1
|
Study of the Unidimensionality of the Subjective Measurement Scale of Schizophrenia Coping Oral Health Profile and Index: SCOOHPI. Behav Sci (Basel) 2022; 12:bs12110442. [DOI: 10.3390/bs12110442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/02/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The Schizophrenia Coping Oral Health Profile and Index (SCOOHPI) scale studies the coping strategies of schizophrenic patients with regard to oral health. The structural validity of this scale is studied has been studied using factor analyses. In this article, we study the unidimensionality of the SCOOHPI scale to use it as an index. Methods: We studied the internal consistency of the items of the SCOOHPI scale. Then, we studied the construct validity. The unidimensionality of the SCOOHPI scale was studied by the partial credit model. Results: The data used in this study come from five hospitals, and the total number of individuals participating in this study is 96, of which 72% are men and 59% are smokers. The SCOOHPI scale has good internal consistency (α = 0.84). The validity of divergence was checked by the absence of correlation between the SCOOHPI scale and the GOHAI (General Oral Health Assessment Index) scale. The unidimensionality of the SCOOHPI scale with data smoothing was demonstrated by the partial credit model. Conclusion: In this study, we completed the study of the psychometric validation of the SCOOHPI. The SCOOHPI scale can then contribute to improving evaluation of the coping strategies of schizophrenic patients with regard to oral health.
Collapse
|
2
|
Psychological distress is independently related to new coronary events at 8 years' follow-up in elderly primary care patients with hypertension. J Psychosom Res 2022; 160:110980. [PMID: 35779439 DOI: 10.1016/j.jpsychores.2022.110980] [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] [Received: 02/18/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Occurrence of psychological distress in hypertensive patients could have a negative synergistic effect on future cardiovascular events (CVEs). The aim of this study was to determine the association between anxiety or depressive symptoms in elderly hypertensive primary care patients and the development of new CVEs and all-cause mortality. METHODS A prospective cohort study was conducted in five Dutch general practices between June 2010 and January 2012. Patients with primary care managed hypertension, aged 60-85 years, were included and completed the GAD-7 and PHQ-9, measuring anxiety and depressive symptoms respectively. The incidence of new CVEs (coronary event, cerebrovascular disease, atrial fibrillation and heart failure) and all-cause mortality at 8 years' follow-up was recorded by data extraction of the digital information systems. RESULTS Among the 555 included participants (mean age 70 ± 6.6 years; 56% female), 29 (5.2%) had a new coronary event, 42 (7.6%) a cerebrovascular disease, 57 (10.3%) atrial fibrillation, 22 (4%) heart failure and 68 (12.3%) died. Elevated anxiety and depression scores increased the risk of a coronary event independently and significantly by 12% (HR 1.12; 95% CI [1.04-1.22], p = 0.005) and 18% (HR 1.18; 95% CI [1.08-1.28], p < 0.0001), respectively, adjusted for relevant (Framingham) baseline covariates. No associations were found with regard to other CVEs and all-cause mortality. CONCLUSION In a random sample of elderly primary care hypertension patients there was a significant association between psychological distress and the occurrence of new coronary events after 8 years' follow-up but not with other CVEs and all-cause mortality.
