1
|
Loef D, van Eijndhoven P, van den Munckhof E, Hoogendoorn A, Manten R, Spaans HP, Tendolkar I, Rutten B, Nuninga J, Somers M, van Dellen E, van Exel E, Schouws S, Dols A, Verwijk E. Pre-treatment predictors of cognitive side-effects after treatment with electroconvulsive therapy in patients with depression: A multicenter study. J Affect Disord 2024; 349:321-331. [PMID: 38195009 DOI: 10.1016/j.jad.2024.01.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/29/2023] [Accepted: 01/03/2024] [Indexed: 01/11/2024]
Abstract
BACKGROUND Electroconvulsive therapy (ECT) is a highly effective treatment for major depressive episodes (MDE). However, ECT-induced cognitive side-effects remain a concern. Identification of pre-treatment predictors that contribute to these side-effects remain unclear. We examined cognitive performance and individual cognitive profiles over time (up to six months) following ECT and investigated possible pre-treatment clinical and demographic predictors of cognitive decline shortly after ECT. METHODS 634 patients with MDE from five sites were included with recruitment periods between 2001 and 2020. Linear mixed models were used to examine how cognitive performance, assessed with an extensive neuropsychological test battery, evolved over time following ECT. Next, possible pre-treatment predictors of cognitive side-effects directly after ECT were examined using linear regression. RESULTS Directly after ECT, only verbal fluency (animal and letter; p < 0.0001; Cohen's d: -0.25 and -0.29 respectively) and verbal recall (p < 0.0001; Cohen's d: -0.26) significantly declined. However, during three and six months of follow-up, cognitive performance across all domains significantly improved, even outperforming baseline levels. No other pre-treatment factor than a younger age predicted a larger deterioration in cognitive performance shortly after ECT. LIMITATIONS There was a substantial amount of missing data especially at 6 months follow-up. CONCLUSIONS Our findings show that verbal fluency and memory retention are temporarily affected immediately after ECT. Younger patients may be more susceptible to experiencing these acute cognitive side-effects, which seems to be mostly due to a more intact cognitive functioning prior to ECT. These findings could contribute to decision-making regarding treatment selection, psychoeducation, and guidance during an ECT course.
Collapse
Affiliation(s)
- Dore Loef
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands; GGZ inGeest Mental Health Care, Amsterdam, the Netherlands.
| | | | | | - Adriaan Hoogendoorn
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands; GGZ inGeest Mental Health Care, Amsterdam, the Netherlands
| | - Ruby Manten
- GGZ Noord-Holland-Noord Mental Health Care, Alkmaar, the Netherlands
| | | | - Indira Tendolkar
- Department of Psychiatry, Radboud umc, Nijmegen, the Netherlands; Donders Institute for Brain, Cognition and Behavior, Department of Psychiatry, Nijmegen, the Netherlands
| | - Bart Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jasper Nuninga
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Metten Somers
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Edwin van Dellen
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Neurology, Universitair Ziekenhuis Brussel Center for Neurosciences, Vrije Universiteit Brussel Brussels, Belgium
| | - Eric van Exel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands; GGZ inGeest Mental Health Care, Amsterdam, the Netherlands
| | - Sigfried Schouws
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands; GGZ inGeest Mental Health Care, Amsterdam, the Netherlands
| | - Annemiek Dols
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Neuroscience, Mood, Anxiety, Psychosis, Sleep & Stress Program, Amsterdam, the Netherlands; Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Esmée Verwijk
- Parnassia Psychiatric Institute, The Hague, the Netherlands; University of Amsterdam, Department of Psychology, Amsterdam, the Netherlands; Amsterdam UMC, AMC, Department of Medical Psychology, Amsterdam, the Netherlands
| |
Collapse
|
2
|
