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Oude Voshaar RC. The 'discontinuity hypothesis' of depression in later life-clinical and research implications. Age Ageing 2023; 52:afad239. [PMID: 38156879 PMCID: PMC10756079 DOI: 10.1093/ageing/afad239] [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: 01/08/2023] [Revised: 01/08/2023] [Indexed: 01/03/2024] Open
Abstract
The term depression is overused as an umbrella term for a variety of conditions, including depressed mood and various psychiatric disorders. According to psychiatric diagnostic criteria, depressive disorders impact nearly all aspects of human life and are a leading cause of disability worldwide. The widespread assumption that different types of depression lie on a continuum of severity has stimulated important research on subthreshold depression in later life. This view assumes that depressed mood is a precursor of a depressive disorder. The present narrative review argues why in later life depressed mood might either (i) lie on a continuum with depressive disorders among people vulnerable for a depressive disorder or (ii) be an ageing-related epiphenomenon of underlying physical illnesses in people who are resilient to depressive disorders ('discontinuity hypothesis'). Three arguments are discussed. First, the course of depressed mood and depressive disorders differs across the life span. Second, screening instruments for depression have low predictive value for depressive disorders in later life. Third, a dose-response relationship has not been consistently found across different types of depression and detrimental health outcomes. Using the umbrella term depression may partly explain why pharmacological treatment is less effective with increasing age, and negative health-related outcomes might be overestimated. The discontinuity hypothesis may prevent pharmacological overtreatment of milder subtypes of depression and may stimulate comprehensive multidisciplinary assessment as well as the development of separate treatment algorithms for depressed mood and depressive disorders.
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Affiliation(s)
- Richard C Oude Voshaar
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherland
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Ma Y, Chen N, Chen J, Huang T, Huang N, Gao X, Liang H. Genetic modification effects of physical frailty on the morbidity of mental disorders in the UK Biobank. Aging Ment Health 2023; 27:2034-2042. [PMID: 36264069 DOI: 10.1080/13607863.2022.2135682] [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: 08/19/2022] [Accepted: 10/09/2022] [Indexed: 11/01/2022]
Abstract
Objectives: Depression and anxiety are two major categories of mental disorders that are highly prevalent in the general population. This study aims to explore the genetic modification effects of physical frailty on the morbidity of mental disorders.Methods: Using data from UK Biobank, we calculate genetic risk scores for depression, anxiety and mental disorders based on 37/44 single-nucleotide polymorphisms (SNPs) of Major Depressive Disorder (MDD) and 9/10 SNPs of anxiety. Frailty status was defined by a modified version of the frailty phenotype based on five individual components. Cox proportional hazard models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of depression and anxiety risk among groups with different frailty status.Results: Of 267,755 participants in UK Biobank, 4,905 (2%) were considered frail, 98,907 (37%) pre-frail and 163,943 (61%) not frail. Compared with the non-frail group, the pre-frail group (HR = 1.53; [95% CI:1.47-1.61]), and frail group (HR = 2.75; [95% CI:2.46-3.07]) were significantly associated with increased risk of depression. Per 1-number increment in frailty component counts were significantly associated with increased risk of mental disorders. In each genetic risk score (GRS) strata, people with pre-frailty and frailty suffered higher risks of mental disorders than the non-frail group.Conclusion: Our results indicate that physical frailty plays an important role in the incidence of mental disorders, even after adjustments for covariates, and patients with genetic individual differences are also affected. Therefore, it is crucial that while diagnosing mental disorders, professionals pay closer attention to those patients who present symptoms of frailty.
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Affiliation(s)
- Yuxin Ma
- School of Public Administration and Policy, Renmin University of China, Beijing, China
| | - Nanqian Chen
- School of Public Administration and Policy, Renmin University of China, Beijing, China
| | - Jie Chen
- School of Public Administration and Policy, Renmin University of China, Beijing, China
| | - Tao Huang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
- Department of Global Health, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
- Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China
| | - Ninghao Huang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Xu Gao
- Department of Occupational & Environmental Health Sciences, School of Public Health, Peking University, Beijing, China
| | - Hailun Liang
- School of Public Administration and Policy, Renmin University of China, Beijing, China
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3
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Atik E, Stricker J, Schückes M, Pittig A. Efficacy of a Brief Blended Cognitive Behavioral Therapy Program for the Treatment of Depression and Anxiety in University Students: Uncontrolled Intervention Study. JMIR Ment Health 2023; 10:e44742. [PMID: 37624631 PMCID: PMC10492172 DOI: 10.2196/44742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/25/2023] [Accepted: 06/25/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Blended cognitive behavioral therapy (bCBT)-the combination of cognitive behavioral therapy and digital mental health applications-has been increasingly used to treat depression and anxiety disorders. As a resource-efficient treatment approach, bCBT appears promising for addressing the growing need for mental health care services, for example, as an early intervention before the chronification of symptoms. However, further research on the efficacy and feasibility of integrated bCBT interventions is needed. OBJECTIVE This study aimed to evaluate the efficacy of a novel bCBT program comprising short (25 min), weekly face-to-face therapy sessions combined with a smartphone-based digital health app for treating mild to moderate symptoms of depression or anxiety. METHODS This prospective uncontrolled trial comprised 2 measurement points (before and after treatment) and 2 intervention groups. We recruited university students with mild to moderate symptoms of depression or anxiety. On the basis of the primary symptoms, participants were assigned to either a depression intervention group (n=67 completers) or an anxiety intervention group (n=33 completers). Participants in each group received 6 weekly individual psychotherapy sessions via videoconference and completed modules tailored to their respective symptoms in the smartphone-based digital health app. RESULTS The depression group displayed medium to large improvements in the symptoms of depression (Cohen d=-0.70 to -0.90; P<.001). The anxiety group experienced significant improvements in the symptoms of generalized anxiety assessed with the Generalized Anxiety Disorder-7 scale with a large effect size (Cohen d=-0.80; P<.001) but not in symptoms of anxiety assessed with the Beck Anxiety Inventory (Cohen d=-0.35; P=.06). In addition, both groups experienced significant improvements in their perceived self-efficacy (Cohen d=0.50; P<.001 in the depression group and Cohen d=0.71; P<.001 in the anxiety group) and quality of life related to psychological health (Cohen d=0.87; P<.001 in the depression group and Cohen d=0.40; P=.03 in the anxiety group). Work and social adjustment of patients improved significantly in the depression group (Cohen d=-0.49; P<.001) but not in the anxiety group (Cohen d=-0.06; P=.72). Patients' mental health literacy improved in the anxiety group (Cohen d=0.45; P=.02) but not in the depression group (Cohen d=0.21; P=.10). Patient satisfaction with the bCBT program and ratings of the usability of the digital app were high in both treatment groups. CONCLUSIONS This study provides preliminary evidence for the feasibility and efficacy of a novel brief bCBT intervention. The intervention effects were generalized across a broad spectrum of patient-reported outcomes. Hence, the newly developed bCBT intervention appears promising for treating mild to moderate depression and anxiety in young adults.