Collapse
|
3
|
Aaby A, Ravn SL, Elfström ML, Kasch H, Andersen TE. Does the Danish version of the Spinal Cord Lesion-related Coping Strategies Questionnaire measure what we think it measures? A triangulated mixed-methods validation approach. Spinal Cord 2022; 60:1080-1086. [PMID: 35717550 DOI: 10.1038/s41393-022-00825-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN Triangulated mixed-methods validation study. OBJECTIVES To validate the Danish version of the Spinal Cord Lesion-related Coping Strategies Questionnaire (SCL-CSQ). SETTING Community in Denmark. METHODS Participants were invited via a patient organization and its specialized hospital. Eligibility criteria were having a spinal cord injury (SCI), being 18 years or older, and able to understand and respond in Danish. Quantitative data were collected to determine internal consistency and criterion validity of the three subscales of SCL-CSQ, i.e., acceptance, fighting spirit, and social reliance. The Three-Step Test-Interview approach was employed to determine whether items measured what they were intended to measure (i.e., construct validity based on response processes). RESULTS The quantitative sample consisted of 107 participants, and the interview sample comprised 11 participants. The acceptance and fighting spirit subscales showed adequate internal consistency (Cronbach's alpha of 0.72 and 0.76 respectively) and satisfactory criterion validity (expected correlations with quality of life and depression). The social reliance subscale showed inadequate internal consistency (Cronbach's alpha of 0.58) and criterion validity. All fighting spirit items and all but one acceptance items were interpreted congruently by most participants. Conversely, two social reliance items were only interpreted congruently by 9 and 27%. CONCLUSION The acceptance and fighting spirit subscales of the Danish version of the SCL-CSQ showed good psychometric properties, while the social reliance subscale showed serious issues and should be revised. Researchers and clinicians are urged to reflect on these findings when revising the SCL-CSQ or adapting it to other languages, cultural contexts, and rehabilitation settings.
Collapse
Affiliation(s)
- Anders Aaby
- Specialized Hospital for Polio and Accident Victims, Roedovre, Denmark. .,InCoRE, Department of Psychology, University of Southern Denmark, Odense, Denmark.
| | - Sophie L Ravn
- Specialized Hospital for Polio and Accident Victims, Roedovre, Denmark.,InCoRE, Department of Psychology, University of Southern Denmark, Odense, Denmark.,ThRIVE, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Magnus L Elfström
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Helge Kasch
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tonny E Andersen
- InCoRE, Department of Psychology, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
4
|
Nielsen SW, Eckhoff L, Ruhlmann CHB, Herrstedt J, Dalton SO. The prevalence, distribution and impact of peripheral neuropathy among Danish patients with cancer - a population-based cross-sectional study. Acta Oncol 2022; 61:363-370. [PMID: 34846991 DOI: 10.1080/0284186x.2021.2007283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Prevalence of peripheral neuropathy (PN) has been studied in patients undergoing treatment with taxanes, platinums and vinca alkaloids. The prevalence is unknown in the general oncological cancer population, characterized by advanced age, comorbidities and heterogeneous treatments. MATERIAL AND METHODS A cross-sectional survey was administered to all adult patients, attending outpatient services at three Danish departments of oncology. The survey contained the EORTC-CIPN20, the EORTC-QLQ-C30, the GAD7 and PHQ9 questionnaires. A high PN symptom score was defined as a summary score ≥30 points on the CIPN20. P-values were adjusted for multiple testing. RESULTS With an overall response rate of 83% (2839 patients), prevalence of PN was 17% overall, varying from 6 to 33% between diagnosis groups.A high score was more common among females (19 vs. 14%, p = .008), smokers (21 vs. 15%, p = .04), patients living alone (21 vs. 15%, p = .002) and patients using cannabis (29 vs. 15%, p < .001), as well as patients suffering from diabetes (26 vs. 16%, p < .001), cardiac heart disease (27 vs. 16%, p < .001), arthritis (32 vs. 15%, p < .001) or chronic obstructive pulmonary disease (25 vs. 16%, p = .01). High score patients were also older (69ys vs 67ys, p = .048) and more likely experiencing polypharmacy (OR = 3.38 [95% CI, 2.64;4.35]).Patients with a high CIPN20 symptom score scored worse on all EORTC QLQ-C30 function and symptom scales. The mean adjusted C30 SumScore difference was -18.66 ([95% CI, -20.31; -17.02], p < .001). CONCLUSION Symptoms of PN are experienced widely across cancer groups in the oncology setting. PN symptoms were associated with clinically relevant worse health-related quality of life and with patient-related factors as living alone, various comorbidities, polypharmacy, and cannabis use.
