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Kong F, Yu L, Hou Y, Zhu L, Zhou J, Huang L, Lv Y, Wang L, Zhang L, Yang Y, Ying Y. Efficacy of Internet-Based Cognitive Behavioral Therapy for Subthreshold Depression Among Older Adults in Institutional Long-Term Care Settings: Pragmatic Randomized Controlled Trial. J Med Internet Res 2024; 26:e40187. [PMID: 38427424 PMCID: PMC10943436 DOI: 10.2196/40187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/03/2023] [Accepted: 01/31/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Subthreshold depression (sD) is prevalent in older populations in long-term care (LTC) settings, but psychological therapy in LTC settings in China is not readily available. Thus, internet-based cognitive behavioral therapy (ICBT) may be suitable for this population, but research on the efficacy of ICBT for older adults with sD, especially those living in LTC settings, is limited. OBJECTIVE This study aimed to evaluate the efficacy and acceptability of ICBT treatment for sD among LTC residents in China. We also examined whether ICBT is as effective as group-based cognitive behavioral therapy (CBT) for treating sD in this population. METHODS We conducted a pragmatic randomized controlled trial, which included 18 LTC institutions. A total of 354 participants were randomized to ICBT, group-based CBT, or a waiting list and were followed up for 12 months. The primary outcome was self-reported depressive symptoms on the Center for Epidemiological Studies Depression Scale (CES-D). Secondary outcomes were the scores of the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-Item (GAD-7), and Geriatric Depression Scale (GDS). A mixed-effects model was used to assess the efficacy of ICBT. RESULTS The ICBT group showed a significant improvement in self-reported depressive symptoms, which was maintained at the 12-month follow-up (all P<.001). The ICBT group exhibited a significantly larger reduction in the scores of the CES-D (Cohen d=0.07, 95% CI 0.04-0.09; P=.01), PHQ-9 (d=0.30, 95% CI 0.28-0.33; P<.001), GDS (d=0.10, 95% CI 0.08-0.13; P<.001), and GAD-7 (d=0.19, 95% CI 0.17-0.22; P<.001) compared with a waiting list at postintervention. ICBT had significantly stronger effects than CBT on the PHQ-9 and GAD-7 at postintervention (d=0.15, 95% CI 0.13-0.17; P<.001 and d=0.21, 95% CI 0.19-0.23; P<.001, respectively), 6-month follow-up (d=0.18, 95% CI 0.16-0.21; P<.001 and d=0.18, 95% CI 0.15-0.21; P<.001, respectively), and 12-month follow-up (d=0.15, 95% CI 0.11-0.19; P<.001 and d=0.18, 95% CI 0.14-0.21; P<.001, respectively). CONCLUSIONS ICBT is a relatively effective and acceptable intervention for reducing depressive symptoms among Chinese LTC residents with sD. These findings indicate the usefulness of ICBT application for sD in LTC settings. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2000030697; https://www.chictr.org.cn/showproj.aspx?proj=50781.
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Affiliation(s)
- Fanqian Kong
- Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Libo Yu
- Ningbo College of Health Sciences, Ningbo, Zhejiang, China
| | | | - Lijie Zhu
- Pfizer Research and Development Co, Ltd, Shanghai, China
| | - Jing Zhou
- Ningbo College of Health Sciences, Ningbo, Zhejiang, China
| | - Lingjie Huang
- Ningbo College of Health Sciences, Ningbo, Zhejiang, China
| | - Yueer Lv
- Ningbo College of Health Sciences, Ningbo, Zhejiang, China
| | - Li Wang
- Ningbo College of Health Sciences, Ningbo, Zhejiang, China
| | - Li Zhang
- Ningbo College of Health Sciences, Ningbo, Zhejiang, China
| | - Yiling Yang
- Ningbo College of Health Sciences, Ningbo, Zhejiang, China
| | - Yuchen Ying
- Ningbo College of Health Sciences, Ningbo, Zhejiang, China
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Tops L, Beerten SG, Vandenbulcke M, Vermandere M, Deschodt M. Integrated Care Models for Older Adults with Depression and Physical Comorbidity: A Scoping Review. Int J Integr Care 2024; 24:1. [PMID: 38222854 PMCID: PMC10786096 DOI: 10.5334/ijic.7576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 12/07/2023] [Indexed: 01/16/2024] Open
Abstract
Objective Multimorbidity is a growing challenge in the care for older people with mental illness. To address both physical and mental illnesses, integrated care management is required. The purpose of this scoping review is to identify core components of integrated care models for older adults with depression and physical comorbidity, and map reported outcomes and implementation strategies. Methods PubMed, EMBASE, CINAHL and Cochrane Library were searched independently by two reviewers for studies concerning integrated care interventions for older adults with depression and physical comorbidity. We used the SELFIE framework to map core components of integrated care models. Clinical and organisational outcomes were mapped. Results Thirty-eight studies describing thirteen care models were included. In all care models, a multidisciplinary team was involved. The following core components were mainly described: continuity, person-centredness, tailored holistic assessment, pro-activeness, treatment interaction, individualized care planning, and coordination tailored to complexity of care needs. Twenty-seven different outcomes were evaluated, with more attention given to clinical than to organisational outcomes. Conclusion The core components that comprise integrated care models are diverse. Future studies should focus more on implementation aspects of the intervention and describe financial parts, e.g., the cost of the intervention for the healthcare user, more transparently.
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Affiliation(s)
- Laura Tops
- Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 7, Box 7001, 3000, Leuven, Belgium
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Simon Gabriël Beerten
- Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 7, Box 7001, 3000, Leuven, Belgium
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Mathieu Vandenbulcke
- Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Geriatric Psychiatry, University Psychiatric Centre, KU Leuven, Leuven, Belgium
| | - Mieke Vermandere
- Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 7, Box 7001, 3000, Leuven, Belgium
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Mieke Deschodt
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Competence Center for Nursing, University Hospitals Leuven, Belgium
- Gerontology and Geriatrics, University Hospitals Leuven, Belgium
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Park S, Cubillos L, Martinez-Camblor P, Bartels SM, Torrey WC, John DT, Cepeda M, Bell K, Castro S, Suárez-Obando F, Uribe-Restrepo JM, Gómez-Restrepo C, Marsch LA. Integrating Depression and Alcohol Use Care Into Primary Care in Low- and Middle-Income Countries: A Meta-Analysis. Psychiatr Serv 2023; 74:950-962. [PMID: 36852551 DOI: 10.1176/appi.ps.20220267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE Evaluation of the effectiveness of integration of depression and alcohol use disorder care into primary health care in low- and middle-income countries (LMICs) is limited. The authors aimed to quantify the effectiveness of integrating mental health care into primary care by examining depression and alcohol use disorder outcomes. The study updates a previous systematic review summarizing research on care integration in LMICs. METHODS Following PRISMA guidelines, the authors included studies from the previous review and studies published from 2017 to 2020 that included adults with alcohol use disorder or depression. Studies were evaluated for type of integration model with the typology developed previously. A meta-analysis using a random-effects model to assess effectiveness of integrated interventions was conducted. Meta-regression analyses to examine the impact of study characteristics on depression and alcohol use disorder outcomes were conducted. RESULTS In total, 49 new articles were identified, and 74 articles from the previous and current studies met inclusion criteria for the meta-analysis. Overall random effect sizes were 0.28 (95% CI=0.22-0.35) and 0.17 (95% CI=0.11-0.24) for studies targeting care integration for depression or for alcohol use disorder, respectively, into primary care in LMICs. High heterogeneity within and among studies was observed. No significant association was found between country income level and depression and alcohol use outcomes. However, differences in effect sizes between types of integration model were statistically significant (p<0.001). CONCLUSIONS Integration of mental health care into primary health care in LMICs was found to improve depression and alcohol use disorder outcomes. This evidence should be considered when designing interventions to improve mental health screening and treatment in LMICs.
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Affiliation(s)
- Sena Park
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Leonardo Cubillos
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Pablo Martinez-Camblor
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sophia M Bartels
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - William C Torrey
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Deepak T John
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Magda Cepeda
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Kathleen Bell
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Sergio Castro
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Fernando Suárez-Obando
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - José Miguel Uribe-Restrepo
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Carlos Gómez-Restrepo
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Lisa A Marsch
- Center for Technology and Behavioral Health (Park, Cubillos, Bartels, Torrey, John, Bell, Marsch), Department of Anesthesiology (Martinez-Camblor), Department of Psychiatry (Torrey, Marsch), Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire; Department of Clinical Epidemiology and Biostatistics (Cepeda, Gómez-Restrepo), Department of Psychiatry and Mental Health (Castro, Suárez-Obando, Uribe-Restrepo, Gómez-Restrepo), Pontificia Universidad Javeriana, Bogotá, Colombia
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Wang Y, Guo D, Wang M, Hu M, Zhu D, Yu Q, Li Z, Zhang X, Ding R, Zhao M, He P. Community-based integrated care for patients with diabetes and depression (CIC-PDD): study protocol for a cluster randomized controlled trial. Trials 2023; 24:550. [PMID: 37608381 PMCID: PMC10464429 DOI: 10.1186/s13063-023-07561-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 08/02/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Managing the multimorbidity of diabetes and depression remains a clinical challenge for patients and healthcare professionals due to the fragmented healthcare delivery system. To effectively cope with multimorbidity, there is an urgent need for the health system to transform into people-centered integrated care (PCIC) system globally. Therefore, this paper describes the protocol of community-based integrated care for patients with diabetes and depression (CIC-PDD) project, an integrated and shared-care intervention project. METHODS/DESIGN CIC-PDD project is conducted in two phases, namely "care model development" and "implementation and evaluation." In the first phase, CIC-PDD model was designed and developed based on the four criteria of collaborative care model (CCM) and was subsequently adjusted to align with the context of China. The second phase entails a pragmatic, two-arm, cluster randomized controlled implementation trial, accompanied by parallel mixed-methods process evaluation and cost-effectiveness analysis. DISCUSSION We anticipate CIC-PDD project will facilitate the development and innovation of PCIC model and related theories worldwide, particularly in low- and middle-income countries (LMICs). In addition, CIC-PDD project will contribute to the exploration of primary health care (PHC) in addressing the multimorbidity of physical and mental health issues. TRIAL REGISTRATION ClinicalTrials.gov registration ChiCTR2200065608 (China Clinical Trials Registry https://www.chictr.org.cn ). Registered on November 9, 2022.