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Affiliation(s)
- Ece Atik
- Translational Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
| | - Johannes Stricker
- Clinical Psychology Research Group, Department of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Andre Pittig
- Translational Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
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Wu Q, Feng J, Pan CW. Risk factors for depression in the elderly: An umbrella review of published meta-analyses and systematic reviews. J Affect Disord 2022; 307:37-45. [PMID: 35351490 DOI: 10.1016/j.jad.2022.03.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Depression has been identified as one of the leading causes of the disease burden worldwide. Identification of the potential factors that increased or decreased the risk of depression could be important to provide prevention strategies. We aimed to conduct an umbrella review of risk factors for depression in the elderly and assessed the credibility of evidence of the association between each factor and depression. METHODS We searched PubMed and Web of Science from 1990 to April 11, 2021 for articles investigating associations between potential factors and depression. For each association, we recalculated the summary effect size and 95% confidence intervals using random effects models. The 95% prediction interval and between-heterogeneity were also reported. For publication bias, small-study effect and excess of significance bias were assessed. RESULTS Twenty-five publications met the inclusion criteria, including twenty-two meta-analyses and three qualitative systematic reviews. Approximately 1,199,927 participants and 82 unique factors were reported. Two factors were rated as convincing evidence and four factors showed highly suggestive evidence. These risk factors were aspirin use, individuals aged 80 years and above, sleep disturbances and persistent sleep disturbances, hearing problem, poor vision, and cardiac disease. LIMITATIONS Most studies that we included were of low quality. CONCLUSIONS We found several risk factors for depression with different levels of evidence, in which aspirin use and individuals aged 80 years and above presented the strongest evidence. Further research is warranted to support other findings from this umbrella review using a large, well-designed cohort study.
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Affiliation(s)
- Qian Wu
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Jian Feng
- Kunshan Mental Health Center, Suzhou, China.
| | - Chen-Wei Pan
- School of Public Health, Medical College of Soochow University, Suzhou, China.
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Jiang X, Luo Y, Chen Y, Yan J, Xia Y, Yao L, Wang X, He S, Wang F, Wang T, Chen Y. Comparative Efficacy of Multiple Therapies for the Treatment of Patients With Subthreshold Depression: A Systematic Review and Network Meta-Analysis. Front Behav Neurosci 2021; 15:755547. [PMID: 34690713 PMCID: PMC8531252 DOI: 10.3389/fnbeh.2021.755547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/13/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Subthreshold depression (SD) is considered to be the precursor stage of major depression, which is correlated with functional impairment and increased suicide rate. Although there are multiple therapies for the treatment of SD, the comparison and efficacy of various methods has yet to be evaluated. This study aimed to evaluate the efficacy of different therapies by performing a Bayesian network meta-analysis. Methods: We searched eight databases on April 3, 2021. Center for Epidemiologic Studies Depression Scale (CES-D), Beck Depression Inventory scale (BDI), the Patient Health Questionnaire-9 (PHQ-9), and the Kessler Screening Scale for Psychological Distress (K-6) were used as efficacy outcomes. This Bayesian network meta-analysis used a fixed-effects model. Findings: Twenty-one randomized controlled trials involving 5,048 participants were included in this study. The results suggested that electroacupuncture (MD −12.00, 95% CrI −15.00, −10.00), conventional acupuncture plus wheat-grain moxibustion (MD −9.70, 95% CrI −14.00, −5.30), and the Chinese traditional peripateticism pill plus group counseling (MD −9.00, 95% CrI −11.00, −6.70) had better efficacy than the control group (CG) in improving CES-D. For BDI outcome, bright light therapy (MD −9.70, 95% CrI −13.00, −6.00), behavioral activation program (MD −5.70, 95% CrI −6.10, −5.40), and dim light therapy (MD −6.30, 95% CrI −10.00, −2.20) were better than the CG. Tai chi (MD −3.00, 95% CrI −4.00, −2.00) was better than CG for PHQ-9 outcomes. Telephone-based cognitive behavioral treatment (MD −2.50 95% CrI −2.70, −2.30) was better than the CG for K-6 scores. Conclusion: Our results suggest that electroacupuncture or bright light therapy appear to be the better choices in the treatment of SD. This study provide new insights into clinical treatment selection and may aid the development of guidelines for the management of SD.