Collapse
Affiliation(s)
- Sebastian Werngreen Nielsen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde and Naestved, Denmark
| | - Lise Eckhoff
- Department of Oncology R, Odense University Hospital, Odense C, Denmark
| | - Christina Halgaard Bruvik Ruhlmann
- Department of Oncology R, Odense University Hospital, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Jørn Herrstedt
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde and Naestved, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde and Naestved, Denmark
- Survivorship & Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Nielsen SW, Ruhlmann CH, Eckhoff L, Brønnum D, Herrstedt J, Dalton SO. Cannabis use among Danish patients with cancer: a cross-sectional survey of sociodemographic traits, quality of life, and patient experiences. Support Care Cancer 2021; 30:1181-1190. [PMID: 34453567 DOI: 10.1007/s00520-021-06515-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/20/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Patients with cancer are using cannabis for self-treatment. The reasons, experienced effects, and prevalence of use are unknown in the European general oncological population. METHODS Adult patients with cancer attending outpatient oncology clinics were invited to participate in a cross-sectional survey. The questionnaire consisted of sociodemographic questions, validated scales on quality of life, neuropathy, anxiety and depression as well as questions regarding use of cannabis. RESULTS The overall response rate was 83% (2839 patients) and 13% of patients were using or had used cannabis during their treatment. Rate of use was higher in smokers (19% vs 11%, p adjusted 0.002), in patients in active cancer treatment (14% vs 10%, p adjusted = 0.02), and in patients with depression (19% vs 11%, adjusted p = 0.002). Cannabis use was also correlated with lower quality of life (EORTC C30 SumScore mean diff. = - 7.61, 95% CI = [- 9.69; - 5.53]). In total, 77% of users experienced at least one positive effect of cannabis, 18% experienced no effect, and 5% experienced other effects. At least one side effect was experienced by 33% of users. Management of pain and nausea were the primary reasons for initiating cannabis use (39% for both). Less nausea and better sleep were the most common effects experienced (26% for both). Oils for oral use were the most common route of administration (88%). CONCLUSION Cannabis use among patients with cancer is prevalent and correlated with worse quality of life. Patients report using cannabis for symptom management and many experience relief of their symptoms. However, one third of patients experienced side effects.
Collapse
Affiliation(s)
- Sebastian W Nielsen
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 9, 4000, Roskilde, Denmark.
| | - Christina H Ruhlmann
- Department of Clinical Research, University of Southern Denmark, 5000, Odense C, Denmark.,Department of Oncology R, Odense University Hospital, 5000, Odense C, Denmark
| | - Lise Eckhoff
- Department of Oncology R, Odense University Hospital, 5000, Odense C, Denmark
| | - Dorthe Brønnum
- Centre for Clinical Research, North Denmark Regional Hospital, 9800, Hjoerring, Denmark
| | - Jørn Herrstedt
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Vestermarksvej 9, 4000, Roskilde, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1165, Copenhagen, Denmark
| | - Susanne O Dalton
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 1165, Copenhagen, Denmark.,Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, 2100, Copenhagen, Denmark
| |
Collapse
|
6
|
Brejnebøl MW, Walvik L, Christensen AK, Jensen RG, von Buchwald C. Stress reactions in a tertiary oto-rhino-laryngological department during the first wave of the COVID-19 pandemic in the Danish Capital region. Acta Otolaryngol 2021; 141:791-795. [PMID: 34340651 DOI: 10.1080/00016489.2021.1947525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Health care workers (HCW) at otorhinolaryngological departments have an increased risk of contracting COVID-19, due to aerosol-inducing diagnostic and surgical procedures in the airways. The ongoing exposure to physical and psychological stressors could impact the mental health of HCW. AIM/OBJECTIVE To investigate the impact on mental health in an otorhinolaryngological department during the COVID-19 pandemic. MATERIALS/METHOD Cross-sectional questionnaire study, assessing symptoms of depression (PHQ-9) and anxiety (GAD-10). Physicians, nurses, and secretaries were included at a tertiary department of otorhinolaryngology in the Capital Region of Denmark during the COVID-19 lockdown in spring 2020. RESULTS Positive screenings for stress reactions were found in 22% for depressive symptoms and 15.5% anxiety. 27% feared becoming infected, 47% feared infecting their families in relation to work. 27% felt others were distancing from them, and 38% isolated themselves from others because of their work. Women had an odds ratio of 9.18 (CI 1.49-179) for depressive stress reactions. CONCLUSION HCW were primarily concerned with transmitting COVID-19 to their relatives. Secondarily, there was a concern about becoming infected despite feeling adequately protected by personal protective equipment. Women were at higher risk of more severe depressive symptoms when corrected for professions.