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Affiliation(s)
- Yanshang Wang
- School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- China Center for Health Development Studies, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
| | - Dan Guo
- China Center for Health Development Studies, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
| | - Ming Wang
- School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- China Center for Health Development Studies, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
| | - Mingzheng Hu
- School of Public Health, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
- China Center for Health Development Studies, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
| | - Qianqian Yu
- School of Management, Weifang Medical University, Weicheng District, 7166 Baotong Street, Weifang, 261053, Shandong, China
| | - Zhansheng Li
- Health Commission of Weifang, 6396 Dongfeng East Street, Weifang, 261061, Shandong, China
| | - Xiaoyi Zhang
- Health Commission of Weifang, 6396 Dongfeng East Street, Weifang, 261061, Shandong, China
| | - Ruoxi Ding
- China Center for Health Development Studies, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China
| | - Miaomiao Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Xuhui District, 600 Wanping South Street, Shanghai, 200030, China
- Center for Mental Health Management, China Hospital Development Institute, Shanghai Jiao Tong University, Xuhui District, 600 Wanping South Street, Shanghai, 200030, China
| | - Ping He
- China Center for Health Development Studies, Peking University, Haidian District, 38 Xue Yuan Road, Beijing, 100191, China.
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5
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Veroniki AA, Soobiah C, Nincic V, Lai Y, Rios P, MacDonald H, Khan PA, Ghassemi M, Yazdi F, Brownson RC, Chambers DA, Dolovich LR, Edwards A, Glasziou PP, Graham ID, Hemmelgarn BR, Holmes BJ, Isaranuwatchai W, Legare F, McGowan J, Presseau J, Squires JE, Stelfox HT, Strifler L, Van der Weijden T, Fahim C, Tricco AC, Straus SE. Efficacy of sustained knowledge translation (KT) interventions in chronic disease management in older adults: systematic review and meta-analysis of complex interventions. BMC Med 2023; 21:269. [PMID: 37488589 PMCID: PMC10367354 DOI: 10.1186/s12916-023-02966-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 06/27/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Chronic disease management (CDM) through sustained knowledge translation (KT) interventions ensures long-term, high-quality care. We assessed implementation of KT interventions for supporting CDM and their efficacy when sustained in older adults. METHODS Design: Systematic review with meta-analysis engaging 17 knowledge users using integrated KT. ELIGIBILITY CRITERIA Randomized controlled trials (RCTs) including adults (> 65 years old) with chronic disease(s), their caregivers, health and/or policy-decision makers receiving a KT intervention to carry out a CDM intervention for at least 12 months (versus other KT interventions or usual care). INFORMATION SOURCES We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from each database's inception to March 2020. OUTCOME MEASURES Sustainability, fidelity, adherence of KT interventions for CDM practice, quality of life (QOL) and quality of care (QOC). Data extraction, risk of bias (ROB) assessment: We screened, abstracted and appraised articles (Effective Practice and Organisation of Care ROB tool) independently and in duplicate. DATA SYNTHESIS We performed both random-effects and fixed-effect meta-analyses and estimated mean differences (MDs) for continuous and odds ratios (ORs) for dichotomous data. RESULTS We included 158 RCTs (973,074 participants [961,745 patients, 5540 caregivers, 5789 providers]) and 39 companion reports comprising 329 KT interventions, involving patients (43.2%), healthcare providers (20.7%) or both (10.9%). We identified 16 studies described as assessing sustainability in 8.1% interventions, 67 studies as assessing adherence in 35.6% interventions and 20 studies as assessing fidelity in 8.7% of the interventions. Most meta-analyses suggested that KT interventions improved QOL, but imprecisely (36 item Short-Form mental [SF-36 mental]: MD 1.11, 95% confidence interval [CI] [- 1.25, 3.47], 14 RCTs, 5876 participants, I2 = 96%; European QOL-5 dimensions: MD 0.01, 95% CI [- 0.01, 0.02], 15 RCTs, 6628 participants, I2 = 25%; St George's Respiratory Questionnaire: MD - 2.12, 95% CI [- 3.72, - 0.51] 44 12 RCTs, 2893 participants, I2 = 44%). KT interventions improved QOC (OR 1.55, 95% CI [1.29, 1.85], 12 RCTS, 5271 participants, I2 = 21%). CONCLUSIONS KT intervention sustainability was infrequently defined and assessed. Sustained KT interventions have the potential to improve QOL and QOC in older adults with CDM. However, their overall efficacy remains uncertain and it varies by effect modifiers, including intervention type, chronic disease number, comorbidities, and participant age. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018084810.
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Affiliation(s)
- Areti Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON Canada
| | - Charlene Soobiah
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON Canada
| | - Vera Nincic
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Yonda Lai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Patricia Rios
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Heather MacDonald
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Paul A. Khan
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Marco Ghassemi
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Fatemeh Yazdi
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Ross C. Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO USA
- Department of Surgery and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO USA
| | - David A. Chambers
- National Cancer Institute, 9609 Medical Center Drive, Rockville, MD USA
| | - Lisa R. Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON Canada
- Department of Family Medicine David Braley Health Sciences Centre, McMaster University, 100 Main Street West, Hamilton, ON Canada
| | - Annemarie Edwards
- Canadian Partnership Against Cancer, 1 University Avenue, Toronto, ON Canada
| | - Paul P. Glasziou
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226 Australia
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
- The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON Canada
| | - Brenda R. Hemmelgarn
- Department of Medicine, University of Alberta, C MacKenzie Health Sciences Centre, WalterEdmonton, AB 2J2.00 Canada
| | - Bev J. Holmes
- The Michael Smith Foundation for Health Research (MSFHR), 200 - 1285 West Broadway, Vancouver, BC Canada
| | - Wanrudee Isaranuwatchai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - France Legare
- Département de Médecine Familiale Et Médecine d’urgenceFaculté de Médecine, Université Laval Pavillon Ferdinand-Vandry1050, Avenue de La Médecine, Local 2431, Québec, QC Canada
- Axe Santé Des Populations Et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec 1050, Chemin Sainte-Foy, Local K0-03, Québec, QC Canada
| | - Jessie McGowan
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
| | - Justin Presseau
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
- The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON Canada
| | - Janet E. Squires
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
| | - Henry T. Stelfox
- Departments of Critical Care Medicine, Medicine and Community Health Sciences, O’Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, AB Canada
| | - Lisa Strifler
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Trudy Van der Weijden
- Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Debeyeplein 1, Maastricht, The Netherlands
| | - Christine Fahim
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Andrea C. Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- Epidemiology Division & Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON Canada
- Department of Geriatric Medicine, University of Toronto, Toronto, ON Canada
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Whitfield J, Owens S, Bhat A, Felker B, Jewell T, Chwastiak L. Successful ingredients of effective Collaborative Care programs in low- and middle-income countries: A rapid review. Glob Ment Health (Camb) 2023; 10:e11. [PMID: 37854388 PMCID: PMC10579696 DOI: 10.1017/gmh.2022.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/01/2022] [Accepted: 11/22/2022] [Indexed: 03/19/2023] Open
Abstract
Integrating mental health care in primary healthcare settings is a compelling strategy to address the mental health treatment gap in low- and middle-income countries (LMICs). Collaborative Care is the integrated care model with the most evidence supporting its effectiveness, but most research has been conducted in high-income countries. Efforts to implement this complex multi-component model at scale in LMICs will be enhanced by understanding the model components that have been effective in LMIC settings. Following Cochrane Rapid Reviews Methods Group recommendations, we conducted a rapid review to identify studies of the effectiveness of Collaborative Care for priority adult mental disorders of mhGAP (mood and anxiety disorders, psychosis, substance use disorders and epilepsy) in outpatient medical settings in LMICs. Article screening and data extraction were performed using Covidence software. Data extraction by two authors utilized a checklist of key components of effective interventions. Information was aggregated to examine how frequently the components were applied. Our search yielded 25 articles describing 20 Collaborative Care models that treated depression, anxiety, schizophrenia, alcohol use disorder or epilepsy in nine different LMICs. Fourteen of these models demonstrated statistically significantly improved clinical outcomes compared to comparison groups. Successful models shared key structural and process-of-care elements: a multi-disciplinary care team with structured communication; standardized protocols for evidence-based treatments; systematic identification of mental disorders, and a stepped-care approach to treatment intensification. There was substantial heterogeneity across studies with respect to the specifics of model components, and clear evidence of the importance of tailoring the model to the local context. This review provides evidence that Collaborative Care is effective across a range of mental disorders in LMICs. More work is needed to demonstrate population-level and longer-term outcomes, and to identify strategies that will support successful and sustained implementation in routine clinical settings.