Stigma associated with parental depression or cancer: Impact on spouse and offspring's cortisol levels and socioemotional functioning. Dev Psychopathol 2021; 32:1822-1837. [DOI: 10.1017/s0954579420001431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AbstractStress associated with caring for a mentally ill spouse can adversely affect the health status of caregivers and their children. Adding to the stress of caregiving is the stigma often placed against spouses and children of people with mental illness. Contrary to mental illness, many physical disorders such as cancer may be less stigmatized (expect pulmonary cancer). In this study, we measured externalized and internalized stigma, as well as psychological (depressive symptoms and stressful life events) and physiological (basal salivary cortisol levels) markers of stress in 115 spouses and 154 children of parents suffering from major depressive disorder, cancer, or no illness (control group). The results show that spouses and children from families with parental depression present significantly more externalized stigma than spouses and children from families with parental cancer or no illness, although we find no group differences on internalized stigma. The analysis did not show a significant group difference either for spouses or their children on depressive symptomatology, although spouses from the parental depression group reported greater work/family stress. Finally, we found that although for both spouses children the awakening cortisol response was greater on weekdays than on weekend days, salivary cortisol levels did not differ between groups. Bayes factor calculated on the null result for cortisol levels was greater than 100, providing strong evidence for the null hypothesis H0. Altogether, these results suggest an impact of stigma toward mental health disorder on psychological markers of stress but no impact of stigma on physiological markers of stress. We suggest that these results may be due to the characteristics of the families who participated in the present study.
Collapse
|
3
|
Ojagbemi A, Bello T, Luo Z, Gureje O. Chronic Conditions, New Onset, and Persistent Disability in the Ibadan Study of Aging. J Gerontol A Biol Sci Med Sci 2017; 72:997-1005. [PMID: 27038233 DOI: 10.1093/gerona/glv188] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/24/2015] [Indexed: 11/13/2022] Open
Abstract
Background. Information about the contribution of chronic conditions to disability in the sub-Saharan African older persons is derived from implicit data. We investigated the association of chronic conditions with incident and persistent disability among community-dwelling elderly Nigerians. Methods. We followed disability-free participants in a household cluster randomized sample of 2,149 Nigerians, aged 65 years or older, in three waves over 5 years (2003-2009). Disability was measured using culturally adapted tools. Dementia and depression were ascertained using validated interviewer-administered measures. The presence of pain in six sites, angina, systemic hypertension, diabetes, heart and respiratory disease, and vision and hearing impairment were assessed using standardized self-report of clinician diagnoses. Independent predictors of disability were investigated using separate multivariate binomial and multinomial regression models with Bonferroni corrections. Results. Among 1,887 disability-free participants, 457 (24.2%) had incident disability over 5 years; there were 234 (12.4%), 177 (9.4%), and 106 (5.6%) new cases in each of the waves. A total of 181 (10.0%) persons had disability persistently. Having a pain condition (relative risk ratio [RRR] = 4.7, 95% confidence interval [CI] = 2.0-11.0), especially when nonlocalizing (RRR = 1.5, 95% CI = 1.0-2.2), was the main predictor of incident disability in the study. Dementia was associated with cumulative deaths over 5 years (RRR = 3.5, 95% CI = 2.3-5.3). There were no significant associations between having a chronic condition and persistent disability following correction for false discovery rates. Conclusion. Using direct measurements, musculoskeletal pain appears to be the most disabling condition in this sub-Saharan African elderly cohort surviving for up to 5 years with chronic conditions. Dementia may be associated with early death.