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Affiliation(s)
- Xiumin Jiang
- South China Research Center for Acupuncture and Moxibustion, Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yongxin Luo
- Department of Biostatistics and Preventive Medicine, School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yiwen Chen
- South China Research Center for Acupuncture and Moxibustion, Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jinglan Yan
- South China Research Center for Acupuncture and Moxibustion, Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yucen Xia
- South China Research Center for Acupuncture and Moxibustion, Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lin Yao
- Research Institute of Acupuncture and Moxibustion, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xiaotong Wang
- South China Research Center for Acupuncture and Moxibustion, Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Su He
- South China Research Center for Acupuncture and Moxibustion, Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Feixue Wang
- Research Institute of Acupuncture and Moxibustion, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Taiyi Wang
- Research Institute of Acupuncture and Moxibustion, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yongjun Chen
- South China Research Center for Acupuncture and Moxibustion, Clinical Medical College of Acupuncture, Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, China.,Research Institute of Acupuncture and Moxibustion, Shandong University of Traditional Chinese Medicine, Jinan, China.,Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangzhou, China
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Zvolensky MJ, Kauffman BY, Bogiaizian D, Viana AG, Bakhshaie J, Peraza N. Worry among Latinx college students: relations to anxious arousal, social anxiety, general depression, and insomnia. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2021; 69:529-536. [PMID: 31702977 PMCID: PMC7205584 DOI: 10.1080/07448481.2019.1686004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 08/21/2019] [Accepted: 10/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Latinx young adults in college (ages 18-25 years) are at a heightened risk for health disparities and there is a need to understand individual-based characteristics that are related to such health inequalities including anxiety, depression, and sleep disturbances. The cross-sectional current study investigated the role of worry in relation to anxious arousal, social anxiety, general depression, and insomnia among Latinx college students. Participants/Method: Participants included 401 (Mage = 21 years; SD =2.01; 83% female) Latinx students at a large, southwestern university. Results: Results indicated that greater levels of worry were related to increased levels of anxious arousal, social anxiety, general depression, and insomnia. These findings were evident above and beyond variance accounted for by age, sex, and subjective social status. Conclusions: The current investigation suggests that elevated levels of worry among Latinx young adults may be associated with greater levels of anxiety, depression, and insomnia.
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Affiliation(s)
- Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
| | | | - Daniel Bogiaizian
- Psychotherapeutic Area of “Asociación Ayuda”, Anxiety Disorders Clinic (Buenos Aires, Argentina)
| | - Andres G. Viana
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Jafar Bakhshaie
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Natalia Peraza
- Department of Psychology, University of Houston, Houston, TX, USA
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7
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López L, Smit F, Cuijpers P, Otero P, Blanco V, Torres Á, Vázquez FL. Problem-solving intervention to prevent depression in non-professional caregivers: a randomized controlled trial with 8 years of follow-up. Psychol Med 2020; 50:1002-1009. [PMID: 31017076 DOI: 10.1017/s0033291719000916] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Studies of psychological interventions for the prevention of depression have found significant effects in the short-term, but the long-term efficacy has yet to be determined. This study evaluated the 8-year effect of a randomized controlled trial for indicated prevention of depression in female caregivers. METHODS A total of 173 non-professional female caregivers with subclinical depressive symptoms not meeting criteria for a major depressive episode (MDE) were randomized to either a brief problem-solving intervention (n = 89) or usual-care control group (n = 84). Blinded evaluators conducted an assessment at the 8-year follow-up. The primary outcome was Depression Status, defined by diagnoses of MDE since the 1-year follow-up using the Structured Clinical Interview for the Disorders of the DSM-5. The secondary outcome was current Depressive Symptom Severity. Regression analyses were conducted to evaluate the effect of the intervention on the outcomes. RESULTS There were no significant differences in the Depression Status between the problem-solving (30.3%) and control groups (26.2%) (adjusted OR 1.25, 95% CI -0.58 to 2.69). Depressive Symptom Severity, however, was significantly lower in the problem-solving group compared to the control group at this follow-up, amounting to a small effect size of Cohen's d = 0.39 (adjusted B = -3.32, p = 0.018). CONCLUSIONS This is the first study to assess such a long-term follow-up of intervention of indicated prevention of depression. Results seem to indicate that the protective effect of the intervention became smaller over time during follow-up. Future research should replicate these results.
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Affiliation(s)
- Lara López
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Filip Smit
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam Medical Centers, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Patricia Otero
- Department of Psychology, University of A Coruña, A Coruña, Spain
| | - Vanessa Blanco
- Department of Evolutive and Educational Psychology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ángela Torres
- Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Fernando L Vázquez
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
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Zimmermann M, O'Donohue W, Vechiu C. A Primary Care Prevention System for Behavioral Health: The Behavioral Health Annual Wellness Checkup. J Clin Psychol Med Settings 2019; 27:268-284. [PMID: 31468369 DOI: 10.1007/s10880-019-09658-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Behavioral health problems are involved in the majority of primary care visits. These behavior disorders (e.g., depression, anxiety, smoking, insomnia, etc.) are costly, burdensome to both the patient and the healthcare system, and result in greater medical utilization/cost and poorer future health outcomes. Integrated behavioral healthcare has been proposed as a model for more efficiently addressing the burden of behavioral health problems. While this model has demonstrated some promise in the treatment of behavioral health problems, as well as in the reduction in costs and improvement in healthcare outcomes, the primary prevention of behavioral health problems in this delivery model has been relatively neglected. The present paper discusses the potential value of incorporating the prevention of behavioral health problems into the annual physical/wellness checkup and proposes a detailed system for how this might be accomplished. Limitations, future research, and costs associated with increased prevention in a primary care context are discussed.