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Affiliation(s)
- Jessica Whitfield
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
| | - Shanise Owens
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Bradford Felker
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Teresa Jewell
- University of Washington Health Sciences Library, University of Washington, Seattle, WA, USA
| | - Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA
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Rao KD, Mehta A, Kautsar H, Kak M, Karem G, Misra M, Joshi H, Herbst CH, Perry HB. Improving quality of non-communicable disease services at primary care facilities in middle-income countries: A scoping review. Soc Sci Med 2023; 320:115679. [PMID: 36731302 DOI: 10.1016/j.socscimed.2023.115679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/02/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
Health systems in middle-income countries face important challenges in managing the high burden of Non-Communicable Diseases (NCD). Primary health care is widely recognized as key to managing NCDs in communities. However, the effectiveness of this approach is limited by poor quality of care (QoC), among others. This scoping review identifies the types of interventions that have been used in middle-income countries to improve the quality of NCD services at primary care facilities. Further, it identifies the range of outcomes these quality interventions have influenced. This scoping review covered both the grey and peer-reviewed literature. The 149 articles reviewed were classified into four domains - governance, service-delivery systems, health workforce, and patients and communities. There was a remarkable unevenness in the geographic distribution of studies - lower middle-income countries and some regions (Middle East, North Africa, and South East Asia) had a scarcity of published studies. NCDs such as stroke and cardiovascular disease, mental health, cancer, and respiratory disorders received less attention. The thrust of quality interventions was directed at the practice of NCD care by clinicians, facilities, or patients. Few studies provided evidence from interventions at the organizations or policy levels. Overall, effectiveness of quality interventions was mixed across domains. In general, positive or mixed effects on provider clinical skills and behavior, as well as, improvements in patient outcomes were found across interventions. Access to care and coverage of screening services were positively influenced by the interventions reviewed. This review shows that quality improvement interventions tried in middle-income countries mostly focused at the provider and facility level, with few focusing on the organizational and policy level. There is a need to further study the effectiveness of organizational and policy level interventions on the practice and outcomes of NCD care.
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Affiliation(s)
- Krishna D Rao
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Akriti Mehta
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - Hunied Kautsar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | | | | | - Madhavi Misra
- Johns Hopkins India Private Limited, New Delhi, India
| | - Harsha Joshi
- Johns Hopkins India Private Limited, New Delhi, India
| | | | - Henry B Perry
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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8
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Chen S, Conwell Y, Xue J, Li L, Zhao T, Tang W, Bogner H, Dong H. Effectiveness of integrated care for older adults with depression and hypertension in rural China: A cluster randomized controlled trial. PLoS Med 2022; 19:e1004019. [PMID: 36279299 PMCID: PMC9639850 DOI: 10.1371/journal.pmed.1004019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 11/07/2022] [Accepted: 10/04/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Effectiveness of integrated care management for common, comorbid physical and mental disorders has been insufficiently examined in low- and middle-income countries (LMICs). We tested hypotheses that older adults treated in rural Chinese primary care clinics with integrated care management of comorbid depression and hypertension (HTN) would show greater improvements in depression symptom severity and HTN control than those who received usual care. METHODS AND FINDINGS The study, registered with ClinicalTrials.gov as Identifier NCT01938963, was a cluster randomized controlled trial with 12-month follow-up conducted from January 1, 2014 through September 30, 2018, with analyses conducted in 2020 to 2021. Participants were residents of 218 rural villages located in 10 randomly selected townships of Zhejiang Province, China. Each village hosts 1 primary care clinic that serves all residents. Ten townships, each containing approximately 20 villages, were randomly selected to deliver either the Chinese Older Adult Collaborations in Health (COACH) intervention or enhanced care-as-usual (eCAU) to eligible village clinic patients. The COACH intervention consisted of algorithm-driven treatment of depression and HTN by village primary care doctors supported by village lay workers with telephone consultation from centrally located psychiatrists. Participants included clinic patients aged ≥60 years with a diagnosis of HTN and clinically significant depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score ≥10). Of 2,899 eligible village residents, 2,365 (82%) agreed to participate. They had a mean age of 74.5 years, 67% were women, 55% had no schooling, 59% were married, and 20% lived alone. Observers, older adult participants, and their primary care providers (PCPs) were blinded to study hypotheses but not to group assignment. Primary outcomes were change in depression symptom severity as measured by the Hamilton Depression Rating Scale (HDRS) total score and the proportion with controlled HTN, defined as systolic blood pressure (BP) <130 mm Hg or diastolic BP <80 for participants with diabetes mellitus, coronary heart disease, or renal disease, and systolic BP <140 or diastolic BP <90 for all others. Analyses were conducted using generalized linear mixed effect models with intention to treat. Sixty-seven of 1,133 participants assigned to eCAU and 85 of 1,232 COACH participants were lost to follow-up over 12 months. Thirty-six participants died of natural causes, 22 in the COACH arm and 14 receiving eCAU. Forty COACH participants discontinued antidepressant medication due to side effects. Compared with participants who received eCAU, COACH participants showed greater reduction in depressive symptoms (Cohen's d [±SD] = -1.43 [-1.71, -1.15]; p < 0.001) and greater likelihood of achieving HTN control (odds ratio [OR] [95% CI] = 18.24 [8.40, 39.63]; p < 0.001). Limitations of the study include the inability to mask research assessors and participants to which condition a village was assigned, and lack of information about participants' adherence to recommendations for lifestyle and medication management of HTN and depression. Generalizability of the model to other regions of China or other LMICs may be limited. CONCLUSIONS The COACH model of integrated care management resulted in greater improvement in both depression symptom severity and HTN control among older adult residents of rural Chinese villages who had both conditions than did eCAU. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT01938963 https://clinicaltrials.gov/ct2/show/NCT01938963.