Collapse
Affiliation(s)
- Maiken Wissing Brejnebøl
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lena Walvik
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Ramon Gordon Jensen
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
7
|
Frydensberg VS, Johansen JB, Möller S, Strömberg A, Pedersen SS. Psychometric evaluation of the implantable cardioverter defibrillator body image concerns questionnaire (ICD-BICQ). J Cardiovasc Electrophysiol 2021; 32:2295-2311. [PMID: 34091980 DOI: 10.1111/jce.15122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/18/2021] [Accepted: 05/27/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Patients receiving an implantable cardioverter defibrillator (ICD) generally adapt well to living with their device, but we know little about the prevalence of patients' body image concerns (BICs) postimplant. METHODS The objectives were to evaluate the psychometric properties of the ICD-body image concerns questionnaire (BICQ), find a cut-off indicating BICs and determine the prevalence of BICs. Construct validity was determined using the Kaiser-Meyer-Olkin test, Scree-plot and explorative factor analysis. Internal consistency was examined via Cronbach's alpha. Correlations to other validated questionnaires, a weighted and simple scale and a cut-off indicating BICs was evaluated. RESULTS In total, 331 patients completed the 39-item ICD-BICQ together with: Type D Scale (DS14), Generalized Anxiety Disorder scale (GAD-7), Patient Health Questionnaire (PHQ-9), and Florida Patient Acceptance Survey. Five patients were excluded due to reoperations, leaving 326 patients in the analyses. Results revealed a one-factor structure with 32 items and Cronbach's alpha at .948. A cut-off at 36 points displayed the 20% patients with the highest score of BICs. The prevalence was 29.8% in women and 18.4% in men. CONCLUSION The psychometric evaluation of the 32-item ICD-BICQ showed acceptable construct validity and internal reliability. We recommend a cut-off score at 36 points to identify patients at risk of having BICs. The prevalence of BICs indicated that both men and women are at risk of having BICs. The ICD-BICQ can be used in clinical practice to help healthcare professionals to identify patients at risk of BICs and as to evaluate BICs when implementing new operation techniques.
Collapse
Affiliation(s)
- Vivi Skibdal Frydensberg
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark.,OPEN-Open Patient Data Explorative Network, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Sören Möller
- OPEN-Open Patient Data Explorative Network, Odense University Hospital and Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anna Strömberg
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Health, Medicine and Caring Sciences and Department of Cardiology, Linköping University, Linköping, Sweden
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
8
|
Saracino RM, Aytürk E, Cham H, Rosenfeld B, Feuerstahler LM, Nelson CJ. Are we accurately evaluating depression in patients with cancer? Psychol Assess 2020; 32:98-107. [PMID: 31393150 PMCID: PMC6928435 DOI: 10.1037/pas0000765] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Depression remains poorly managed in oncology, in part because of the difficulty of reliably screening and assessing for depression in the context of medical illness. Whether somatic items really skew the ability to identify "true" depression, or represent meaningful indicators of depression, remains to be determined. This study utilized item response theory (IRT) to compare the performance of traditional depression criteria with Endicott's substitutive criteria (ESC; tearfulness or depressed appearance; social withdrawal; brooding; cannot be cheered up). The Patient Health Questionnaire (PHQ-9), ESC, and Center for Epidemiologic Studies Depression Scale (CES-D) were administered to 558 outpatients with cancer. IRT models were utilized to evaluate global and item fit for traditional PHQ-9 items compared with a modified version replacing the 4 somatic items with ESC. The modified PHQ-9 ESC scale was the best fit using a partial credit model; model fit was improved after collapsing the middle 2 response categories and removing psychomotor agitation/retardation. This improved model showed satisfactory scale precision and internal consistency, and was free from differential item functioning for gender, age, and race. Concurrent and criterion validity were supported. Thus, as many have speculated, utilizing the ESC may result in more accurate identification of depressive symptoms in oncology. Depressed mood, anhedonia, and suicidal ideation retained their expected properties in the modified scale, indicating that the traditional underlying syndrome of depression likely remains the same, but the ESC may provide more specificity when assessing patients with cancer. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