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Affiliation(s)
- Martha Zimmermann
- Department of Psychology, University of Nevada, Reno, Reno, NV, USA.
| | | | - Catalina Vechiu
- Department of Psychology, University of Nevada, Reno, Reno, NV, USA
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Saldivia S, Inostroza C, Bustos C, Rincón P, Aslan J, Bühring V, Farhang M, King M, Cova F. Effectiveness of a group-based psychosocial program to prevent depression and anxiety in older people attending primary health care centres: a randomised controlled trial. BMC Geriatr 2019; 19:237. [PMID: 31464588 PMCID: PMC6716832 DOI: 10.1186/s12877-019-1255-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 08/20/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Evidence about the effectiveness of psychosocial interventions to reduce the incidence of depression and anxiety and promote subjective well-being in older people is limited, particularly in Latin-American countries. This study thus aims to assess a program specifically designed to address this issue in persons aged 65 to 80 and attending primary health care centres. METHOD Older people who use primary care centres are to be randomly assigned to the program or to a control group. Only independent users will be included; those having had a major depressive disorder or an anxiety disorder in the last 6 months will be excluded. The program is group based; it includes cognitive stimulation, expansion of social support networks and cognitive behaviour strategies. Depressive and anxiety symptoms and disorders, as well as psychological well-being, will be assessed using standardised instruments, once before implementing the program and later, after 18 and 36 weeks. DISCUSSION Primary care is a setting where interventions to improve mental health can be beneficial. Providing evidence-based programs that work with older people is a priority for public mental health. TRIAL REGISTRATION A protocol for this study has been registered prospectively at ISRCTN registry on 25 July 2018. Identifier: ISRCTN32235611 .
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Affiliation(s)
- Sandra Saldivia
- Dpto. de Psiquiatria y Salud Mental Universidad de Concepcion, Concepcion, Chile
| | - Carolina Inostroza
- Dpto. de Psiquiatria y Salud Mental Universidad de Concepcion, Concepcion, Chile
- Dpto. de Psicologia Universidad de Concepcion, Concepcion, Chile
| | - Claudio Bustos
- Dpto. de Psiquiatria y Salud Mental Universidad de Concepcion, Concepcion, Chile
| | - Paulina Rincón
- Dpto. de Psicologia Universidad de Concepcion, Concepcion, Chile
| | - Joseph Aslan
- Dpto. de Psicologia Universidad de Concepcion, Concepcion, Chile
| | - Vasily Bühring
- Dpto. de Psicologia Universidad de Concepcion, Concepcion, Chile
| | - Maryam Farhang
- Dpto. de Psicologia Universidad de Concepcion, Concepcion, Chile
| | - Michael King
- Division of Psychiatry, University College of London, London, England
| | - Félix Cova
- Dpto. de Psicologia Universidad de Concepcion, Concepcion, Chile
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Meuldijk D, Wuthrich VM. Stepped‐care treatment of anxiety and depression in older adults: A narrative review. Aust J Rural Health 2019; 27:275-280. [DOI: 10.1111/ajr.12524] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- Denise Meuldijk
- Centre for Emotional Health Department of Psychology Macquarie University Sydney New South Wales Australia
| | - Viviana M. Wuthrich
- Centre for Emotional Health Department of Psychology Macquarie University Sydney New South Wales Australia
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11
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Hellwig S, Domschke K. Anxiety in Late Life: An Update on Pathomechanisms. Gerontology 2019; 65:465-473. [DOI: 10.1159/000500306] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 04/14/2019] [Indexed: 11/19/2022] Open
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Abstract
Poor mental health has profound economic consequences. Given the burden of poor mental health, the economic case for preventing mental illness and promoting better mental health may be very strong, but too often prevention attracts little attention and few resources. This article describes the potential role that can be played by economic evidence alongside experimental trials and observational studies, or through modeling, to substantiate the need for increased investment in prevention. It illustrates areas of action across the life course where there is already a good economic case. It also suggests some further areas of substantive public health concern, with promising effectiveness evidence, that may benefit from economic analysis. Financial and economic barriers to implementation are then presented, and strategies to address the barriers and increase investment in the prevention of mental illness are suggested.
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Affiliation(s)
- David McDaid
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, United Kingdom; ,
| | - A-La Park
- Personal Social Services Research Unit, Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, United Kingdom; ,
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Factor Structure of the Attentional Control Scale in Younger and Older Adults: Relationships with Anxiety and Depression. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2018. [DOI: 10.1007/s10862-018-9705-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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14
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Olivan-Blázquez B, Montero-Marin J, García-Toro M, Vicens-Pons E, Serrano-Ripoll MJ, Castro-Gracia A, Sarasa-Bosque MC, Mendive-Arbeloa JM, López-del-Hoyo Y, Garcia-Campayo J. Facilitators and barriers to modifying dietary and hygiene behaviours as adjuvant treatment in patients with depression in primary care: a qualitative study. BMC Psychiatry 2018; 18:205. [PMID: 29921245 PMCID: PMC6008925 DOI: 10.1186/s12888-018-1779-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 06/07/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Major depression is a highly prevalent condition. Its pathogenesis is related to a wide variety of biological and psychosocial factors and among these is factors related to lifestyle. Lifestyle-based interventions seem to be appropriate strategies as coadjutant treatment. The objective of this study is to explore and identify expectations and experiences of both patients and healthcare professionals that can point to the main barriers and facilitators with regard to the promotion of healthy dietary and hygiene behaviours in patients suffering from major depression. METHODS A qualitative design was used to collect information from a wide range of purposefully and theoretically guided samples of depressed patients and health professionals from Primary Care (PC). Both in-depth interviews and discussion groups were used. A standardized protocol was designed to guide the interviews and groups, including the preparation of a topic list to be addressed, with previously tested, open suggestions that could be of interest. A thematic analysis was performed from grounded theory in order to explore, develop and define until saturation the emergent categories of analysis derived from the individual interview and group data. RESULTS Both patients as well as PC professionals noted a series of central aspects with respect to the implementation of a programme for the acquisition of healthy dietary and hygiene habits for depressive patients, which may be organized around 'personal', 'programmatic', and 'transversal' aspects. As for the personal aspects, categories regarding 'patient history', and 'disposition' were found; the programmatic aspects included categories such as 'presentation and monitoring', and modification of 'cognitive' and 'behavioural' habits; whereas the transversal aspects comprised the possibilities of 'social support' and defining categories of 'objectives'. CONCLUSION The implementation of intervention programmes that combine dietary and hygiene-related factors in patients with depression is complex, given the nature of the disorder itself, and its symptoms such as apathy and feelings of guilt or incompetence. Key issues exist for the success of the intervention, such as the simplicity of guidelines, tailoring through motivational interviewing, prolonged and intense monitoring throughout the different stages of the disorder, and the provision of adequate feedback and social support. PC could be an appropriate level in which to implement these interventions.