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Affiliation(s)
- Shulin Chen
- Department of Psychology, Zhejiang University, Hangzhou, China
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester, Rochester, New York, United States of America
- * E-mail:
| | - Jiang Xue
- Department of Psychology, Zhejiang University, Hangzhou, China
| | - Lydia Li
- School of Social Work, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Tingjie Zhao
- Department of Biostatistics and Data Science, Tulane University, New Orleans, Louisiana, United States of America
| | - Wan Tang
- Department of Biostatistics and Data Science, Tulane University, New Orleans, Louisiana, United States of America
| | - Hillary Bogner
- Department of Family Medicine, University of Pennsylvania, Philadelphia, Philadelphia, United States of America
| | - Hengjin Dong
- Center for Health Policy Studies, School of Public Health, Zhejiang University, Hangzhou, China
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van Ginneken N, Chin WY, Lim YC, Ussif A, Singh R, Shahmalak U, Purgato M, Rojas-García A, Uphoff E, McMullen S, Foss HS, Thapa Pachya A, Rashidian L, Borghesani A, Henschke N, Chong LY, Lewin S. Primary-level worker interventions for the care of people living with mental disorders and distress in low- and middle-income countries. Cochrane Database Syst Rev 2021; 8:CD009149. [PMID: 34352116 PMCID: PMC8406740 DOI: 10.1002/14651858.cd009149.pub3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Community-based primary-level workers (PWs) are an important strategy for addressing gaps in mental health service delivery in low- and middle-income countries. OBJECTIVES: To evaluate the effectiveness of PW-led treatments for persons with mental health symptoms in LMICs, compared to usual care. SEARCH METHODS: MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, ICTRP, reference lists (to 20 June 2019). SELECTION CRITERIA: Randomised trials of PW-led or collaborative-care interventions treating people with mental health symptoms or their carers in LMICs. PWs included: primary health professionals (PHPs), lay health workers (LHWs), community non-health professionals (CPs). DATA COLLECTION AND ANALYSIS: Seven conditions were identified apriori and analysed by disorder and PW examining recovery, prevalence, symptom change, quality-of-life (QOL), functioning, service use (SU), and adverse events (AEs). Risk ratios (RRs) were used for dichotomous outcomes; mean difference (MDs), standardised mean differences (SMDs), or mean change differences (MCDs) for continuous outcomes. For SMDs, 0.20 to 0.49 represented small, 0.50 to 0.79 moderate, and ≥0.80 large clinical effects. Analysis timepoints: T1 (<1 month), T2 (1-6 months), T3 ( >6 months) post-intervention. MAIN RESULTS: Description of studies 95 trials (72 new since 2013) from 30 LMICs (25 trials from 13 LICs). Risk of bias Most common: detection bias, attrition bias (efficacy), insufficient protection against contamination. Intervention effects *Unless indicated, comparisons were usual care at T2. "Probably", "may", or "uncertain" indicates "moderate", "low," or "very low" certainty evidence. Adults with common mental disorders (CMDs) LHW-led interventions a. may increase recovery (2 trials, 308 participants; RR 1.29, 95%CI 1.06 to 1.56); b. may reduce prevalence (2 trials, 479 participants; RR 0.42, 95%CI 0.18 to 0.96); c. may reduce symptoms (4 trials, 798 participants; SMD -0.59, 95%CI -1.01 to -0.16); d. may improve QOL (1 trial, 521 participants; SMD 0.51, 95%CI 0.34 to 0.69); e. may slightly reduce functional impairment (3 trials, 1399 participants; SMD -0.47, 95%CI -0.8 to -0.15); f. may reduce AEs (risk of suicide ideation/attempts); g. may have uncertain effects on SU. Collaborative-care a. may increase recovery (5 trials, 804 participants; RR 2.26, 95%CI 1.50 to 3.43); b. may reduce prevalence although the actual effect range indicates it may have little-or-no effect (2 trials, 2820 participants; RR 0.57, 95%CI 0.32 to 1.01); c. may slightly reduce symptoms (6 trials, 4419 participants; SMD -0.35, 95%CI -0.63 to -0.08); d. may slightly improve QOL (6 trials, 2199 participants; SMD 0.34, 95%CI 0.16 to 0.53); e. probably has little-to-no effect on functional impairment (5 trials, 4216 participants; SMD -0.13, 95%CI -0.28 to 0.03); f. may reduce SU (referral to MH specialists); g. may have uncertain effects on AEs (death). Women with perinatal depression (PND) LHW-led interventions a. may increase recovery (4 trials, 1243 participants; RR 1.29, 95%CI 1.08 to 1.54); b. probably slightly reduce symptoms (5 trials, 1989 participants; SMD -0.26, 95%CI -0.37 to -0.14); c. may slightly reduce functional impairment (4 trials, 1856 participants; SMD -0.23, 95%CI -0.41 to -0.04); d. may have little-to-no effect on AEs (death); e. may have uncertain effects on SU. Collaborative-care a. has uncertain effects on symptoms/QOL/SU/AEs. Adults with post-traumatic stress (PTS) or CMDs in humanitarian settings LHW-led interventions a. may slightly reduce depression symptoms (5 trials, 1986 participants; SMD -0.36, 95%CI -0.56 to -0.15); b. probably slightly improve QOL (4 trials, 1918 participants; SMD -0.27, 95%CI -0.39 to -0.15); c. may have uncertain effects on symptoms (PTS)/functioning/SU/AEs. PHP-led interventions a. may reduce PTS symptom prevalence (1 trial, 313 participants; RR 5.50, 95%CI 2.50 to 12.10) and depression prevalence (1 trial, 313 participants; RR 4.60, 95%CI 2.10 to 10.08); b. may have uncertain effects on symptoms/functioning/SU/AEs. Adults with harmful/hazardous alcohol or substance use LHW-led interventions a. may increase recovery from harmful/hazardous alcohol use although the actual effect range indicates it may have little-or-no effect (4 trials, 872 participants; RR 1.28, 95%CI 0.94 to 1.74); b. may have little-to-no effect on the prevalence of methamphetamine use (1 trial, 882 participants; RR 1.01, 95%CI 0.91 to 1.13) and functional impairment (2 trials, 498 participants; SMD -0.14, 95%CI -0.32 to 0.03); c. probably slightly reduce risk of harmful/hazardous alcohol use (3 trials, 667 participants; SMD -0.22, 95%CI -0.32 to -0.11); d. may have uncertain effects on SU/AEs. PHP/CP-led interventions a. probably have little-to-no effect on recovery from harmful/hazardous alcohol use (3 trials, 1075 participants; RR 0.93, 95%CI 0.77 to 1.12) or QOL (1 trial, 560 participants; MD 0.00, 95%CI -0.10 to 0.10); b. probably slightly reduce risk of harmful/hazardous alcohol and substance use (2 trials, 705 participants; SMD -0.20, 95%CI -0.35 to -0.05; moderate-certainty evidence); c. may have uncertain effects on prevalence (cannabis use)/SU/AEs. PW-led interventions for alcohol/substance dependence a. may have uncertain effects. Adults with severe mental disorders *Comparisons were specialist-led care at T1. LHW-led interventions a. may have little-to-no effect on caregiver burden (1 trial, 253 participants; MD -0.04, 95%CI -0.18 to 0.11); b. may have uncertain effects on symptoms/functioning/SU/AEs. PHP-led or collaborative-care a. may reduce functional impairment (7 trials, 874 participants; SMD -1.13, 95%CI -1.78 to -0.47); b. may have uncertain effects on recovery/relapse/symptoms/QOL/SU. Adults with dementia and carers PHP/LHW-led carer interventions a. may have little-to-no effect on the severity of behavioural symptoms in dementia patients (2 trials, 134 participants; SMD -0.26, 95%CI -0.60 to 0.08); b. may reduce carers' mental distress (2 trials, 134 participants; SMD -0.47, 95%CI -0.82 to -0.13); c. may have uncertain effects on QOL/functioning/SU/AEs. Children with PTS or CMDs LHW-led interventions a. may have little-to-no effect on PTS symptoms (3 trials, 1090 participants; MCD -1.34, 95%CI -2.83 to 0.14); b. probably have little-to-no effect on depression symptoms (3 trials, 1092 participants; MCD -0.61, 95%CI -1.23 to 0.02) or on functional impairment (3 trials, 1092 participants; MCD -0.81, 95%CI -1.48 to -0.13); c. may have little-or-no effect on AEs. CP-led interventions a. may have little-to-no effect on depression symptoms (2 trials, 602 participants; SMD -0.19, 95%CI -0.57 to 0.19) or on AEs; b. may have uncertain effects on recovery/symptoms(PTS)/functioning. AUTHORS' CONCLUSIONS PW-led interventions show promising benefits in improving outcomes for CMDs, PND, PTS, harmful alcohol/substance use, and dementia carers in LMICs.
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Affiliation(s)
- Nadja van Ginneken
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Amin Ussif
- Norwegian Institute of Public Health, Oslo, Norway
| | - Rakesh Singh
- Department of Community Health Sciences, School of Medicine and School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Ujala Shahmalak
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Antonio Rojas-García
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders, Centre for Reviews and Dissemination, University of York, York, UK
| | - Sarah McMullen
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, Manchester, UK
| | | | - Ambika Thapa Pachya
- Department of Community Health Sciences, School of Medicine and School of Public Health, Patan Academy of Health Sciences, Lalitpur, Nepal
| | | | - Anna Borghesani
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | | | - Lee-Yee Chong
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Zhao Y, Zhang P, Oldenburg B, Hall T, Lu S, Haregu TN, He L. The impact of mental and physical multimorbidity on healthcare utilization and health spending in China: A nationwide longitudinal population-based study. Int J Geriatr Psychiatry 2021; 36:500-510. [PMID: 33037674 DOI: 10.1002/gps.5445] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/31/2020] [Accepted: 10/02/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND In China, little evidence exists on the effect of mental and physical multimorbidity on individuals and the health system. This study aims to examine the prevalence of mental-physical multimorbidity and its impact on health service utilization and health expenditures. METHODS We conducted a panel study using two waves of data (in 2011 and 2015) from the China Health and Retirement Longitudinal Study, including 10,181 participants aged 45 years and older. Generalized linear regression models were used to assess the association of multimorbidity with total health expenditure and out-of-pocket expenditure (OOPE) on outpatient and inpatient care. Random-effects logistic regression models were used to examine the impact of multimorbidity on outpatient visits, admission to hospital and incidence of catastrophic health expenditure (CHE). RESULTS Overall, 3210 participants (31.53% of 10,181) had mental-physical multimorbidity in 2015 in China. Compared to patients with a single physical disease, individuals with physical-mental multimorbidity had over 150% of the increase in the number of outpatient visits and days of hospitalization. The percentage change of OOPE for outpatient and inpatient care was 156.8% and 163.6%, respectively. Mental-physical multimorbidity was associated with an increased likelihood of experiencing CHE (OR = 2.205, 95% CI = 2.048, 2.051). CONCLUSION Multimorbidity, particularly mental-physical multimorbidity, is associated with higher levels of health service use and a greater financial burden to individuals in China. Healthcare system needs to shift from single-disease models to new financing and service delivery models to more effectively manage mental-physical multimorbidity.