- Rebecca M Saracino
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | - Ezgi Aytürk
- Department of Psychology, Fordham University
| | | | - Barry Rosenfeld
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| | | | - Christian J Nelson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center
| |
Collapse
|
9
|
Anum A, Adjorlolo S, Kugbey N. Depressive symptomatology in adolescents in Ghana: Examination of psychometric properties of the Patient Health Questionnaire-9. J Affect Disord 2019; 256:213-218. [PMID: 31181377 DOI: 10.1016/j.jad.2019.06.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/12/2019] [Accepted: 06/02/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Patient Health Questionnaire (PHQ-9) has been used extensively in research and clinical settings. However, there is limited information regarding the psychometric properties of the PHQ-9 among adolescents, particularly in sub-Saharan Africa. METHODS Data were collected from 553 adolescents (girls = 322, 58.1%) using a cross-sectional survey design to investigate the factorial validity, construct validity and internal consistency of the PHQ-9 in Ghana. RESULTS Confirmatory factor analysis (CFA) and multi-group CFA support a one-factor structure of the PHQ-9 that was invariant across gender. The PHQ-9 correlates significantly with measures of anxiety, depression, mental wellbeing, and suicidal behavior. The internal consistency of the PHQ-9 was 0.71. LIMITATION The study did not include a gold standard measure of depression to assess the diagnostic properties (e.g., sensitivity and specificity) of the PHQ-9. CONCLUSION The results suggest that major depressive disorder, measured by the PHQ-9, is a homogeneous construct across gender and that the PHQ-9 can be used to screen for depressive symptoms in adolescent boys and girls in Ghana.
Collapse
Affiliation(s)
- Adote Anum
- Department of Psychology, School of Social Sciences, College of Humanities, University of Ghana, P. O. Box LG 84, Legon, Accra, Ghana
| | - Samuel Adjorlolo
- Department of Mental Health, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, P. O. Box LG 43, Legon, Accra, Ghana; Research and Grant Institute of Ghana, P. O. Box GP 2543, Accra, Ghana.
| | - Nuworza Kugbey
- Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Volta Region, Ghana; Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, South Africa
| |
Collapse
|
10
|
Mathiasen K, Riper H, Andersen TE, Roessler KK. Guided Internet-Based Cognitive Behavioral Therapy for Adult Depression and Anxiety in Routine Secondary Care: Observational Study. J Med Internet Res 2018; 20:e10927. [PMID: 30487118 PMCID: PMC6291683 DOI: 10.2196/10927] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Internet-based cognitive behavioral therapy (iCBT) is a promising new treatment method for depression and anxiety. However, it is important to determine whether its results can be replicated in routine care before its implementation on a large scale. Although many studies have demonstrated the efficacy of iCBT under controlled conditions, only a few studies have investigated its effectiveness in routine care. Furthermore, several effects of iCBT such as treatment effects in routine care are unclear. OBJECTIVE This study aimed to evaluate the clinical effectiveness of iCBT for depression and anxiety in routine secondary care. METHODS n a retrospective cohort study, we analysed patients treated for depression or anxiety in a dedicated iCBT clinic in secondary care in Denmark. Patients were examined before treatment and weekly thereafter by using the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 scales for the diagnoses of depression and anxiety, respectively. Primary analyses were conducted using a linear mixed-effects model with random slope and intercept. Secondary analyses were conducted using baseline characteristics as predictors (gender, age, highest level of education, occupational status, marital status, psychotropic medication use, consumption of alcohol, and leisure drugs). Additionally, logistic regression analyses were used to predict noncompletion of treatment. RESULTS A total of 203 (depression, N=60; anxiety, N=143) patients were included. Participants were