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Affiliation(s)
- B. Olivan-Blázquez
- Department of Psychology and Sociology, University of Zaragoza, Violante de Hungria 23, 50009 Zaragoza, Spain
- Research Network on Preventive Activities and Health Promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud - RedIAPP), Barcelona, Spain
- Promosam Network, Red de Excelencia PSI2014-56303-REDT PROMOSAM: (Investigación en procesos, mecanismos y tratamientos psicológicos para la promoción de la salud mental), Economy and Competitiveness Ministry, Madrid, Spain
| | - J. Montero-Marin
- Research Network on Preventive Activities and Health Promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud - RedIAPP), Barcelona, Spain
- Promosam Network, Red de Excelencia PSI2014-56303-REDT PROMOSAM: (Investigación en procesos, mecanismos y tratamientos psicológicos para la promoción de la salud mental), Economy and Competitiveness Ministry, Madrid, Spain
| | - M. García-Toro
- Research Network on Preventive Activities and Health Promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud - RedIAPP), Barcelona, Spain
- Institut Universitari d’Investigació en Ciències de la Salut (IUNICS), Universitat de les Illes Balears (UIB), Palma de Mallorca, Spain
| | - E. Vicens-Pons
- Research Network on Preventive Activities and Health Promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud - RedIAPP), Barcelona, Spain
- Departamento de Psiquiatría, Parc Sanitari San Joan de Déu, Sant Boi de Llobregat, Spain
| | - M. J. Serrano-Ripoll
- Institut Universitari d’Investigació en Ciències de la Salut (IUNICS), Universitat de les Illes Balears (UIB), Palma de Mallorca, Spain
| | - A. Castro-Gracia
- Institut Universitari d’Investigació en Ciències de la Salut (IUNICS), Universitat de les Illes Balears (UIB), Palma de Mallorca, Spain
| | | | | | - Y. López-del-Hoyo
- Department of Psychology and Sociology, University of Zaragoza, Violante de Hungria 23, 50009 Zaragoza, Spain
- Research Network on Preventive Activities and Health Promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud - RedIAPP), Barcelona, Spain
- Promosam Network, Red de Excelencia PSI2014-56303-REDT PROMOSAM: (Investigación en procesos, mecanismos y tratamientos psicológicos para la promoción de la salud mental), Economy and Competitiveness Ministry, Madrid, Spain
| | - J. Garcia-Campayo
- Research Network on Preventive Activities and Health Promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud - RedIAPP), Barcelona, Spain
- Promosam Network, Red de Excelencia PSI2014-56303-REDT PROMOSAM: (Investigación en procesos, mecanismos y tratamientos psicológicos para la promoción de la salud mental), Economy and Competitiveness Ministry, Madrid, Spain
- Aragones Health Service, Zaragoza, Spain
- Department of Medicine and Psychiatry, University of Zaragoza, Zaragoza, Spain
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15
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Cohen A, Dias A, Azariah F, Krishna RN, Sequeira M, Abraham S, Cuijpers P, Morse JQ, Reynolds CF, Patel V. Aging and well-being in Goa, India: a qualitative study. Aging Ment Health 2018; 22:168-174. [PMID: 27689842 PMCID: PMC5374050 DOI: 10.1080/13607863.2016.1236239] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The population of India is aging rapidly. This demographic shift brings with it a host of challenges to the health and well-being of older adults, including the increased prevalence of non-communicable diseases, among them depressive disorders. In this paper, we report on qualitative research intended to inform the development of a locally acceptable and appropriate intervention to improve the well-being of older adults in Goa, India and, specifically, to prevent late-life depression. METHOD Semi-structured interviews with 20 individuals, aged 60 years and older, attending two primary care clinics in Goa, India. Transcripts were reviewed to identify emerging themes, a coding scheme was developed and thematic analyses were conducted. RESULTS Analyses of the interview transcripts revealed the following key themes: (1) notions of old age tended to be negative and there were widespread fears of becoming widowed or incapacitated; (2) the most frequently reported health conditions were joint pain, diabetes and heart disease; (3) emotional distress was described using the terms 'tension', 'stress', 'worry' and 'thinking'; (4) family issues often involved financial matters, difficult relationships with daughters-in-law and conflicted feelings about living with the family or independently; (5) other than a pension scheme, participants did not know of community resources available to older adults. CONCLUSIONS Our findings are in general agreement with those of previous research, and with our experiences of working with older adults in Pittsburgh and the Netherlands. This research will inform the development of an intervention to prevent depression in older adults in Goa.