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Affiliation(s)
- Yang Zhao
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- WHO Collaborating Centre on Implementation Research for Prevention and Control of Noncommunicable Diseases, Melbourne, Victoria, Australia
| | - Puhong Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Brian Oldenburg
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- WHO Collaborating Centre on Implementation Research for Prevention and Control of Noncommunicable Diseases, Melbourne, Victoria, Australia
| | - Teresa Hall
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shurong Lu
- The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tilahun Nigatu Haregu
- WHO Collaborating Centre on Implementation Research for Prevention and Control of Noncommunicable Diseases, Melbourne, Victoria, Australia
| | - Li He
- College of Physical Education and Sport, Beijing Normal University, Beijing, China
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11
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Zhang J, Wang R, Wang C, Wang Y, Chen X, Mi G, Chen X, Cheng X, Wang L, Wu X, Xue F, Wang Q. Prevalence of mental disorders in 21st century Shandong Province, China: A ten-year comparative study. J Affect Disord 2021; 283:344-353. [PMID: 33578348 DOI: 10.1016/j.jad.2021.01.068] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/11/2021] [Accepted: 01/30/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Although the 2000s observed enormous changes in China, little is known about the variation in the prevalence of mental disorders. The study compared the prevalence in a Chinese population between 2004 and 2015. METHODS Multistage stratified random sampling methods were used to identify primary sampling sites for cross-sectional surveys in 2004 and 2015 in Shandong, China. In 2004 and 2015, 22,718 and 28,194 adults, respectively, completed an expanded version of the General Health Questionnaire, then 5,402 and 9,420 adults, respectively, were administered a Chinese version of the Structured Clinical Interview for Diagnostic and Statistical Manual-IV axis I disorders. RESULTS The adjusted 1-month prevalence of any mental disorders was 18•7% (95% CI: 16•7-20•8) and 17•1% (95% CI:15•9-18•4) in 2004 and 2015, respectively. However, the prevalence of major depressive disorders increased from 1•5% (95% CI: 1•2 -1•8) in 2004 to 2•3% (95% CI: 1•9-2•8) in 2015; meanwhile the prevalence of alcohol abuse disorders were becoming more common among men and urban residents. Although mood and anxiety disorders were more prevalent in women, a much more prevalent alcohol abuse disorders for men contributed to a higher overall prevalence among men than among women. Compared to that in urban residents, the overall prevalence in rural residents declined more, and it was lower in 2015 than in 2004. LIMITATIONS The results may not apply to the population from other regions. CONCLUSIONS Despite of the stable overall prevalence, mental disorders beyond psychotic disorders should be focused on, especially alcohol abuse and major depressive disorders.
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Affiliation(s)
- Jingxuan Zhang
- Shandong Provincial Mental Health Center, Jinan City, Shandong, China
| | - Ruzhan Wang
- Shandong Provincial Mental Health Center, Jinan City, Shandong, China
| | - Can Wang
- Shandong Provincial Mental Health Center, Jinan City, Shandong, China
| | - Yanhu Wang
- Shandong Provincial Mental Health Center, Jinan City, Shandong, China
| | - Xiuzhe Chen
- Shandong Provincial Mental Health Center, Jinan City, Shandong, China
| | - Guolin Mi
- Shandong Provincial Mental Health Center, Jinan City, Shandong, China
| | - Xu Chen
- Shandong Provincial Mental Health Center, Jinan City, Shandong, China
| | - Xiaojing Cheng
- Shandong Provincial Mental Health Center, Jinan City, Shandong, China
| | - Lina Wang
- Shandong Provincial Mental Health Center, Jinan City, Shandong, China
| | - Xinying Wu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Lixia district, Jinan, 250012 China; Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Lixia district, Jinan, 250012 China; Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Qing Wang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Lixia district, Jinan, 250012 China; Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, China.
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12
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Cubillos L, Bartels SM, Torrey WC, Naslund J, Uribe-Restrepo JM, Gaviola C, Díaz SC, John DT, Williams MJ, Cepeda M, Gómez-Restrepo C, Marsch LA. The effectiveness and cost-effectiveness of integrating mental health services in primary care in low- and middle-income countries: systematic review. BJPsych Bull 2021; 45:40-52. [PMID: 32321610 PMCID: PMC8058938 DOI: 10.1192/bjb.2020.35] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 03/11/2020] [Accepted: 03/14/2020] [Indexed: 11/23/2022] Open
Abstract
AIMS AND METHOD This systematic review examines the effectiveness and cost-effectiveness of behavioural health integration into primary healthcare in the management of depression and unhealthy alcohol use in low- and middle-income countries. Following PRISMA guidelines, this review included research that studied patients aged ≥18 years with unhealthy alcohol use and/or depression of any clinical severity. An exploration of the models of integration was used to characterise a typology of behavioural health integration specific for low- and middle-income countries. RESULTS Fifty-eight articles met inclusion criteria. Studies evidenced increased effectiveness of integrated care over treatment as usual for both conditions. The economic evaluations found increased direct health costs but cost-effective estimates. The included studies used six distinct behavioural health integration models. CLINICAL IMPLICATIONS Behavioural health integration may yield improved health outcomes, although it may require additional resources. The proposed typology can assist decision-makers to advance the implementation of integrated models.
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Affiliation(s)
- Leonardo Cubillos
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
| | - Sophia M. Bartels
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, USA
| | - William C. Torrey
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, USA
| | - John Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, USA
| | | | - Chelsea Gaviola
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, USA
| | - Sergio Castro Díaz
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Colombia
| | - Deepak T. John
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, USA
| | - Makeda J. Williams
- Center for Global Mental Health Research, National Institute of Mental Health, USA
| | - Magda Cepeda
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Colombia
| | - Carlos Gómez-Restrepo
- Department of Psychiatry and Mental Health, Pontificia Universidad Javeriana, Colombia
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Colombia
| | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, USA
- The Dartmouth Institute, Geisel School of Medicine at Dartmouth, USA
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13
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Han X, Jiang F, Zhou H, Needleman J, Guo M, Chen Y, Liu Y, Tang Y. Hospitalization Pattern, Inpatient Service Utilization and Quality of Care in Patients With Alcohol Use Disorder: A Sequence Analysis of Discharge Medical Records. Alcohol Alcohol 2020; 55:179-186. [PMID: 31845973 DOI: 10.1093/alcalc/agz081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/02/2019] [Accepted: 09/03/2019] [Indexed: 11/12/2022] Open
Abstract
AIMS To identify and group hospitalization trajectory of alcohol use disorder (AUD) patients and its associations with service utilization, healthcare quality and hospital-level variations. METHODS Inpatients with AUD as the primary diagnosis from 2012 to 2014 in Beijing, China, were identified. Their discharge medical records were extracted and analyzed using the sequence analysis and the cluster analysis. RESULTS Eight-hundred thirty-one patients were included, and their hospitalization patterns were grouped into four clusters: short stay (n = 565 (67.99%)), mean psychiatric length of stay in 3 years: (32.25 ± 18.69), repeated short stay (n = 211 (25.39%), 137.76 ± 88.8 days), repeated long stay (n = 41 (4.93%), 405.44 ± 146.54 days), permanent stay (n = 14 (1.68%), 818.14 ± 225.22 days). The latter two clusters (6.61% patients) used 37.26% of the total psychiatric hospital days and 33.65% of the total psychiatric hospitalization expenses. All the patients in the permanent stay cluster and 41.77% of the patients in the short stay cluster were readmitted at least once within 3 years. Two-hundred thirty-four patients (28.16%) were admitted at least once for non-psychiatric reasons, primarily for diseases of circulatory and digestive systems. Cluster composition varied significantly among different hospitals. CONCLUSION Hospitalization pattern of patients with AUD varies greatly, and while most (>2/3) hospitalizations were short stay, those with repeated long stay and permanent stay used more than one third of the hospital days and expenses. Our findings suggest interventions targeting at certain patients may be more effective in reducing resource utilization.
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Affiliation(s)
- Xueyan Han
- Department of Health Policy and Management, School of public health, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 3 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Feng Jiang
- Department of Health Policy and Management, School of public health, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 3 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Huixuan Zhou
- Department of Health Policy and Management, School of public health, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 3 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Jack Needleman
- Department of Health Policy and Management, UCLA Fielding School of Public Health, 650 Charles Young Dr. S., 31-269 CHS Box, Los Angeles, CA 951772, USA
| | - Moning Guo
- Department of Health Statistics, Beijing Municipal Health Commission Information Centre, No. 277 Zhao Deng Yu Lu, Xicheng District, Beijing 100034, China
| | - Yin Chen
- Administrative Office, Peking University International Hospital, No. 29 Sheng Ming Yuan Lu, Haidian District, Beijing 102206, China
| | - Yuanli Liu
- Department of Health Policy and Management, School of public health, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 3 Dong Dan San Tiao, Dongcheng District, Beijing 100730, China
| | - Yilang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, 12 Executive Park Drive NE, Suite 300, Atlanta, GA 30329, USA.,Mental Health Service Line, Atlanta VA Medical Center, 1670 Clairmont Road, Decatur, GA 30033, USA
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14
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Bai Z, Xu Z, Xu X, Qin X, Hu W, Hu Z. Association between social capital and depression among older people: evidence from Anhui Province, China. BMC Public Health 2020; 20:1560. [PMID: 33066764 PMCID: PMC7565750 DOI: 10.1186/s12889-020-09657-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND To examine the relationship between social capital and depression among community-dwelling older adults in Anhui Province, China. METHODS A cross-sectional study was conducted among older people selected from three cities of Anhui Province, China using a multi-stage stratified cluster random sampling method. Data were collected through questionnaire interviews and information on demographic characteristics, social capital, and depression was collected. The generalized linear model and classification and regression tree model were employed to assess the association between social capital and depression. RESULTS Totally, 1810 older people aged ≥60 years were included in the final analysis. Overall, all of the social capital dimensions were positively associated with depression: social participation (coefficient: 0.35, 95% CI: 0.22-0.48), social support (coefficient:0.18, 95% CI:0.07-0.28), social connection (coefficient: 0.76, 95% CI:0.53-1.00), trust (coefficient:0.62, 95% CI:0.33-0.92), cohesion (coefficient:0.31, 95% CI:0.17-0.44) and reciprocity (coefficient:0.30, 95% CI:0.11-0.48), which suggested that older people with higher social capital had a smaller chance to develop depression. A complex joint effect of certain social capital dimensions on depression was also observed. The association with depression and the combinative effect of social capital varied among older adults across the cities. CONCLUSIONS Our study suggests that improving social capital could aid in the prevention of depression among older adults.