Collapse
Affiliation(s)
- Akin Ojagbemi
- World Health Organization (WHO) Collaborating Centre for Research and Training in Mental Health, Neuroscience, and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Toyin Bello
- World Health Organization (WHO) Collaborating Centre for Research and Training in Mental Health, Neuroscience, and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Zhehui Luo
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing
| | - Oye Gureje
- World Health Organization (WHO) Collaborating Centre for Research and Training in Mental Health, Neuroscience, and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| |
Collapse
|
4
|
Abstract
From 2007 to 2010, The Netherlands experienced a major Q fever outbreak with more than 4000 notifications. Previous studies suggested that Q fever patients could suffer long-term post-infection health impairments, especially fatigue. Our objective was to assess the Coxiella burnetii antibody prevalence and health status including fatigue, and assess their interrelationship in Herpen, a high-incidence village, 7 years after the outbreak began. In 2014, we invited all 2161 adult inhabitants for a questionnaire and a C. burnetii indirect fluorescence antibody assay (IFA). The health status was measured with the Nijmegen Clinical Screening Instrument (NCSI), consisting of eight subdomains including fatigue. Of the 70·1% (1517/2161) participants, 33·8% (513/1517) were IFA positive. Of 147 participants who were IFA positive in 2007, 25 (17%) seroreverted and were now IFA negative. Not positive IFA status, but age <50 years, smoking and co-morbidity, were independent risk factors for fatigue. Notified participants reported significantly more often fatigue (31/49, 63%) than non-notified IFA-positive participants (150/451, 33%). Although fatigue is a common sequel after acute Q fever, in this community-based survey we found no difference in fatigue levels between participants with and without C. burnetii antibodies.
Collapse
|
5
|
Novick D, Montgomery W, Moneta MV, Peng X, Brugnoli R, Haro JM. Chinese patients with major depression: Do concomitant pain symptoms affect quality of life independently of severity of depression? Int J Psychiatry Clin Pract 2015; 19:174-81. [PMID: 25946899 DOI: 10.3109/13651501.2015.1031681] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study investigated whether painful physical symptoms (PPSs) influenced quality of life (QoL) when adjusting for severity of depression. METHODS Severity of depression, QoL and PPSs were assessed at baseline and 3 months among the Chinese cohort (n = 300) of a 3-month observational study of major depressive disorder (MDD) in East Asia. The presence of PPS was defined as 'a mean score of ≥2 on the Somatic Symptom Inventory pain-related items'. Regression analyses determined predictors of QoL at 3 months, adjusting for age, sex, depressive symptoms, overall severity and QoL at baseline. RESULTS PPSs were present (PPS+) at baseline in 35.3% of patients. Over 3 months, in the whole sample, EuroQoL visual analogue scale (EQ-VAS) score improved from 45.5 (standard deviation [SD]: 20.9) to 81 (SD: 16.7), and EuroQoL 5-Dimension Questionnaire (EQ-5D) score improved from 0.52 (SD: 0.31) to 0.89 (0.16). At 3 months, mean EQ-VAS was 75.9 (SD: 17.7) for PPS+ versus 83.7 (SD: 15.6) for PPS-, and mean EQ-5D was 0.83 (SD: 0.17) versus 0.92 (SD: 0.14). PPS+ at baseline was a significant predictor of QoL at 3 months after adjusting for socio-demographic and baseline clinical variables. CONCLUSIONS PPSs were associated with less improvement in QoL in patients receiving treatment for MDD, independent of severity of depression.
Collapse
Affiliation(s)
- Diego Novick
- a Eli Lilly and Company , Windlesham, Surrey , UK
| | | | | | | | | | | |
Collapse
|
6
|
Girls' quality of life prior to detention in relation to psychiatric disorders, trauma exposure and socioeconomic status. Qual Life Res 2014; 24:1419-29. [PMID: 25429824 DOI: 10.1007/s11136-014-0878-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Practice and research on detained girls has mainly been problem oriented, overlooking these minors' own perspective on and satisfaction with life. The aim of this study was to examine how girls evaluate multiple domains of quality of life (QoL) and how each domain is affected by psychiatric (co)morbidity, trauma, and socioeconomic status (SES). METHODS An abbreviated version of the World Health Organization (WHO) QoL Instrument was used to assess the girls' (N = 121; M(age) = 16.28) QoL prior to detention. This self-report questionnaire consists of two benchmark items referring to their overall QoL and health, and 24 remaining items measuring their QoL regarding four domains (physical health, psychological health, social relationships, and environment). The Diagnostic Interview Schedule for Children-IV was used to assess the past-year prevalence of psychiatric disorders and life-time trauma exposure. RESULTS Detained girls perceived their QoL almost as good as the 12- to 20-year-olds from the WHO's international field trial on all but one domain (i.e., psychological health). They were most satisfied with their social relationships and least satisfied with their psychological health. Psychiatric disorders, trauma, and low SES were distinctively and negatively related to various domains of QoL. The girls' psychological health was most adversely affected by psychosocial and socioeconomic problems, while these variables had an almost negligible impact on their satisfaction with their social relationships. CONCLUSIONS The particularity of each domain of QoL supports a multidimensional conceptualization of QoL. Regarding treatment, psychological health appears as a domain of major concern, while social relationships might serve as a source of resilience.