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Affiliation(s)
- Alex Cohen
- London School of Hygiene & Tropical Medicine, Faculty of Epidemiology & Population Health, Department of Population Health, London, United Kingdom
| | - Amit Dias
- Department of Preventive and Social Medicine, Goa Medical College, Goa, India
- Sangath, Goa, INDIA
| | | | | | | | | | - Pim Cuijpers
- Department of Clinical Psychology, VU-University Amsterdam, Amsterdam, the Netherlands
| | - Jennifer Q. Morse
- Graduate Psychology Programs, Chatham University, Pittsburgh, PA 15232, USA
| | - Charles F. Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine; and Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Vikram Patel
- London School of Hygiene & Tropical Medicine, Faculty of Epidemiology & Population Health, Department of Population Health, London, United Kingdom
- Sangath, Goa, INDIA
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16
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Moreno-Peral P, Conejo-Cerón S, Rubio-Valera M, Fernández A, Navas-Campaña D, Rodríguez-Morejón A, Motrico E, Rigabert A, Luna JDD, Martín-Pérez C, Rodríguez-Bayón A, Ballesta-Rodríguez MI, Luciano JV, Bellón JÁ. Effectiveness of Psychological and/or Educational Interventions in the Prevention of Anxiety: A Systematic Review, Meta-analysis, and Meta-regression. JAMA Psychiatry 2017; 74:1021-1029. [PMID: 28877316 PMCID: PMC5710546 DOI: 10.1001/jamapsychiatry.2017.2509] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/29/2017] [Indexed: 12/31/2022]
Abstract
Importance To our knowledge, no systematic reviews or meta-analyses have been conducted to assess the effectiveness of preventive psychological and/or educational interventions for anxiety in varied populations. Objective To evaluate the effectiveness of preventive psychological and/or educational interventions for anxiety in varied population types. Data Sources A systematic review and meta-analysis was conducted based on literature searches of MEDLINE, PsycINFO, Web of Science, EMBASE, OpenGrey, Cochrane Central Register of Controlled Trials, and other sources from inception to March 7, 2017. Study Selection A search was performed of randomized clinical trials assessing the effectiveness of preventive psychological and/or educational interventions for anxiety in varying populations free of anxiety at baseline as measured using validated instruments. There was no setting or language restriction. Eligibility criteria assessment was conducted by 2 of us. Data Extraction and Synthesis Data extraction and assessment of risk of bias (Cochrane Collaboration's tool) were performed by 2 of us. Pooled standardized mean differences (SMDs) were calculated using random-effect models. Heterogeneity was explored by random-effects meta-regression. Main Outcomes and Measures Incidence of new cases of anxiety disorders or reduction of anxiety symptoms as measured by validated instruments. Results Of the 3273 abstracts reviewed, 131 were selected for full-text review, and 29 met the inclusion criteria, representing 10 430 patients from 11 countries on 4 continents. Meta-analysis calculations were based on 36 comparisons. The pooled SMD was -0.31 (95% CI, -0.40 to -0.21; P < .001) and heterogeneity was substantial (I2 = 61.1%; 95% CI, 44% to 73%). There was evidence of publication bias, but the effect size barely varied after adjustment (SMD, -0.27; 95% CI, -0.37 to -0.17; P < .001). Sensitivity analyses confirmed the robustness of effect size results. A meta-regression including 5 variables explained 99.6% of between-study variability, revealing an association between higher SMD, waiting list (comparator) (β = -0.33 [95% CI, -0.55 to -0.11]; P = .005) and a lower sample size (lg) (β = 0.15 [95% CI, 0.06 to 0.23]; P = .001). No association was observed with risk of bias, family physician providing intervention, and use of standardized interviews as outcomes. Conclusions and Relevance Psychological and/or educational interventions had a small but statistically significant benefit for anxiety prevention in all populations evaluated. Although more studies with larger samples and active comparators are needed, these findings suggest that anxiety prevention programs should be further developed and implemented.
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Affiliation(s)
- Patricia Moreno-Peral
- Research Unit, Primary Care District of Málaga-Guadalhorce, Málaga, Spain
- Prevention and Health Promotion Research Network, Málaga, Spain
- Institute of Biomedical Research in Málaga, Málaga, Spain
| | - Sonia Conejo-Cerón
- Research Unit, Primary Care District of Málaga-Guadalhorce, Málaga, Spain
- Prevention and Health Promotion Research Network, Málaga, Spain
- Institute of Biomedical Research in Málaga, Málaga, Spain
| | - Maria Rubio-Valera
- Sant Joan de Déu Research Foundation, Barcelona, Spain
- Network for Biomedical Research on Epidemiology and Public Health, Biomedical Research Networking Center for Epidemiology and Public Health, Madrid, Spain
- School of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Anna Fernández
- Network for Biomedical Research on Epidemiology and Public Health, Biomedical Research Networking Center for Epidemiology and Public Health, Madrid, Spain
- Service of Community Health, Public Health Agency of Barcelona, Barcelona, Spain
| | - Desirée Navas-Campaña
- Research Unit, Primary Care District of Málaga-Guadalhorce, Málaga, Spain
- Prevention and Health Promotion Research Network, Málaga, Spain
- Institute of Biomedical Research in Málaga, Málaga, Spain
| | - Alberto Rodríguez-Morejón
- Prevention and Health Promotion Research Network, Málaga, Spain
- Institute of Biomedical Research in Málaga, Málaga, Spain
- Department of Personality, Evaluation, and Psychological Treatment, Universidad de Málaga, Málaga, Spain
| | - Emma Motrico
- Prevention and Health Promotion Research Network, Málaga, Spain
- Department of Psychology, University Loyola Andalucía, Seville, Spain
| | - Alina Rigabert
- Department of Psychology, University Loyola Andalucía, Seville, Spain
| | - Juan de Dios Luna
- Prevention and Health Promotion Research Network, Málaga, Spain
- Department of Biostatistics, University of Granada, Granada, Spain
| | - Carlos Martín-Pérez
- Prevention and Health Promotion Research Network, Málaga, Spain
- Primary Care Center of Marquesado, Área Nordeste de Granada, Granada, Spain
| | - Antonina Rodríguez-Bayón
- Prevention and Health Promotion Research Network, Málaga, Spain
- Primary Care Center of San José, Linares, Jaén, Spain
| | | | - Juan Vicente Luciano
- Prevention and Health Promotion Research Network, Málaga, Spain
- Sant Joan de Déu Research Foundation, Barcelona, Spain