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Affiliation(s)
- Zhongliang Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, China
- Department of Health Services Management, School of Health Services Management, Anhui Medical University, Hefei, 230032, China
- School of Public Health and Social Work, Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, 4059, Australia
| | - Zhiwei Xu
- School of Public Health and Social Work, Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, 4059, Australia
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, 4059, Australia
| | - Xiaoru Xu
- Department of Health Services Management, School of Health Services Management, Anhui Medical University, Hefei, 230032, China
| | - Xia Qin
- Department of Health Services Management, School of Health Services Management, Anhui Medical University, Hefei, 230032, China
| | - Wenbiao Hu
- School of Public Health and Social Work, Institute of Health & Biomedical Innovation, Queensland University of Technology, Brisbane, 4059, Australia.
| | - Zhi Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, China.
- Department of Health Services Management, School of Health Services Management, Anhui Medical University, Hefei, 230032, China.
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15
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Zhang J, Zhang Y, Luan Z, Zhang X, Jiang H, Wang A. A study on depression of the elderly with different sleep quality in pension institutions in Northeastern China. BMC Geriatr 2020; 20:374. [PMID: 32993532 PMCID: PMC7526187 DOI: 10.1186/s12877-020-01777-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 09/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background China owns he largest aged population in the world, and the elderly adults who live in pension institutions are more likely to suffer from mental disorders than other elderly adults. The purpose of this study is to discover the risky factors of depression among nursing home residents with various sleeping quality. Methods We conducted a cross-sectional study in Northeastern China from May to September in 2017 using multistage sampling method and 507 elderly people without cognitive impairment in six pension institutions were interviewed. The Pittsburgh Sleep Quality Index (PSQI) and Geriatric Depression Scale (GDS) were adopted to collect the information of sleep quality and depression. We used logistic regression to analyze the factors influencing depression among the elderly adults with poor or good sleep quality. Results The overall depression rate among elderly adults was 21.7%. The logistic regression analysis revealed that marital status, chronic disease, regular exercise, physical ache, filial piety and chewing ability had significant effects on the depression of the elderly with good sleep quality. Loneliness, self-caring ability, chewing ability and chronic diseases had significant effects on depression of the elderly with poor sleep quality. Conclusion The prevalence of depressive symptoms in the elderly is not high. However, sleeping quality distinguishes root causes on elderly adults depression. Therefore, the risk factors of depression among elderly adults should be analyzed separately.
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Affiliation(s)
- Jun Zhang
- Nursing Department, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, China
| | | | - Zhenggang Luan
- Department of Intensive Care Unit, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Xiujie Zhang
- Nursing Department, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, China
| | - Haoran Jiang
- China Medical University, Shenyang, 110122, China
| | - Aiping Wang
- Nursing Department, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, China.
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16
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Bartels SJ, DiMilia PR, Fortuna KL, Naslund JA. Integrated Care for Older Adults with Serious Mental Illness and Medical Comorbidity: Evidence-Based Models and Future Research Directions. Clin Geriatr Med 2020; 36:341-352. [PMID: 32222306 DOI: 10.1016/j.cger.2019.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The excess risk of early mortality, medical comorbidity, early institutionalization, and high costs among older adults with serious mental illness necessitates development and dissemination of effective and sustainable integrated care models that simultaneously address mental and physical health needs. This overview highlights current, evidence-based integrated care models, which predominantly adopt the following approaches: (1) psychosocial skills training, (2) integrated illness self-management, and (3) collaborative care and behavioral health homes. Finally, innovative models that build on these approaches by incorporating novel uses of telehealth, mobile health technology and peer support, and strategies from developing economies are discussed.
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Affiliation(s)
- Stephen J Bartels
- Dartmouth Centers for Health and Aging, 46 Centerra Parkway, Box 201, Lebanon, NH 03766, USA.
| | - Peter R DiMilia
- The Dartmouth Institute for Health Policy and Clinical Practice, 46 Centerra Parkway, Box 201, Lebanon, NH 03766, USA
| | - Karen L Fortuna
- Psychiatry, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Box 201, Lebanon, NH 03766, USA
| | - John A Naslund
- Dartmouth Center for Technology and Behavioral Health, 46 Centerra Parkway, Box 201, Lebanon, NH 03766, USA
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17
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Moriarty AS, Coventry PA, Hudson JL, Cook N, Fenton OJ, Bower P, Lovell K, Archer J, Clarke R, Richards DA, Dickens C, Gask L, Waheed W, Huijbregts KM, van der Feltz-Cornelis C, Ali S, Gilbody S, McMillan D. The role of relapse prevention for depression in collaborative care: A systematic review. J Affect Disord 2020; 265:618-644. [PMID: 31791677 DOI: 10.1016/j.jad.2019.11.105] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/01/2019] [Accepted: 11/21/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Relapse (the re-emergence of depression symptoms before full recovery) is common in depression and relapse prevention strategies are not well researched in primary care settings. Collaborative care is effective for treating acute phase depression but little is known about the use of relapse prevention strategies in collaborative care. We undertook a systematic review to identify and characterise relapse prevention strategies in the context of collaborative care. METHODS We searched for Randomised Controlled Trials (RCTs) of collaborative care for depression. In addition to published material, we obtained provider and patient manuals from authors to provide more detail on intervention content. We reported the extent to which collaborative care interventions addressed four relapse prevention components. RESULTS 93 RCTs were identified. 31 included a formal relapse prevention plan; 42 had proactive monitoring and follow-up after the acute phase; 39 reported strategies for optimising sustained medication adherence; and 20 of the trials reported psychological or psycho-educational treatments persisting beyond the acute phase or focussing on long-term health/relapse prevention. 30 (32.3%) did not report relapse prevention approaches. LIMITATIONS We did not receive trial materials for approximately half of the trials, which limited our ability to identify relevant features of intervention content. CONCLUSION Relapse is a significant risk amongst people treated for depression and interventions are needed that specifically address and minimise this risk. Given the advantages of collaborative care as a delivery system for depression care, there is scope for more consistency and increased effort to implement and evaluate relapse prevention strategies.
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Affiliation(s)
- Andrew S Moriarty
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Peter A Coventry
- Department of Health Sciences and Centre for Reviews and Dissemination, University of York, Heslington, York, YO10 5DD, UK.
| | - Joanna L Hudson
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Natalie Cook
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Oliver J Fenton
- Tees, Esk and Wear Valleys NHS Foundation Trust, South and West Community Mental Health Team, Acomb Garth, 2 Oak Rise, York, YO24 4LJ, UK.
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Janine Archer
- School of Health and Society, University of Salford, Mary Seacole Building, Broad St, Frederick Road Campus, Salford, M6 6PU, UK.
| | - Rose Clarke
- Sheffield IAPT, St George's Community Health Centre, Winter Street, Sheffield, South Yorkshire, S3 7ND, UK.
| | - David A Richards
- Institute of Health Research, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Chris Dickens
- Institute of Health Research, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Linda Gask
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Waquas Waheed
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Klaas M Huijbregts
- GGNet, Mental Health, RGC SKB Winterswijk, Beatrixpark 1, 7101 BN Winterswijk, The Netherlands.
| | | | - Shehzad Ali
- Epidemiology and Biostatistics Department, Schulich School of Medicine & Dentistry, Western University, Kresge Building, Room K201, London, Ontario, N6A 5C1, Canada; Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
| | - Simon Gilbody
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Dean McMillan
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
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18
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Zhang A, Kong D, Jiang L, Sun F, Dunkle RE, Liu C. Understanding the Effectiveness of Psychosocial Services for Anxiety and Depression in Chinese Older Adults: A Systematic Review and Meta-Analysis of Controlled Trials. THE GERONTOLOGIST 2020; 60:e76-e92. [PMID: 30753474 DOI: 10.1093/geront/gny185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There exists an imperative need to comprehensively evaluate the effectiveness of psychosocial interventions for Chinese geriatric populations' mental wellbeing. This study conducted a systematic review and meta-analysis of psychosocial services for Chinese older adults' depression and anxiety. RESEARCH DESIGN AND METHODS A search of nine electronic databases, five geriatric mental health journals, and reference lists was conducted for studies published between 1980 and April. 2018. Thirty-three studies (including totally 3,478 participants, 107 effect sizes) of true and quasiexperimental controlled trials were eligible and included for meta-analysis using robust variance estimation in meta-regression. Outcome indicators were geriatric depression and anxiety. RESULTS An overall significant treatment effect was identified for geriatric depression and anxiety (d = 0.577, 95% confidence interval [CI]: 0.288, 0.867, p < .001). Outcomes, geographic area, participants' marriage, service setting, and types of control group were moderators for treatment effects. Subgroup analysis observed statistically significant effect size among studies in Taiwan, used innovative service methods and small group interventions. Both in-person, home-based interventions and interventions provided by nurse practitioners and specially trained providers were statistically significant. DISCUSSION AND IMPLICATIONS Psychosocial services can benefit Chinese geriatric populations. Innovative and culturally relevant programs received strongest research supports. Future research should incorporate social interaction as an important component for serving Chinese older adults' mental wellbeing.