Collapse
|
7
|
Forlani C, Morri M, Ferrari B, Dalmonte E, Menchetti M, De Ronchi D, Atti AR. Prevalence and gender differences in late-life depression: a population-based study. Am J Geriatr Psychiatry 2014; 22:370-80. [PMID: 23567427 DOI: 10.1016/j.jagp.2012.08.015] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 08/07/2012] [Accepted: 08/29/2012] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The worldwide phenomenon of an aging population combined with the increasing prevalence of depression in late life are issues that need to be addressed. This study aims to estimate the frequency of depression and subthreshold depression occurring in a sample of cognitively well-functioning, community-dwelling, older Italian adults and to investigate sociodemographic and clinical correlates of depression, exploring gender differences. METHODS We used a cross-sectional analyses of survivors in a population-based study (the Faenza Project) that included 359 subjects aged 74 years and older (49.3% women). A modified version of Cambridge Examination for Mental Disorders of Elderly Persons-Revised was administered to all participants. Prevalence rates of depression and 95% confidence intervals (CIs) were estimated according to International Classification of Diseases, Tenth Revision criteria. Statistical analyses were implemented to describe sociodemographic and clinical features associated with depression. Odds ratios were estimated by multivariate logistic regression, and the dependant variable was any type of depression. RESULTS Overall prevalence of depression was 25.1% (95% CI: 20.6-29.6), with no evidence of gender difference. Prevalence of mild, moderate, and severe depression was 16.4% (95% CI: 12.6-20.2), 7.5% (95% CI: 4.8-10.2), and 1.1 (95% CI: -0.4-2.6), respectively. A rate of 5.6% of the population complained of subthreshold depressive symptoms. After age 81, depression occurrence decreased as age increased. The association between depression and functional measures, such as primary activity, mobility, and disability in performing household chores, were stronger in men than in women. Similarly, severely disabling conditions like stroke were more strongly associated with depression in men than in women. CONCLUSION Our data suggest a disparity between men and women regarding the impact of depression on everyday life. Specific gender differences need to be taken into account for the evaluation of the depression-related burden in late life.
Collapse
Affiliation(s)
- Claudia Forlani
- Institute of Psychiatry, University of Bologna, Bologna, Italy.