mainly female (78.3% with depression and 65.7% with anxiety), with a mean age of 36.03 (SD 10.97) years (range, 19-67 years) for patients with depression and 36.80 (SD 13.55) years (range, 19-69 years) for patients with anxiety. The completion rates were 62% (37) and 40% (57) for depression and anxiety treatments, respectively. The primary analyses revealed large and significant reductions in the symptom levels of depression (beta=-6.27, SE 0.83, P<.001, d=1.0) and anxiety (beta=-3.78, SE 0.43, P<.001, d=1.1). High baseline severity of the primary disorder was associated with high treatment gains (r=-0.31 for depression; r=-0.41 for anxiety). In patients with anxiety, high baseline severity also predicted a high risk of noncompletion (odds ratio=1.08, CI=1.01-1.16, P=.03). An increase in the baseline severity of the comorbid disorder slightly increased the risk of noncompletion for both disorders (depression: odds ratio=1.03, CI=1.01-1.06, P=.02; anxiety: odds ratio=1.08, CI=1.01-1.16, P=.03). CONCLUSIONS iCBT can be clinically effective in routine care. Since depression and anxiety are costly and debilitating disorders that are vastly undertreated, this finding is important. Additionally, iCBT may help bridge the gap between the need for treatment and its provision. Our results are comparable to the within-group results of efficacy and effectiveness studies. Our noncompletion rates are similar to those observed in psychotherapy but are higher than those reported in similar clinics. Multiple factors predicted outcome and noncompletion. However, all predictor effects were statistically weak.
Collapse
Affiliation(s)
- Kim Mathiasen
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Centre for Telepsychiatry, Mental Health Services of Southern Denmark, Odense, Denmark
| | - Heleen Riper
- Department of Mental Health, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Research and Innovation, Specialized Mental Health Care, GGZ InGeest, Amsterdam, Netherlands
| | - Tonny E Andersen
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Kirsten K Roessler
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
11
|
Zimmerman M, Morgan TA, Stanton K. The severity of psychiatric disorders. World Psychiatry 2018; 17:258-275. [PMID: 30192110 PMCID: PMC6127765 DOI: 10.1002/wps.20569] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 06/13/2018] [Accepted: 06/13/2018] [Indexed: 12/19/2022] Open
Abstract
The issue of the severity of psychiatric disorders has great clinical importance. For example, severity influences decisions about level of care, and affects decisions to seek government assistance due to psychiatric disability. Controversy exists as to the efficacy of antidepressants across the spectrum of depression severity, and whether patients with severe depression should be preferentially treated with medication rather than psychotherapy. Measures of severity are used to evaluate outcome in treatment studies and may be used as meaningful endpoints in clinical practice. But, what does it mean to say that someone has a severe illness? Does severity refer to the number of symptoms a patient is experiencing? To the intensity of the symptoms? To symptom frequency or persistence? To the impact of symptoms on functioning or on quality of life? To the likelihood of the illness resulting in permanent disability or death? Putting aside the issue of how severity should be operationalized, another consideration is whether severity should be conceptualized similarly for all illnesses or be disorder specific. In this paper, we examine how severity is characterized in research and contemporary psychiatric diagnostic systems, with a special focus on depression and personality disorders. Our review shows that the DSM-5 has defined the severity of various disorders in different ways, and that researchers have adopted a myriad of ways of defining severity for both depression and personality disorders, although the severity of the former was predominantly defined according to scores on symptom rating scales, whereas the severity of the latter was often linked with impairments in functioning. Because the functional impact of symptom-defined disorders depends on factors extrinsic to those disorders, such as self-efficacy, resilience, coping ability, social support, cultural and social expectations, as well as the responsibilities related to one's primary role function and the availability of others to assume those responsibilities, we argue that the severity of such disorders should be defined independently from functional impairment.
Collapse
Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human BehaviorBrown University School of Medicine, Rhode Island HospitalProvidenceRIUSA
| | - Theresa A. Morgan
- Department of Psychiatry and Human BehaviorBrown University School of Medicine, Rhode Island HospitalProvidenceRIUSA
| | - Kasey Stanton
- Department of Psychiatry and Human BehaviorBrown University School of Medicine, Rhode Island HospitalProvidenceRIUSA
| |
Collapse
|
12
|
Abstract
Adaptation to living with cardiovascular disease may differ from patient to patient and is influenced not only by disease severity and limitations incurred by the disease but also by socioeconomic factors (e.g. health literacy), the patients' psychological make-up and susceptibility to distress. Co-morbid depression and/or anxiety is prevalent in 20% of patients with cardiovascular disease, which may be either transient or chronic. Distress, such as depression, reduces adherence, serves as a barrier to behaviour change and the adoption of a healthy lifestyle, and increases the risk that patients drop out of cardiac rehabilitation, impacting on patients' quality of life, risk of hospitalisation and mortality. Hence it is paramount to identify this subset of high-risk patients in clinical practice. This review provides a general overview of the prevalence of selected psychosocial risk factors, their impact on patient-reported and clinical outcomes, and biological and behavioural mechanisms that may explain the association between psychosocial factors and health outcomes. The review also provides recommendations on which self-report screening measures to use to identify patients at high risk due to their psychosocial profile, and the effectiveness of available trials that target these risk factors. Despite challenges and barriers associated with screening of patients combined with appropriate treatment, it is paramount that we treat not only the heart but also the mind in order to improve the quality of care and patient and clinical outcomes.
Collapse
Affiliation(s)
- Susanne S Pedersen
- 1 Department of Psychology, University of Southern Denmark, Denmark.,2 Department of Cardiology, Odense University Hospital, Denmark
| | - Roland von Känel
- 3 Department of Neurology, Inselspital Bern University Hospital and University of Bern, Switzerland.,4 Department of Clinical Research, University of Bern, Switzerland.,5 Department of Psychosomatic Medicine, Clinic Barmelweid, Switzerland.,6 Hypertension in Africa Research Team, Potchefstroom, North-West University, South Africa
| | - Phillip J Tully
- 7 Bordeaux Population Health, University of Bordeaux, France.,8 Freemasons Foundation Centre for Men's Health, The University of Adelaide, Australia
| | - Johan Denollet
- 9 CoRPS - Department of Medical and Clinical Psychology, Tilburg University, the Netherlands.,10 Department of Cardiology, Antwerp University Hospital, Belgium
| |
Collapse
|
13
|
Optimism as predictor of patient-reported outcomes in patients with an implantable cardioverter defibrillator (data from the WEBCARE study). Gen Hosp Psychiatry 2018; 50:90-95. [PMID: 29127812 DOI: 10.1016/j.genhosppsych.2017.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The implantable cardioverter defibrillator (ICD) is the treatment of choice for prevention of sudden cardiac death. However, a subgroup of ICD patients experiences psychological adjustment problems post implant. To date, positive psychological constructs (e.g. optimism) have been understudied in this population. Hence, we examined the association between optimism and anxiety, depression, and health status at 12-months post implant. METHODS Patients (N=171) enrolled in the WEB-based distress management study for ICD patients were included in the analyses. Optimism and pessimism (LOT), and Type D personality (DS14) were administered at baseline, while anxiety (GAD-7), depression (PHQ-9), and health status (SF-12) were assessed at 12-months. RESULTS The mean age was 59.6±10.06 with 81% being male. After controlling for demographic, personality, and clinical variables, baseline optimism was associated with lower anxiety (β=-0.210; p=0.011) and depression (β=-0.222; p=0.005), and better physical (β=0.227; p=0.004) and mental health status (β=0.350; p=0.000) at follow-up. Optimism was also associated with change in mental health status (β=0.195; p=0.007) but not with change in anxiety, depression, and physical health status at follow-up. CONCLUSIONS Our findings indicate that optimism is associated with less distress and possibly helps safeguard mental health in ICD patients. Increase optimism might be the way forward to reduce long-term distress and impaired health status. TRIAL REGISTRATION http://www.ClinicalTrials.gov. Identifier: NCT00895700.
Collapse
|
14
|
Makransky G, Lilleholt L, Aaby A. Development and validation of the Multimodal Presence Scale for virtual reality environments: A confirmatory factor analysis and item response theory approach. COMPUTERS IN HUMAN BEHAVIOR 2017. [DOI: 10.1016/j.chb.2017.02.066] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|