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St Boi de Llobregat, Spain
| | - Juan Ángel Bellón
- Research Unit, Primary Care District of Málaga-Guadalhorce, Málaga, Spain
- Prevention and Health Promotion Research Network, Málaga, Spain
- Institute of Biomedical Research in Málaga, Málaga, Spain
- Primary Care Center of El Palo, Málaga, Spain
- Department of Preventive Medicine, Public Health and Psychiatry, University of Málaga, Málaga, Spain
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17
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Deady M, Choi I, Calvo RA, Glozier N, Christensen H, Harvey SB. eHealth interventions for the prevention of depression and anxiety in the general population: a systematic review and meta-analysis. BMC Psychiatry 2017; 17:310. [PMID: 28851342 PMCID: PMC5576307 DOI: 10.1186/s12888-017-1473-1] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 08/21/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Anxiety and depression are associated with a range of adverse outcomes and represent a large global burden to individuals and health care systems. Prevention programs are an important way to avert a proportion of the burden associated with such conditions both at a clinical and subclinical level. eHealth interventions provide an opportunity to offer accessible, acceptable, easily disseminated globally low-cost interventions on a wide scale. However, the efficacy of these programs remains unclear. The aim of this study is to review and evaluate the effects of eHealth prevention interventions for anxiety and depression. METHOD A systematic search was conducted on four relevant databases to identify randomized controlled trials of eHealth interventions aimed at the prevention of anxiety and depression in the general population published between 2000 and January 2016. The quality of studies was assessed and a meta-analysis was performed using pooled effect size estimates obtained from a random effects model. RESULTS Ten trials were included in the systematic review and meta-analysis. All studies were of sufficient quality and utilized cognitive behavioural techniques. At post-treatment, the overall mean difference between the intervention and control groups was 0.25 (95% confidence internal: 0.09, 0.41; p = 0.003) for depression outcome studies and 0.31 (95% CI: 0.10, 0.52; p = 0.004) for anxiety outcome studies, indicating a small but positive effect of the eHealth interventions. The effect sizes for universal and indicated/selective interventions were similar (0.29 and 0.25 respectively). However, there was inadequate evidence to suggest that such interventions have an effect on long-term disorder incidence rates. CONCLUSIONS Evidence suggests that eHealth prevention interventions for anxiety and depression are associated with small but positive effects on symptom reduction. However, there is inadequate evidence on the medium to long-term effect of such interventions, and importantly, on the reduction of incidence of disorders. Further work to explore the impact of eHealth psychological interventions on long-term incidence rates.
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Affiliation(s)
- M. Deady
- 0000 0004 4902 0432grid.1005.4School of Psychiatry, University of New South Wales, Sydney, NSW 2052 Australia ,0000 0001 0640 7766grid.418393.4Black Dog Institute, Randwick, NSW 2031 Australia
| | - I. Choi
- 0000 0004 1936 834Xgrid.1013.3Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050 Australia
| | - R. A. Calvo
- 0000 0004 1936 834Xgrid.1013.3School of Electrical and Information Engineering, University of Sydney, Sydney, NSW 2006 Australia
| | - N. Glozier
- 0000 0004 1936 834Xgrid.1013.3Brain and Mind Centre, University of Sydney, Camperdown, NSW 2050 Australia
| | - H. Christensen
- 0000 0001 0640 7766grid.418393.4Black Dog Institute, Randwick, NSW 2031 Australia
| | - S. B. Harvey
- 0000 0004 4902 0432grid.1005.4School of Psychiatry, University of New South Wales, Sydney, NSW 2052 Australia ,0000 0001 0640 7766grid.418393.4Black Dog Institute, Randwick, NSW 2031 Australia ,0000 0004 0417 5393grid.416398.1St George Hospital, Kogarah, NSW 2217 Australia
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18
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Pols AD, van Dijk SE, Bosmans JE, Hoekstra T, van Marwijk HWJ, van Tulder MW, Adriaanse MC. Effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression: A pragmatic cluster randomized controlled trial. PLoS One 2017; 12:e0181023. [PMID: 28763451 PMCID: PMC5538642 DOI: 10.1371/journal.pone.0181023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 06/20/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose Given the public health significance of poorly treatable co-morbid major depressive disorders (MDD) among patients with type 2 diabetes mellitus (DM2) and coronary heart disease (CHD), we need to investigate whether strategies to prevent the development of major depression could reduce its burden of disease. We therefore evaluated the effectiveness of a stepped-care program for subthreshold depression in comparison with usual care in patients with DM2 and/or CHD. Methods A cluster randomized controlled trial, with 27 primary care centers serving as clusters. A total of 236 DM2 and/or CHD patients with subthreshold depression (nine item Patient Health Questionnaire (PHQ-9) score ≥ 6, no current MDD according to DSM-IV criteria) were allocated to the intervention group (N = 96) or usual care group (n = 140). The stepped-care program was delivered by trained practice nurses during one year and consisted of four sequential treatment steps: watchful waiting, guided self-help, problem solving treatment and referral to the general practitioner. The primary outcome was the 12-month cumulative incidence of MDD as measured with the Mini International Neuropsychiatric Interview (MINI). Secondary outcomes included severity of depression (measured by PHQ-9) at 3, 6, 9 and 12 months. Results Of 236 patients (mean age, 67,5 (SD 10) years; 54.7% men), 210 (89%) completed the MINI at 12 months. The cumulative incidence of MDD was 9 of 89 (10.1%) participants in the intervention group and 12 of 121 (9.9%) participants in the usual care group. We found no statistically significant overall effect of the intervention (OR = 1.21; 95% confidence interval (0.12 to 12.41)) and there were no statistically significant differences in the course or severity of depressive symptoms between the two groups. Conclusions This study suggest that Step-Dep was not more effective in preventing MDD than usual care in a primary care population with DM2 and/or CHD and subthreshold depression.
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Affiliation(s)
- Alide D. Pols
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
- Department of General Practice & Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Susan E. van Dijk
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
| | - Judith E. Bosmans
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
| | - Trynke Hoekstra
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics, VU University Amsterdam, Amsterdam, the Netherlands
| | - Harm W. J. van Marwijk
- Department of General Practice & Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
- CLAHRC Greater Manchester and NIHR School for Primary Care Research, the University of Manchester, Manchester, United Kingdom
| | - Maurits W. van Tulder
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
| | - Marcel C. Adriaanse
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, Amsterdam, the Netherlands
- * E-mail:
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Conejo-Cerón S, Moreno-Peral P, Rodríguez-Morejón A, Motrico E, Navas-Campaña D, Rigabert A, Martín-Pérez C, Rodríguez-Bayón A, Ballesta-Rodríguez MI, Luna JDD, García-Campayo J, Roca M, Bellón JÁ. Effectiveness of Psychological and Educational Interventions to Prevent Depression in Primary Care: A Systematic Review and Meta-Analysis. Ann Fam Med 2017; 15:262-271. [PMID: 28483893 PMCID: PMC5422089 DOI: 10.1370/afm.2031] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/22/2016] [Accepted: 11/18/2016] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Although evidence exists for the efficacy of psychosocial interventions to prevent the onset of depression, little is known about its prevention in primary care. We aimed to evaluate the effectiveness of psychological and educational interventions to prevent depression in primary care. METHODS We conducted a systematic review and meta-analysis of relevant randomized controlled trials (RCTs) examining the effect of psychological and educational interventions to prevent depression in nondepressed primary care attendees. We searched MEDLINE, PsycINFO, Web of Science, OpenGrey Repository, Cochrane Central Register of Controlled Trials, and other sources up to May 2016. At least 2 reviewers independently evaluated the eligibility criteria, extracted data, and assessed the risk of bias. We calculated standardized mean differences (SMD) using random-effects models. RESULTS We selected 14 studies (7,365 patients) that met the inclusion criteria, 13 of which were valid to perform a meta-analysis. Most of the interventions had a cognitive-behavioral orientation, and in only 4 RCTs were the intervention clinicians primary care staff. The pooled SMD was -0.163 (95%CI, -0.256 to -0.070; P = .001). The risk of bias and the heterogeneity (I2 = 20.6%) were low, and there was no evidence of publication bias. Meta-regression detected no association between SMD and follow-up times or SMD and risk of bias. Subgroup analysis suggested greater effectiveness when the RCTs used care as usual as the comparator compared with those using placebo. CONCLUSIONS Psychological and educational interventions to prevent depression had a modest though statistically significant preventive effect in primary care. Further RCTs using placebo or active comparators are needed.
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Affiliation(s)
- Sonia Conejo-Cerón
- Unidad de Investigación, Distrito de Atención Primaria Málaga-Guadalhorce, Málaga, Spain (Conejo-Cerón, Moreno-Peral, Navas-Campaña, Bellón); Red de Investigación en Actividades Preventivas y de Promoción de la Salud (redIAPP), Barcelona, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Motrico, Navas-Campaña, Rigabert, Martín-Pérez, Rodríguez-Bayón, Ballesta-Rodríguez, Luna, García-Campayo, Roca, Bellón); Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Bellón); Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Malaga, Spain (Rodríguez-Morejón); Departamento de Psicología, Universidad Loyola Andalucía, Sevilla, Spain (Motrico, Rigabert); Centro de Salud Marquesado, Área Nordeste de Granada, Granada, Spain (Martín-Pérez); Centro de Salud San José, Linares, Jaén, Spain (Rodríguez-Bayón); Centro de Salud Federico del Castillo, Jaén, Spain (Ballesta-Rodríguez); Departamento de Bioestadística. Universidad de Granada, Granada, Spain (Luna); Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain (Luna); Departamento de Psiquiatría, Hospital Universitario Miguel Servet, Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain (García-Campayo); Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain (Roca); Centro de Salud El Palo, Málaga, Spain (Bellón); Departamento de Medicina Preventiva, Salud Pública y Psiquiatría, Universidad de Málaga, Málaga, Spain (Bellón).
| | - Patricia Moreno-Peral
- Unidad de Investigación, Distrito de Atención Primaria Málaga-Guadalhorce, Málaga, Spain (Conejo-Cerón, Moreno-Peral, Navas-Campaña, Bellón); Red de Investigación en Actividades Preventivas y de Promoción de la Salud (redIAPP), Barcelona, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Motrico, Navas-Campaña, Rigabert, Martín-Pérez, Rodríguez-Bayón, Ballesta-Rodríguez, Luna, García-Campayo, Roca, Bellón); Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Bellón); Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Malaga, Spain (Rodríguez-Morejón); Departamento de Psicología, Universidad Loyola Andalucía, Sevilla, Spain (Motrico, Rigabert); Centro de Salud Marquesado, Área Nordeste de Granada, Granada, Spain (Martín-Pérez); Centro de Salud San José, Linares, Jaén, Spain (Rodríguez-Bayón); Centro de Salud Federico del Castillo, Jaén, Spain (Ballesta-Rodríguez); Departamento de Bioestadística. Universidad de Granada, Granada, Spain (Luna); Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain (Luna); Departamento de Psiquiatría, Hospital Universitario Miguel Servet, Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain (García-Campayo); Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain (Roca); Centro de Salud El Palo, Málaga, Spain (Bellón); Departamento de Medicina Preventiva, Salud Pública y Psiquiatría, Universidad de Málaga, Málaga, Spain (Bellón)
| | - Alberto Rodríguez-Morejón
- Unidad de Investigación, Distrito de Atención Primaria Málaga-Guadalhorce, Málaga, