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, Center for Internal Medicine, University Medical Center, Hamburg-Eppendorf, Germany.
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Kuby AK, Löwe B, Fabisch AB, Piontek K, Härter M, König HH, Shedden-Mora MC. Predictors of Seeking Psychotherapy in Primary Care Patients with High Somatic Symptom Burden. Behav Med 2019; 45:231-239. [PMID: 30526413 DOI: 10.1080/08964289.2018.1510366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Many primary care patients with high somatic symptom burden do not initiate mental health treatment. Using a cross-sectional design, this study aimed to identify predictors of psychotherapy seeking behavior for patients with high somatic symptom burden within the last 12 months. Data from 20 primary care practices were analyzed. Patients with high somatic symptom burden were identified using the Patient Health Questionnaire, structured interviews, and information from primary care physicians (PCPs). Within the final sample of 142 patients, 54 (38.03%) had been seeking psychotherapy. More severe somatic symptoms, taking psychopharmacological medication and frequently discussing psychosocial distress with PCPs, were associated with psychotherapy seeking behavior. Depressive and anxiety symptoms, and whether PCPs had diagnosed a somatoform disorder or recommended psychotherapy, were not. The results underline the importance of patient-related factors in psychotherapy seeking behavior.
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Affiliation(s)
- Amina K Kuby
- a Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf , Hamburg , Germany.,b Department of Nursing and Management, Hamburg University of Applied Sciences , Hamburg , Germany
| | - Bernd Löwe
- a Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Alexandra B Fabisch
- a Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Katharina Piontek
- c Institute for Medical Psychology, University Medicine Greifswald , Greifswald , Germany
| | - Martin Härter
- d Department of Medical Psychology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Hans-Helmut König
- e Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Meike C Shedden-Mora
- a Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
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12
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Heddaeus D, Dirmaier J, Daubmann A, Grochtdreis T, König HH, Löwe B, Maehder K, Porzelt S, Rosenkranz M, Schäfer I, Scherer M, Schulte B, von dem Knesebeck O, Wegscheider K, Weigel A, Werner S, Zimmermann T, Härter M. [Clinical trial of a stepped and collaborative care model for mental illnesses and comorbidities in the Hamburg Network for Health Services Research]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:205-213. [PMID: 30607447 DOI: 10.1007/s00103-018-2865-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Healthcare for mental disorders is a big challenge for the German healthcare system. In cases of comorbid mental diseases, patients suffer from an especially high burden of disease. So far, innovative care models for collaborative and stepped care have only been investigated with respect to their effectiveness for single mental disorders.The project "Collaborative and Stepped Care in Mental Health by Overcoming Treatment Sector Barriers" (COMET), which is being carried out by the Hamburg Network for Health Services Research (HAM-NET) from 2017 until 2020, examines an innovative, guideline-based healthcare model for the improvement of healthcare for patients with mental illnesses and their potential comorbidities. In this article this new stepped and collaborative care model for patients in primary care that integrates general practitioners, psychiatrists, psychotherapists, and hospitals is presented. For the implementation and facilitation of the model, guideline-based treatment pathways, a tablet-based computer program for screening, diagnostic and guideline-based treatment recommendations, as well as a web-based transferal platform were developed.The results of this project on the effectiveness and efficacy of the model can help determine if the model can be implemented in routine healthcare. This could represent a major step towards more integrated and cross-sectoral healthcare for patients with mental illnesses.
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Affiliation(s)
- Daniela Heddaeus
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Jörg Dirmaier
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Anne Daubmann
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Thomas Grochtdreis
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Hans-Helmut König
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Bernd Löwe
- Institut und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Kerstin Maehder
- Institut und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Sarah Porzelt
- Institut und Poliklinik für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Moritz Rosenkranz
- Zentrum für interdisziplinäre Suchtforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Ingo Schäfer
- Zentrum für interdisziplinäre Suchtforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Martin Scherer
- Institut und Poliklinik für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Bernd Schulte
- Zentrum für interdisziplinäre Suchtforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Olaf von dem Knesebeck
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Karl Wegscheider
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Angelika Weigel
- Institut und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Silke Werner
- Institut für Medizinische Soziologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Thomas Zimmermann
- Institut und Poliklinik für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Martin Härter
- Institut und Poliklinik für Medizinische Psychologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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13
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Limburg K, Dinkel A, Schmid-Mühlbauer G, Sattel H, Radziej K, Becker-Bense S, Henningsen P, Dieterich M, Lahmann C. Neurologists' Assessment of Mental Comorbidity in Patients With Vertigo and Dizziness in Routine Clinical Care-Comparison With a Structured Clinical Interview. Front Neurol 2018; 9:957. [PMID: 30483214 PMCID: PMC6242889 DOI: 10.3389/fneur.2018.00957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/25/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Mental health comorbidities are frequent in patients with vertigo and dizziness. The current study was conducted in a specialized interdisciplinary university center for vertigo and dizziness. Clinical routines consist of a structured work-up in which neuro-otological and neurological tests are performed to first detect possible organic vestibular deficits. In addition, psychiatric disorders and comorbidities are considered. The study aimed to evaluate neurologists' awareness of psychiatric next to somatic disorders within patients' first examination in terms of diagnostic congruence between neurologists' diagnoses and structured clinical assessment of mental disorders. Methods: The study involved 392 patients. Diagnostic evaluation included (a) structured history-taking (including psychosocial anamnesis), neurological, and neuro-otological diagnostics conducted by neurologists and (b) a structured clinical interview for mental disorders (SCID-I) conducted by psychologists and final-year medical or psychology students. Cohen's Kappa was calculated to determine agreement rates regarding depression and anxiety disorders; additionally, sensitivity and specificity were evaluated. Results: Neurologists' assessments led to at least one psychiatric diagnosis among the main diagnoses in 40 (10.2 %) patients, whereas the structured clinical interview led to at least one DSM-IV psychiatric diagnosis in 174 (44.4%) of the patients. Agreement was low (κ < 0.2); sensitivity was low (15%) but specificity was high (98%). Conclusions: Agreement between the diagnosis of neurologists and structured clinical interviews for psychiatric disorders is low. Since psychiatric disorders are frequent in vertigo and dizziness and tend to take a chronic course, improving early recognition and implementing appropriate care concepts is vital.
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Affiliation(s)
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | | | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Katharina Radziej
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Sandra Becker-Bense
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Marianne Dieterich
- German Center for Vertigo and Balance Disorders, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,Department of Neurology, University Hospital, Ludwig-Maximilians University, Munich, Germany.,Cluster of Systems Neurology-SyNergy, Munich, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany
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14
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Piontek K, Shedden-Mora MC, Gladigau M, Kuby A, Löwe B. Diagnosis of somatoform disorders in primary care: diagnostic agreement, predictors, and comaprisons with depression and anxiety. BMC Psychiatry 2018; 18:361. [PMID: 30419878 PMCID: PMC6233530 DOI: 10.1186/s12888-018-1940-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/24/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To investigate (a) the diagnostic agreement between diagnoses of somatoform disorders, depressive and anxiety disorders obtained from a structured clinical interview and diagnoses reported from primary care physicians (PCPs) and (b) to identify patient and PCP-related predictors for the diagnostic agreement regarding the presence of a somatoform disorder. METHODS Data from a cross-sectional study comprising 112 primary care patients at high risk for somatoform disorders were analyzed. Diagnoses according to International Classification of Diseases, 10th revision (ICD-10) for somatoform, depressive and anxiety disorders were obtained from the Composite International Diagnostic Interview (CIDI) and compared with the diagnoses of the patients' PCPs documented in their medical records. Using multiple regression analyses, predictors for the PCPs' diagnosis of a somatoform disorder were analyzed. RESULTS The agreement between PCP diagnoses and CIDI diagnoses was 32.3% for somatoform disorders, 48.0% for depressive disorders and 25.0% for anxiety disorders. Multiple regression analyses revealed the likelihood of being diagnosed with a somatoform disorder by PCP increased with somatic symptom severity (OR = 1.22, 95% CI 1.03-1.44). Regarding PCP-related characteristics, a specialization in internal medicine (OR = 5.95, 95% CI 1.70-20.80) and working in a solo practice (OR = 2.92, 95% CI 1.02-8.38) increased the likelihood that patients were diagnosed with a somatoform disorder. CONCLUSIONS The present results indicate that the process of diagnosing somatoform disorders in primary care needs to be improved. Findings further underline the necessity to implement appropriate strategies to improve early detection of patients. TRIAL REGISTRATION ISRCTN ISRCTN55870770 . Registered 22 October 2014. Retrospectively registered.