| | - Monica Morri
- Institute of Psychiatry, University of Bologna, Bologna, Italy
| | - Barbara Ferrari
- Institute of Psychiatry, University of Bologna, Bologna, Italy
| | - Edoardo Dalmonte
- Unit of Geriatric Medicine, Local Health Authority of Ravenna, Italy
| | - Marco Menchetti
- Institute of Psychiatry, University of Bologna, Bologna, Italy
| | - Diana De Ronchi
- Institute of Psychiatry, University of Bologna, Bologna, Italy
| | - Anna Rita Atti
- Institute of Psychiatry, University of Bologna, Bologna, Italy
| |
Collapse
|
8
|
Zeng Q, Xu Y, Chun Wang W. Quality of life in outpatients with depression in China. J Affect Disord 2013; 150:513-21. [PMID: 23714374 DOI: 10.1016/j.jad.2013.04.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 04/25/2013] [Accepted: 04/26/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Quality of life (QOL) is an important outcome measure for patients with depression, but QOL research involving large samples of patients has been uncommon. The purpose of this study was to evaluate the QOL of Chinese outpatients with depression and its determinants. METHODS Using a cross-sectional survey design, data were collected continuously from 19,984 outpatients; 19,950 usable questionnaires were obtained. Along with the QOL index (WHOQOL-BREF), the questionnaire also included participants' sociodemographic characteristics, outpatient visits, and medication use information. RESULTS Less than 5% of depressed patients reported "good" or "very good" QOL, while less than 3% were satisfied with their general health. The overall score was low (54.12); four QOL domain (physical health, psychological, social relationships, and environment) scores (range, 35.03-40.10) were significantly lower than in other community population surveys. QOL scores were significantly lower among first-visit than non-first-visit patients. Medication users reported significantly higher QOL scores than non-users, with NaSSA more effective than SSRIs, followed by other types, SNRIs, and no medication, in that order. LIMITATIONS Since this was an observational, cross-sectional survey with continuous outpatient data collection method instead of random sampling, generalization of the results is limited, and causality cannot be determined. However, the "natural" observational design, large sample size, and similarity in findings with other studies reveal the "real world" QOL of depressed outpatients in mainland China. CONCLUSIONS Depressed patients had a low QOL, and the scores of first-visit patients with severe symptoms were significantly lower than non-first-visit patients. Though medication can improve patients' QOL, different types of medications have different impacts.
Collapse
Affiliation(s)
- Qingzhi Zeng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, PR China
| | | | | |
Collapse
|
9
|
Using the analytic hierarchy process to elicit patient preferences: prioritizing multiple outcome measures of antidepressant drug treatment. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2013; 5:225-37. [PMID: 23098363 DOI: 10.1007/bf03262495] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVE In health technology assessment, the evidence obtained from clinical trials regarding multiple clinical outcomes is used to support reimbursement claims. At present, the relevance of these outcome measures for patients is, however, not systematically assessed, and judgments on their relevance may differ among patients and healthcare professionals. The analytic hierarchy process (AHP) is a technique for multi-criteria decision analysis that can be used for preference elicitation. In the present study, we explored the value of using the AHP to prioritize the relevance of outcome measures for major depression by patients, psychiatrists and psychotherapists, and to elicit preferences for alternative healthcare interventions regarding this weighted set of outcome measures. METHODS Supported by the pairwise comparison technique of the AHP, a patient group and an expert group of psychiatrists and psychotherapists discussed and estimated the priorities of the clinical outcome measures of antidepressant treatment. These outcome measures included remission of depression, response to drug treatment, no relapse, (serious) adverse events, social function, no anxiety, no pain, and cognitive function. Clinical evidence on the outcomes of three antidepressants regarding these outcome measures was derived from a previous benefit assessment by the Institute for Quality and Efficiency in Health Care (IQWiG; Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen). RESULTS The most important outcome measures according to the patients were, in order of decreasing importance: response to drug treatment, cognitive function, social function, no anxiety, remission, and no relapse. The patients and the experts showed some remarkable differences regarding the relative importance of response (weight patients = 0.37; weight experts = 0.05) and remission (weight patients = 0.09; weight experts = 0.40); however, both experts and patients agreed upon the list of the six most important measures, with experts only adding one additional outcome measure. CONCLUSIONS The AHP can easily be used to elicit patient preferences and the study has demonstrated differences between patients and experts. The AHP is useful for policy makers in combining multiple clinical outcomes of healthcare interventions grounded in randomized controlled trials in an overall health economic evaluation. This may be particularly relevant in cases where different outcome measures lead to conflicting results about the best alternative to reimburse. Alternatively, AHP may also support researchers in selecting (primary) outcome measures with the highest relevance.
Collapse
|
10
|
Novick D, Montgomery W, Kadziola Z, Moneta V, Peng X, Brugnoli R, Haro JM. Do concomitant pain symptoms in patients with major depression affect quality of life even when taking into account baseline depression severity? Patient Prefer Adherence 2013; 7:463-70. [PMID: 23818764 PMCID: PMC3693583 DOI: 10.2147/ppa.s41703] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with major depressive disorder (MDD) may suffer from concomitant pain symptoms. The aim of this study is to determine whether the presence of painful physical symptoms (PPS) influences quality of life when taking into account baseline depression severity. METHODS Patients with a new or first episode of MDD (n = 909) were enrolled in a 3-month prospective observational study in East Asia. The Hamilton Depression Rating Scale, Clinical Global Impression-Severity score, Somatic Symptom Inventory, and EuroQoL questionnaire-5 Dimensions (EQ-5D) and EQ-Visual Analogue Scale (EQ-VAS) were assessed at baseline and 3 months' follow-up. The presence of PPS was defined as a mean score of ≥2 on the Somatic Symptom Inventory pain-related items. Regression analyses determined predictors of quality of life at 3 months, adjusting for age, sex, depressive symptoms, overall severity, and quality of life at baseline. RESULTS PPS were present (PPS+) at baseline in 52% of patients. During the 3-month follow-up, EQ-VAS scores improved from 47.7 (standard deviation [SD] 20.6) to 72.5 (SD 20.4), and EQ-5D improved from 0.48 (SD 0.34) to 0.80 (SD 0.26). At 3 months, mean EQ-VAS was 66.4 (SD 21.2) for baseline PPS+ patients versus 78.5 (SD 17.6) for baseline PPS- patients, and mean EQ-5D was 0.71 (SD 0.29) versus 0.89 (SD 0.18). PPS+ at baseline was a significant predictor of quality of life at 3 months after adjusting for sociodemographic and baseline clinical variables. CONCLUSION The presence of painful physical symptoms is associated with less improvement in quality of life in patients receiving treatment for major depression, even when adjusting for depression severity.
Collapse
Affiliation(s)
- Diego Novick
- Eli Lilly and Company, Windlesham, Surrey, UK
- Correspondence: Diego Novick, Lilly Research Centre, Erl Wood Manor,
Sunninghill Road, Windlesham, Surrey GU20 6PH, UK, Tel +44 127 648 3832, Fax +44 127
648 3192, Email
| | | | | | - Victoria Moneta
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu,
CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu,
CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
11
|
Casañas R, Catalán R, del Val JL, Real J, Valero S, Casas M. Effectiveness of a psycho-educational group program for major depression in primary care: a randomized controlled trial. BMC Psychiatry 2012; 12:230. [PMID: 23249399 PMCID: PMC3551665 DOI: 10.1186/1471-244x-12-230] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 12/10/2012] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Studies show the effectiveness of group psychoeducation in reducing symptoms in people with depression. However, few controlled studies that have included aspects of personal care and healthy lifestyle (diet, physical exercise, sleep) together with cognitive-behavioral techniques in psychoeducation are proven to be effective.The objective of this study is to assess the effectiveness of a psychoeducational program, which includes aspects of personal care and healthy lifestyle, in patients with mild/moderate depression symptoms in Primary Care (PC). METHODS In a randomized, controlled trial, 246 participants over 20 years old with ICD-10 major depression were recruited through nurses/general practitioners at 12 urban Primary Care Centers (PCCs) in Barcelona. The intervention group (IG) (n=119) received a group psychoeducational program (12 weekly, 1.5 h sessions led by two nurses) and the control group (CG) (n=112) received usual care. Patients were assessed at baseline and at, 3, 6 and 9 months. The main outcome measures were the BDI, EQ-5D and remission based upon the BDI. RESULTS 231 randomized patients were included, of whom 85 had mild depression and 146 moderate depression. The analyses showed significant differences between groups in relation to remission of symptoms, especially in the mild depression group with a high rate of 57% (p=0.009) at post-treatment and 65% (p=0.006) at 9 month follow up, and only showed significant differences on the BDI at post-treatment (p=0.016; effect size Cohen's d'=.51) and at 6 and 9 month follow-up (p= 0.048; d'=.44).In the overall and moderate sample, the analyses only showed significant differences between groups on the BDI at post-treatment, p=0.02 (d'=.29) and p=0.010 (d'=.47), respectively.The psychoeducation group improved significantly on the EQ-5D at short and long-term. CONCLUSIONS This psychoeducational intervention is a short and long-term effective treatment for patients with mild depression symptoms. It results in a high remission rate, is recommended in PC and can be carried out by nurses with previous training. In moderate patients, group psychoeducation is effective in the short-term. TRIAL REGISTRATION Clinical Trials.gov identifier NCT00841737.
Collapse
Affiliation(s)
- Rocío Casañas
- Research Department. Centre Higiene Mental (CHM) Les Corts, c/ Numancia, 103-105, Bajos, 08029, Barcelona, Spain
- Psychiatry and Legal Medicine Department, Universidad Autónoma de Barcelona, Barcelona, Spain
- Barcelona Research Support Unit in Primary Care. IDIAP Jordi Gol, Catalan Institute of Health, Barcelona, Spain
| | - Rosa Catalán
- Clinical Institute of Neurosciences (ICN), Hospital Clinic, C/ Villarroel 170, 08036, Barcelona, Spain
- Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Jose Luis del Val
- Barcelona Research Support Unit in Primary Care. IDIAP Jordi Gol, Catalan Institute of Health, Barcelona, Spain
| | - Jordi Real
- Barcelona Research Support Unit in Primary Care. IDIAP Jordi Gol, Catalan Institute of Health, Barcelona, Spain
| | - Sergi Valero
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, C/Passeig de la Vall d’Hebron, 119-129, 08035, Barcelona, Spain
| | - Miquel Casas
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, C/Passeig de la Vall d’Hebron, 119-129, 08035, Barcelona, Spain
| |
Collapse
|
12
|
Antidepressant-dependent mRNA changes in mouse associated with hippocampal neurogenesis in a mouse model of depression. Pharmacogenet Genomics 2012; 22:765-76. [DOI: 10.1097/fpc.0b013e328356fa90] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
|
13
|
Farmer C, Farrand P, O’Mahen H. 'I am not a depressed person': how identity conflict affects help-seeking rates for major depressive disorder. BMC Psychiatry 2012; 12:164. [PMID: 23031330 PMCID: PMC3568063 DOI: 10.1186/1471-244x-12-164] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 09/20/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a significant treatment gap for patients with depression. A third of sufferers never seek help, and the vast majority of those who do only do so after considerable delay. Little is understood regarding poor help-seeking rates amongst people with depression, with existing research mainly focussed on the impact of barriers to treatment. The current study explored psychological factors affecting help-seeking behaviour in clinically depressed individuals. METHODS Semi-structured interviews were conducted with 20 current or previously clinically depressed participants who either had or had not sought professional help. Thematic analysis was used to analyse results. RESULTS The onset of depressive symptoms created conflict with participants' identity and personal goals. Delays in seeking help were primarily attributed to the desire to protect identity and goals from the threat of depressive symptoms. Participants used avoidance strategies to reduce the perceived threat of depressive symptoms on identity. These strategies interfered with help-seeking. Help-seeking was only undertaken once participants reached a point of acceptance and began to make concessions in their identity and goals, at which time they reduced their use of avoidance. CONCLUSIONS Difficulties resolving conflict between identity and depressive symptoms may account for significant delays in seeking help for depression. The results have implications for predicting health behaviour and improving treatment uptake for depression, and may inform existing help-seeking models.
Collapse
Affiliation(s)
| | - Paul Farrand
- Mood Disorders Centre, University of Exeter, Exeter, UK
| | | |
Collapse
|