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Affiliation(s)
- Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor
| | - Dexia Kong
- Institute for Health, Health Care Policy and Aging Research, Rutgers University, The State University of New Jersey, New Brunswick
| | - Lin Jiang
- School of Social Work, The University of Texas Rio Grande Valley, Edinburg
| | - Fei Sun
- School of Social Work, Michigan State University, East Lansing
| | - Ruth E Dunkle
- School of Social Work, University of Michigan, Ann Arbor
| | - Chun Liu
- The University of Texas at Austin, Steve Hicks School of Social Work
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19
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Zhong BL, Ruan YF, Xu YM, Chen WC, Liu LF. Prevalence and recognition of depressive disorders among Chinese older adults receiving primary care: A multi-center cross-sectional study. J Affect Disord 2020; 260:26-31. [PMID: 31493635 DOI: 10.1016/j.jad.2019.09.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 07/19/2019] [Accepted: 09/02/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND In recent years, there have been increasing calls for integrating late-life mental health services into primary care in China, but data on the epidemiology of depressive disorders in older adults receiving primary care are very limited. This study examined prevalence, correlates and recognition of depressive disorders among Chinese older adults receiving primary care. METHODS A total of 752 older patients (65+ years) were consecutively recruited from 13 primary care clinics in Wuhan, China, and interviewed with the Chinese Mini-international Neuropsychiatric Interview 5.0. RESULTS One-fifth (20.3%) of the older adults met DSM-IV criteria for depressive disorders during the month prior to the interview: 10.2% had major depression, 4.8% had dysthymia, and 5.3% had minor depressive disorder. The recognition rate of older patients with depressive disorders was 1.3% only. In multiple logistic regression analysis, factors significantly associated with depressive disorders included female gender (OR = 1.61), an education of primary school and below (OR = 1.69), poor financial status (OR = 2.44), poor or fair family relationship (OR = 1.66), loneliness (OR = 1.77), hypertension (OR = 1.91), heart disease (OR = 2.02), chronic gastric ulcer (OR = 6.01), and arthritis (OR = 3.55). LIMITATIONS Older adults from primary care clinics of economically underdeveloped regions of China were not included. CONCLUSIONS Depressive disorders are prevalent but poorly recognized in Chinese older adults receiving treatment in primary care clinics. In order to improve the emotional well-being and health of older adults, it is time to integrate the management of common mental disorders into primary healthcare in China.
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Affiliation(s)
- Bao-Liang Zhong
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Hubei Province, China; Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Yi-Fan Ruan
- School of Maxism, China University of Geosciences, Wuhan, Hubei Province, China
| | - Yan-Min Xu
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Wen-Cai Chen
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Ling-Fei Liu
- Institute of Maternal, Child and Adolescent Health, School of Public Health, Lanzhou University, Lanzhou, Gansu Province, China.
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Zhong BL, Xu YM, Xie WX, Liu XJ, Huang ZW. Depressive Symptoms in Elderly Chinese Primary Care Patients: Prevalence and Sociodemographic and Clinical Correlates. J Geriatr Psychiatry Neurol 2019; 32:312-318. [PMID: 31480989 DOI: 10.1177/0891988719862620] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To estimate the prevalence of depressive symptoms (depression thereafter) and to identify the sociodemographic and clinical correlates of depression in a sample of elderly patients treated in the primary care setting in Wuhan, China. BACKGROUND Primary care is an opportune setting for the management of late-life depression in China, but there have been no representative studies on the clinical epidemiology of depression in elderly Chinese primary care patients. METHODS In total, 752 elderly patients (≥ 65 years) were consecutively recruited from 13 primary care centers in Wuhan, China, and interviewed with a standardized questionnaire. Depression was assessed with the 15-item Geriatric Depression Scale (GDS-15). RESULTS Of the elderly Chinese primary care patients, 30.6% had depression (GDS-15 ≥ 5). Correlates of depression were an education level of primary school or less (odds ratio [OR]: 1.94, 95% confidence interval [CI]: 1.36-2.77, P < .001), poor financial status (OR: 2.19, 95% CI: 1.16-4.15, P = .016), lack of an exercise habit (OR: 1.40, 95% CI: 1.06-1.74, P = .023), 2 or more chronic medical conditions (OR: 1.90, 95% CI: 1.34-2.69, P < .001), and loneliness (OR: 3.53, 95% CI: 2.46-5.08, P < .001). CONCLUSIONS Depression is prevalent among elderly Chinese primary care patients, indicating that elderly patients treated in primary care have a high level of need for mental health services in China. There is an urgent need to integrate mental health services into primary health care.
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Affiliation(s)
- Bao-Liang Zhong
- 1 Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Hubei, China.,2 Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Yan-Min Xu
- 2 Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Wu-Xiang Xie
- 3 Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China
| | - Xiu-Jun Liu
- 2 Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Zhuo-Wei Huang
- 2 Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei, China
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Jiang H, Chen S, Huang X, Huang R, Lin P, Cheng W, Xu M, Yang F, Liu J, Li Y, Gao Y, Yang Y. Prevalence of and factors associated with major depressive disorder among HIV-positive individuals in Guangdong, China. J Affect Disord 2019; 246:474-479. [PMID: 30599371 DOI: 10.1016/j.jad.2018.12.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/03/2018] [Accepted: 12/25/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND People living with HIV may suffer from mental disorders. We aimed to explore the prevalence of and factors associated with major depressive disorder (MDD) among HIV-positive individuals in Guangdong, China, about which little is known. METHODS A cross-sectional study was conducted to recruit HIV-positive individuals from the Centers for Disease Prevention and Control of Guangzhou, Zhongshan, and Yangjiang from September 2007 to September 2008. Data were collected by questionnaires. MDD was diagnosed and assessed by two psychiatrists using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders-Patient Edition (SCID-I/P) based on the DSM-IV criteria. Multiple logistic regression analyses were conducted to explore the factors associated with MDD. RESULTS The prevalences of lifetime MDD and current MDD among the 339 included participants were 22.71% (95% confidence interval [CI]: 18.25-27.17%) and 12.09% (95%CI: 8.62%-15.57%), respectively. The results of multiple logistic regression showed that patients with AIDS had a higher risk of lifetime MDD (odds ratio [OR] = 2.69, 95%CI: 1.38-5.26) and current MDD (OR = 3.51, 95%CI: 1.59-7.75) than HIV-infected individuals. Participants with more number of negative life events were more likely to have lifetime MDD (OR = 2.33, 95%CI: 1.34-4.06) and current MDD (OR = 3.77, 95%CI: 1.76-8.09) than individuals with fewer negative life events. Individuals with higher score of social support were less likely to have lifetime MDD (OR = 0.45, 95%CI: 0.26-0.80) and current MDD (OR = 0.46, 95%CI: 0.21-0.97) than individuals with less social support. CONCLUSIONS The prevalence of MDD was high among HIV-positive individuals in China. AIDS diagnosis, decreased social support, and an increased number of negative life events were risk factors for MDD.
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Affiliation(s)
- Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China
| | - Shuyi Chen
- The Second People's Hospital of Bao'an District (Group) General Hospital, Shenzhen, China
| | | | - Ruoyan Huang
- Guangzhou Psychiatric Hospital, Guangzhou, China
| | - Peng Lin
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Weibin Cheng
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Meizhen Xu
- Haizhu District Center for Disease Control and Prevention, Guangzhou, China
| | - Fang Yang
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Jun Liu
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Yan Li
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Yanhui Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China.
| | - Yi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, China.
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Li H, Ge S, Greene B, Dunbar-Jacob J. Depression in the context of chronic diseases in the United States and China. Int J Nurs Sci 2019; 6:117-122. [PMID: 31406877 PMCID: PMC6608796 DOI: 10.1016/j.ijnss.2018.11.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/14/2018] [Accepted: 11/28/2018] [Indexed: 02/07/2023] Open
Abstract
Depression is not only a major global public health concern, but also a common comorbidity among patients who experience chronic diseases, such as cancer, stroke, heart disease, diabetes, and chronic obstructive pulmonary disease. Yet the recognition and treatment varies widely around the world. This study (1) provides an integrated review of the literature on the prevalence of depression among patients with chronic diseases in China and the United States and its relationship to poorer health outcomes and (2) compares the differences in the percentages of patients receiving treatments for depression between the United States and China. Given the current situation, we recommended that primary care and specialty providers should be knowledgeable and alert regarding the signs of depression. Efforts should be directed to further implement integrated care based interventions to manage depression and improve quality of life among patients suffering chronic diseases in both China and the United States.
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Affiliation(s)
- Hongjin Li
- University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA
| | - Song Ge
- University of Houston Downtown, Department of Natural Science, Houston, TX, USA
| | - Brian Greene
- University of Pittsburgh, School of Nursing, Pittsburgh, PA, USA
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Sun KS, Lam TP, Wu D. Chinese perspectives on primary care for common mental disorders: Barriers and policy implications. Int J Soc Psychiatry 2018; 64:417-426. [PMID: 29781372 DOI: 10.1177/0020764018776347] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The World Health Organization (WHO) has called for integration of mental health into primary care for a decade. In Western countries, around 15% to 25% of patients with common mental disorders including mood and anxiety disorders seek help from primary care physicians (PCPs). The rate is only about 5% in China. AIMS This article reviews the Chinese findings on the barriers to primary care for common mental disorders and how they compared with Western findings. METHODS A narrative literature review was conducted, focusing on literature published from mid-1990s in English or Chinese. Patient, PCP and health system factors were reviewed. RESULTS Although Chinese and Western findings show similar themes of barriers, the Chinese have stronger barriers in most aspects, including under-recognition of the need for treatment, stigma on mental illness, somatization, worries about taking psychiatric drugs, uncertainties in the role, competency and legitimacy of PCPs in mental health care and short consultation time. CONCLUSION Current policies in China emphasize enhancement of mental health facilities and workforce in the community. Our review suggests that patients' intention to seek help and PCPs' competency in mental health care are other fundamental factors to be addressed.
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Affiliation(s)
- Kai Sing Sun
- 1 Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Tai Pong Lam
- 1 Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong
| | - Dan Wu
- 2 University of North Carolina at Chapel Hill Project-China, Guangzhou, China
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Chen S, Conwell Y, Xue J, Li LW, Tang W, Bogner HR, Dong H. Protocol of an ongoing randomized controlled trial of care management for comorbid depression and hypertension: the Chinese Older Adult Collaborations in Health (COACH) study. BMC Geriatr 2018; 18:124. [PMID: 29843644 PMCID: PMC5975464 DOI: 10.1186/s12877-018-0808-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 05/04/2018] [Indexed: 01/05/2023] Open
Abstract
Background Depression and hypertension are common, costly, and destructive conditions among the rapidly aging population of China. The two disorders commonly coexist and are poorly recognized and inadequately treated, especially in rural areas. Methods The Chinese Older Adult Collaborations in Health (COACH) Study is a cluster randomized controlled trial (RCT) designed to test the hypotheses that the COACH intervention, designed to manage comorbid depression and hypertension in older adult, rural Chinese primary care patients, will result in better treatment adherence and greater improvement in depressive symptoms and blood pressure control, and better quality of life, than enhanced Care-as-Usual (eCAU). Based on chronic disease management and collaborative care principles, the COACH model integrates the care provided by the older person’s primary care provider (PCP) with that delivered by an Aging Worker (AW) from the village’s Aging Association, supervised by a psychiatrist consultant. One hundred sixty villages, each of which is served by one PCP, will be randomly selected from two counties in Zhejiang Province and assigned to deliver eCAU or the COACH intervention. Approximately 2400 older adult residents from the selected villages who have both clinically significant depressive symptoms and a diagnosis of hypertension will be recruited into the study, randomized by the villages in which they live and receive primary care. After giving informed consent, they will undergo a baseline research evaluation; receive treatment for 12 months with the approach to which their village was assigned; and be re-evaluated at 3, 6, 9, and 12 months after entry. Depression and HTN control are the primary outcomes. Treatment received, health care utilization, and cost data will be obtained from the subjects’ electronic medical records (EMR) and used to assess adherence to care recommendations and, in a preliminary manner, to establish cost and cost effectiveness of the intervention. Discussion The COACH intervention is designed to serve as a model for primary care-based management of common mental disorders that occur in tandem with common chronic conditions of later life. It leverages existing resources in rural settings, integrates social interventions with the medical model, and is consistent with the cultural context of rural life. Trial registration ClinicalTrials.gov ID: NCT01938963; First posted: September 10, 2013.
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Affiliation(s)
- Shulin Chen
- Department of Psychology, Zhejiang University, Hangzhou, China
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY, 14642, USA.
| | - Jiang Xue
- Department of Psychology, Zhejiang University, Hangzhou, China
| | - Lydia W Li
- School of Social Work, University of Michigan, Ann Arbor, USA
| | - Wan Tang
- Department of Global Biostatistics and Data Science, Tulane University, New Orleans, USA
| | - Hillary R Bogner
- Department of Family Medicine, University of Pennsylvania, Philadelphia, USA
| | - Hengjin Dong
- Faculty of Public Health Research, Zhejiang University, Hangzhou, China
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Bartels SJ, DiMilia PR, Fortuna KL, Naslund JA. Integrated Care for Older Adults with Serious Mental Illness and Medical Comorbidity: Evidence-Based Models and Future Research Directions. Psychiatr Clin North Am 2018; 41:153-164. [PMID: 29412843 PMCID: PMC5806142 DOI: 10.1016/j.psc.2017.10.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The excess risk of early mortality, medical comorbidity, early institutionalization, and high costs among older adults with serious mental illness necessitates development and dissemination of effective and sustainable integrated care models that simultaneously address mental and physical health needs. This overview highlights current, evidence-based integrated care models, which predominantly adopt the following approaches: (1) psychosocial skills training, (2) integrated illness self-management, and (3) collaborative care and behavioral health homes. Finally, innovative models that build on these approaches by incorporating novel uses of telehealth, mobile health technology and peer support, and strategies from developing economies are discussed.
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Affiliation(s)
| | - Peter R. DiMilia
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
| | - Karen L. Fortuna
- Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - John A. Naslund
- Dartmouth Center for Technology and Behavioral Health, Lebanon, NH, USA
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Huang HC, Liu SI, Hwang LC, Sun FJ, Tjung JJ, Huang CR, Li TC, Huang YP, Yeung A. The effectiveness of Culturally Sensitive Collaborative Treatment of depressed Chinese in family medicine clinics: A randomized controlled trial. Gen Hosp Psychiatry 2018; 50:96-103. [PMID: 29127813 DOI: 10.1016/j.genhosppsych.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/08/2017] [Accepted: 10/09/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate whether the Culturally Sensitive Collaborative Treatment (CSCT) would improve outcomes for patients with major depression who were managed in family medicine clinics in Taiwan. METHOD A single-blinded randomized trial was conducted in 26 family medicine clinics. Patients with major depressive disorder were consecutively randomized to either CSCT or treatment as usual (TAU). The primary outcome was the severity of depression. Secondary outcomes included treatment response, treatment remission, quality of life, and medication adherence. Outcomes were compared using hierarchical linear models (mixed-effects models) from baseline to 26-week follow-up assessments. RESULTS Of the 280 patients, 141 were randomized to TAU and 139 to CSCT. Hierarchical linear modeling revealed that the CSCT group displayed significantly greater improvement in depressive symptoms over the study period when compared to the TAU group (B=-2.60, P<0.001). The odds of achieving the response, remission, and medication adherence were significantly greater for the CSCT group compared to the TAU group (odds ratio=4.65, 4.12, and 2.06, respectively; all Ps<0.05). However, both groups did not differ significantly in quality of life. CONCLUSION CSCT is effective in improving treatment outcomes for major depression in family medicine clinics in Taiwan.
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Affiliation(s)
- Hui-Chun Huang
- Department of Medical Research, MacKay Memorial Hospital, Taipei 251, Taiwan; Department of Public Health, China Medical University, Taichung 404, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei 112, Taiwan
| | - Shen-Ing Liu
- Department of Psychiatry, MacKay Memorial Hospital, Taipei 104, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan.
| | - Lee-Ching Hwang
- MacKay Junior College of Medicine, Nursing and Management, Taipei 112, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan; Department of Family Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, MacKay Memorial Hospital, Taipei 251, Taiwan; MacKay Junior College of Medicine, Nursing and Management, Taipei 112, Taiwan
| | - Jin-Jin Tjung
- Department of Family Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan
| | - Chiu-Ron Huang
- Department of Medical Research, MacKay Memorial Hospital, Taipei 251, Taiwan
| | - Tsai-Chung Li
- Department of Public Health, China Medical University, Taichung 404, Taiwan
| | - Yo-Ping Huang
- Department of Electrical Engineering, National Taipei University of Technology, Taipei 106, Taiwan
| | - Albert Yeung
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA 02114, USA
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Conwell Y. Scientific Autobiography. Am J Geriatr Psychiatry 2017; 25:1281-1286. [PMID: 28838593 DOI: 10.1016/j.jagp.2017.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Yeates Conwell
- Office for Aging Research and Health Services, Center for the Study and Prevention of Suicide, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY.
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28
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Bartels SJ. Why collaborative care matters for older adults in China. Lancet Psychiatry 2015; 2:286-7. [PMID: 26360064 DOI: 10.1016/s2215-0366(15)00049-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 01/27/2015] [Indexed: 11/26/2022]
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