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Affiliation(s)
- Katharina Piontek
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany. .,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Meike C. Shedden-Mora
- 0000 0001 2180 3484grid.13648.38Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Gladigau
- 0000 0001 2180 3484grid.13648.38Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Amina Kuby
- 0000 0001 2180 3484grid.13648.38Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- 0000 0001 2180 3484grid.13648.38Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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15
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Magaard JL, Liebherz S, Melchior H, Engels A, König HH, Kriston L, Schulz H, Jahed J, Brütt AL, Reber KC, Härter M. Collaborative mental health care program versus a general practitioner program and usual care for treatment of patients with mental or neurological disorders in Germany: protocol of a multiperspective evaluation study. BMC Psychiatry 2018; 18:347. [PMID: 30359248 PMCID: PMC6202836 DOI: 10.1186/s12888-018-1914-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 09/27/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND German statutory health insurances are pursuing the goal of improving treatment of chronically ill people by promoting networks of health care providers and supporting treatments that reflect the current medical knowledge. The so-called PNP program is a collaborative care program developed by a German statutory health insurance, which defines specific rules on psychiatric, neurological, psychosomatic, and psychotherapeutic treatment. It aims to strengthen provision of guideline-based outpatient treatment and collaboration between different health care providers. It includes the general practitioners' program, which aims to strengthen the coordinating role of GPs. This study aims to evaluate the PNP program. METHODS To evaluate the effectiveness of the PNP program, we will conduct a prospective non-randomized controlled trial with primary data comparing patients enrolled in the PNP program and in the general practitioner program (intervention group) to patients enrolled only in the general practitioner program and patients who receive usual care (control groups). To evaluate costs and level of detail of diagnoses in care of patients with PNP program, we will use routinely collected secondary administrative health data in a retrospective quasi-experimental design. Patients who are at least 18 years old, insured by the statutory health insurance AOK, and on sick leave due to one of the mental or neurological diagnoses (affective, anxiety, somatoform or adjustment disorders, alcohol use disorders, schizophrenia, multiple sclerosis) will be included. We will collect data at baseline and at 12-months follow-up. Health-related quality of life (primary data) and direct costs (secondary data) caused by outpatient and inpatient service utilization and medication will be the primary outcomes. We will analyze data using (generalized) linear mixed models and exploratory analyses. We will use entropy balancing to control for possible differences between the groups. We will use an exploratory sequential design including qualitative and descriptive statistical analyses to assess the structure and process quality of the PNP program among health care providers. DISCUSSION The results will help to develop a comprehensive picture of collaborative care programs for mental and neurological health care from the perspective of patients, health care providers, and health insurance companies. TRIAL REGISTRATION German Clinical Trial Register DRKS00013114.
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Affiliation(s)
- Julia Luise Magaard
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W26, 20246 Hamburg, Germany
| | - Sarah Liebherz
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W26, 20246 Hamburg, Germany
| | - Hanne Melchior
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W26, 20246 Hamburg, Germany
| | - Alexander Engels
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W26, 20246 Hamburg, Germany
| | - Holger Schulz
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W26, 20246 Hamburg, Germany
| | | | - Anna Levke Brütt
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W26, 20246 Hamburg, Germany
- Department for Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Katrin Christiane Reber
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W26, 20246 Hamburg, Germany
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16
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Hüsing P, Löwe B, Piontek K, Shedden-Mora M. Somatoform disorder in primary care: The influence of co-morbidity with anxiety and depression on health care utilization. J Eval Clin Pract 2018; 24:892-900. [PMID: 29498165 DOI: 10.1111/jep.12898] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 02/01/2018] [Indexed: 12/25/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Patients with somatoform disorders are frequent attenders in primary and secondary care. While co-morbid mental disorders, especially depression and anxiety, are frequently present, there is controversy on whether mental co-morbidity leads to higher health care utilization (HCU). The present paper investigates the influence of co-morbid depressive and anxiety disorders on primary, specialized somatic and mental HCU in primary care patients with somatoform disorders. Additionally, we investigated the predictive value of self-rated health and illness perception on HCU. METHODS Patients in 19 primary care practices were screened with the Patient Health Questionnaire, and patients at high risk for somatoform disorders were assessed using the Composite International Diagnostic Interview. N = 71 patients with somatoform disorders were analysed. We analysed whether having one vs two co-morbidities (depression and/or anxiety), self-rated health, and illness perception were predictors for primary, specialized somatic and mental HCU using binominal and hierarchical regression analyses. RESULTS Having both co-morbid depressive and anxiety disorder predicted higher primary HCU (IRR = 1.96, 95% CI, 1.30-2.93), and increased the odds of being in mental health care (OR = 5.16, 95% CI, 1.10-24.20), while only one co-morbidity did not. No differences were found for specialized somatic HCU. Illness perception and self-rated health did not predict HCU. CONCLUSION Not a single but only the presence of multiple co-morbidities predicts primary and mental HCU in patients with somatoform disorder. Health care utilization might be essentially influenced by the associated psychological distress, which should be considered in treatment.
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Affiliation(s)
- Paul Hüsing
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Hamburg-Eppendorf & Schön Clinic Hamburg-Eilbek, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Hamburg-Eppendorf & Schön Clinic Hamburg-Eilbek, Hamburg, Germany
| | - Katharina Piontek
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Hamburg-Eppendorf & Schön Clinic Hamburg-Eilbek, Hamburg, Germany.,Department of Medical Psychology, University Medical School, Greifswald, Germany
| | - Meike Shedden-Mora
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Hamburg-Eppendorf & Schön Clinic Hamburg-Eilbek, Hamburg, Germany
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17
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Effectiveness of a Stepped, Collaborative, and Coordinated Health Care Network for Somatoform Disorders (Sofu-Net): A Controlled Cluster Cohort Study. Psychosom Med 2018; 79:1016-1024. [PMID: 28498279 DOI: 10.1097/psy.0000000000000491] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Stepped, collaborative, and coordinated approaches have been proposed as the optimal treatment strategy for somatic symptom and related disorders, but evidence supporting this strategy is lacking. The aim of this study was to assess the effectiveness of a guideline-based health care network for patients who are at high risk of somatoform disorder (Sofu-Net). METHODS In a controlled, prospective, observer-blinded cluster cohort study, patients who were at high risk of somatoform disorder were recruited at 18 primary care practices in the Sofu-Net and at 15 primary care practices that provided care as usual (CAU). The primary outcome at 6-month follow-up was the rate at which the patients received mental health treatment since the establishment of Sofu-Net. The secondary outcomes included the patients' clinical symptom severity. RESULTS A total of 119 patients in the Sofu-Net intervention group and 100 patients in the CAU control group who were at high risk of somatoform disorder were followed for 6 months. A significantly greater proportion of Sofu-Net patients than CAU patients received mental health treatment (47.9% versus 31.0%; odds ratio = 1.96; 95% confidence interval, 1.07-3.58). However, the Sofu-Net group did not show greater reductions in clinical symptom burden compared with the CAU group. CONCLUSIONS The treatment of somatoform disorders within a guideline-based health care network resulted in increased rates of mental health treatment but failed to improve patient clinical outcomes. Future investigations are needed to investigate the combined value of health care networks with specialized psychotherapy interventions in patients at high risk of somatic symptom and related disorders. TRIAL REGISTRATION ISRCTN55870770.
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18
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Abstract
Functional neurological disorders are conceptualized as patterns of neurological symptoms that cannot be attributed to a clear organic etiology. The study by Wilkins et al. in this issue of Psychosomatic Medicine reveals that 8.2% of patients who were initially presented with suspected stroke were later diagnosed with functional disorders, i.e., "functional stroke mimics." However, the percentage of functional stroke mimics varied substantially with patients' nationality, age, and sex. In this editorial comment, we discuss potential reasons for the intercultural variation of the frequency of functional stroke mimics.The current models of symptom perception, in which symptom perception is guided by top-down processes of the central nervous system, are helpful in explaining the intercultural variation of functional symptoms. According to these models, cultural beliefs, previous illnesses, and stressful life situations influence patients' expectations, sensory input, and finally the perception of somatic symptoms. In addition, differences in insurance status, health literacy, and health care experiences are strong predictors of health care use in patients who experience somatic symptoms.This article provides a conceptual model that integrates sociocultural factors with symptom perception and health care use relevant to the different rates of functional somatic symptoms in emergency departments across nationalities. Considering these factors, future attempts to improve care for patients with functional disorders should enhance access to effective treatment for all patient groups, empower patients through education and early participation in the treatment process, and foster interdisciplinary collaboration among specialists from somatic and mental health disciplines.
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19
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Duration of untreated illness in patients with somatoform disorders. J Psychosom Res 2018; 107:1-6. [PMID: 29502757 DOI: 10.1016/j.jpsychores.2018.01.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/20/2017] [Accepted: 01/18/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE A long duration of untreated mental illness (DUI) has been found to be associated with negative long-term outcomes. Although somatic symptom and related disorders are frequent in the general population and in primary care, data regarding the DUI of these disorders is scarce. The aim of this study was to investigate the DUI in patients with somatoform disorders. METHODS In a cross-sectional study, primary care patients at high risk of having a somatoform disorder were identified using the Patient Health Questionnaire (PHQ). In a second step, life-time somatoform disorder diagnosis was established using the Composite International Diagnostic Interview (CIDI). Additionally, DUI was retrospectively assessed via self-reporting and sociodemographic information was collected. Survival analysis was used to estimate the DUI and to identify patient-related predictors of DUI. RESULTS A total of 139 patients with somatoform disorders were included in the analyses. The mean DUI in these patients was 25.2years (median 23.1years). Higher education significantly predicted shorter DUI, whereas gender and age of onset were unrelated to DUI. CONCLUSIONS The results reveal a substantial delay in adequate treatment of patients with somatoform disorders. The reported DUI emphasizes the importance of improvements in the management of patients with these disorders.
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20
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Saint-Pierre C, Herskovic V, Sepúlveda M. Multidisciplinary collaboration in primary care: a systematic review. Fam Pract 2018; 35:132-141. [PMID: 28973173 DOI: 10.1093/fampra/cmx085] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Several studies have discussed the benefits of multidisciplinary collaboration in primary care. However, what remains unclear is how collaboration is undertaken in a multidisciplinary manner in concrete terms. OBJECTIVE To identify how multidisciplinary teams in primary care collaborate, in regards to the professionals involved in the teams and the collaborative activities that take place, and determine whether these characteristics and practices are present across disciplines and whether collaboration affects clinical outcomes. METHODS A systematic literature review of past research, using the MEDLINE, ScienceDirect and Web of Science databases. RESULTS Four types of team composition were identified: specialized teams, highly multidisciplinary teams, doctor-nurse-pharmacist triad and physician-nurse centred teams. Four types of collaboration within teams were identified: co-located collaboration, non-hierarchical collaboration, collaboration through shared consultations and collaboration via referral and counter-referral. Two combinations were commonly repeated: non-hierarchical collaboration in highly multidisciplinary teams and co-located collaboration in specialist teams. Fifty-two per cent of articles reported positive results when comparing collaboration against the non-collaborative alternative, whereas 16% showed no difference and 32% did not present a comparison. CONCLUSION Overall, collaboration was found to be positive or neutral in every study that compared collaboration with a non-collaborative alternative. A collaboration typology based on objective measures was devised, in contrast to typologies that involve interviews, perception-based questionnaires and other subjective instruments.
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Affiliation(s)
- Cecilia Saint-Pierre
- Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Valeria Herskovic
- Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcos Sepúlveda
- Department of Computer Science, Pontificia Universidad Católica de Chile, Santiago, Chile
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21
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Jordan P, Shedden-Mora MC, Löwe B. Predicting suicidal ideation in primary care: An approach to identify easily assessable key variables. Gen Hosp Psychiatry 2018; 51:106-111. [PMID: 29428582 DOI: 10.1016/j.genhosppsych.2018.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 02/01/2018] [Accepted: 02/01/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To obtain predictors of suicidal ideation, which can also be used for an indirect assessment of suicidal ideation (SI). To create a classifier for SI based on variables of the Patient Health Questionnaire (PHQ) and sociodemographic variables, and to obtain an upper bound on the best possible performance of a predictor based on those variables. METHODS From a consecutive sample of 9025 primary care patients, 6805 eligible patients (60% female; mean age = 51.5 years) participated. Advanced methods of machine learning were used to derive the prediction equation. Various classifiers were applied and the area under the curve (AUC) was computed as a performance measure. RESULTS Classifiers based on methods of machine learning outperformed ordinary regression methods and achieved AUCs around 0.87. The key variables in the prediction equation comprised four items - namely feelings of depression/hopelessness, low self-esteem, worrying, and severe sleep disturbances. The generalized anxiety disorder scale (GAD-7) and the somatic symptom subscale (PHQ-15) did not enhance prediction substantially. CONCLUSIONS In predicting suicidal ideation researchers should refrain from using ordinary regression tools. The relevant information is primarily captured by the depression subscale and should be incorporated in a nonlinear model. For clinical practice, a classification tree using only four items of the whole PHQ may be advocated.
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Affiliation(s)
- Pascal Jordan
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany; Psychological Methods, Faculty for Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany.
| | - Meike C Shedden-Mora
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany.
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany.
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Deter HC, Kruse J, Zipfel S. History, aims and present structure of psychosomatic medicine in Germany. Biopsychosoc Med 2018; 12:1. [PMID: 29434655 PMCID: PMC5795290 DOI: 10.1186/s13030-017-0120-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/24/2017] [Indexed: 12/12/2022] Open
Abstract
Combining its two traditions of integrated psychosomatics in internal medicine and focusing on psychotherapeutic/psychiatric methods in many clinical fields, German psychosomatic medicine has developed well over the last decades. It benefits from its institutional independence and the progressive changes in health care. Clinically, disorder-oriented psychotherapy is a core method integrated with other modes of therapy. As a conceptual base for empirical research, non-reductionist accounts of the interactions of (sick) persons with their environment are most important. Germany has developed a model of Psychosomatic Medicine that has conceptualized and integrated psychotherapeutic methods into clinical practice and realized one way to practice bio-psycho-social medicine in the health care system of the country.
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Affiliation(s)
- Hans-Christian Deter
- Medical Clinic, Psychosomatics, Charité, Hindenburgdamm 30, 12200 Berlin, Germany
| | - Johannes Kruse
- Clinic for Psychosomatic Medicine and Psychotherapy, German Association of Psychosomatic Medicine and Psychotherapy (DGPM), University Gießen und Marburg GmbH, Giessen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tuebingen, German College of Psychosomatic Medicine (DKPM), Tuebingen, Germany
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Heinbokel C, Lehmann M, Pohontsch NJ, Zimmermann T, Althaus A, Scherer M, Löwe B. Diagnostic barriers for somatic symptom disorders in primary care: study protocol for a mixed methods study in Germany. BMJ Open 2017; 7:e014157. [PMID: 28801385 PMCID: PMC5724128 DOI: 10.1136/bmjopen-2016-014157] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 05/17/2017] [Accepted: 06/21/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Somatoform or somatic symptom disorders ((S)SD) are common and have a negative impact on the patients' health-related quality of life, healthcare use and costs. In primary care, which is central to the management of (S)SD, diagnosis and treatment tend to be delayed. There is a significant lack of evidence regarding the barriers in the diagnostic process of (S)SD in primary care and how interventions should be tailored to address them. The aim of this study is to analyse the diagnostic process in primary care that results in the diagnosis or non-diagnosis of a (S)SD. METHODS AND ANALYSIS This mixed methods study will investigate the topic with qualitative methods, subsequently proceeding to a quantitative phase where the initial results will be validated and/or generalised. First, focus groups will explore meanings and patterns, inconsistencies and conflicts in general practitioners' (GPs) thoughts and behaviours when diagnosing (S)SD. Second, the results of these focus groups will be used to develop interview guidelines for subsequent face-to-face interviews. Patients and their treating GPs will be interviewed separately on how they experience the history of illness, the diagnostic process and treatment. Third, based on the results of the first two study parts, a questionnaire will be derived and a nationwide survey among German GPs will be conducted, quantifying the barriers and difficulties identified before. ETHICS AND DISSEMINATION Ethics approval was obtained from the Ethics Committee of the Hamburg Medical Association, Germany (approval number PV4763). The results of this study will be disseminated through conference presentation and publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER The study is registered in the German Clinical Trial Register (DRKS), DRKS-ID DRKS00009736.
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Affiliation(s)
- Christina Heinbokel
- Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg Eilbek, Hamburg, Germany
| | - Marco Lehmann
- Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg Eilbek, Hamburg, Germany
| | - Nadine Janis Pohontsch
- General Practice/Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Zimmermann
- General Practice/Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Astrid Althaus
- General Practice/Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of General Medicine Cologne, University Hospital of Cologne, Cologne, Germany
| | - Martin Scherer
- General Practice/Primary Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg Eilbek, Hamburg, Germany
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Jordan P, Shedden-Mora MC, Löwe B. Psychometric analysis of the Generalized Anxiety Disorder scale (GAD-7) in primary care using modern item response theory. PLoS One 2017; 12:e0182162. [PMID: 28771530 PMCID: PMC5542568 DOI: 10.1371/journal.pone.0182162] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 07/13/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The Generalized Anxiety Disorder scale (GAD-7) is one of the most frequently used diagnostic self-report scales for screening, diagnosis and severity assessment of anxiety disorder. Its psychometric properties from the view of the Item Response Theory paradigm have rarely been investigated. We aimed to close this gap by analyzing the GAD-7 within a large sample of primary care patients with respect to its psychometric properties and its implications for scoring using Item Response Theory. METHODS Robust, nonparametric statistics were used to check unidimensionality of the GAD-7. A graded response model was fitted using a Bayesian approach. The model fit was evaluated using posterior predictive p-values, item information functions were derived and optimal predictions of anxiety were calculated. RESULTS The sample included N = 3404 primary care patients (60% female; mean age, 52,2; standard deviation 19.2) The analysis indicated no deviations of the GAD-7 scale from unidimensionality and a decent fit of a graded response model. The commonly suggested ultra-brief measure consisting of the first two items, the GAD-2, was supported by item information analysis. The first four items discriminated better than the last three items with respect to latent anxiety. CONCLUSION The information provided by the first four items should be weighted more heavily. Moreover, estimates corresponding to low to moderate levels of anxiety show greater variability. The psychometric validity of the GAD-2 was supported by our analysis.
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Affiliation(s)
- Pascal Jordan
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany
- Department of Psychological Methods, Faculty of Psychology and Movement Sciences. University of Hamburg, Hamburg, Germany
- * E-mail:
| | - Meike C. Shedden-Mora
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany
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[Bio-psycho-socio or psychotherapeutic medicine - actual development of psychosomatics in clinical practice]. Wien Med Wochenschr 2017; 168:52-61. [PMID: 28744775 DOI: 10.1007/s10354-017-0582-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
In Germany a model of Psychosomatic Medicine has developed, which integrated several psychotherapeutic methods in clinical practice. The concept, which focused on disease mechanisms in the human body and the interaction between diseased individuals and their environment became a basic psychosomatic research strategy and was imlemented in medical care. In this paper the result of a psychosomatic development in clinical health care and research and possible deficiences are described. Perspectives of development and future tasks of Psychosomatic Medicine will be reviewed.
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Zipfel S, Herzog W, Kruse J, Henningsen P. Psychosomatic Medicine in Germany: More Timely than Ever. PSYCHOTHERAPY AND PSYCHOSOMATICS 2017; 85:262-9. [PMID: 27509065 DOI: 10.1159/000447701] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/16/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital Tübingen, Tübingen, Germany
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Häufigkeit somatoformer Syndrome in der Allgemeinmedizin. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2017; 63:202-212. [DOI: 10.13109/zptm.2017.63.2.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sirri L, Grandi S, Tossani E. Medically unexplained symptoms and general practitioners: a comprehensive survey about their attitudes, experiences and management strategies. Fam Pract 2017; 34:201-205. [PMID: 28122844 DOI: 10.1093/fampra/cmw130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Medically unexplained symptoms (MUS) are common in primary care and are one of the most challenging clinical encounters for general practitioners (GPs). OBJECTIVE To assess GPs' clinical experience with MUS and its relationship with their gender, age and length of practice. METHODS Four hundred and thirty-three Italian GPs were invited to complete a questionnaire encompassing the following MUS-related features: workload, cognitive and emotional responses, management strategies, attitudes towards psychological interventions, sources of education and educational needs. RESULTS A total of 347 GPs (80.1%) participated in the study. About seven out of ten physicians spent 'much' or 'very much' time and energy for MUS during their daily practice. Fear of neglecting a medical disease was the most frequent (59.1%) response to MUS. Providing reassurance and support (73.8%) and listening to the patient (69.2%) were the most frequent management strategies. More than half of GPs rated psychological interventions as 'much' or 'very much' useful for MUS. However, only a third of GPs were well informed about the role of psychologists in MUS management. The main sources of education about MUS were scientific papers and continuing medical education courses. Most of GPs (77.5%) needed further education about MUS. GPs' younger age and lower length of practice were significantly associated with negative emotional responses to MUS. CONCLUSION The introduction of guidelines for MUS in Italian primary care settings would promote a collaborative clinical approach to MUS and more formal training on this topic.
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Affiliation(s)
- Laura Sirri
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
| | - Silvana Grandi
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
| | - Eliana Tossani
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
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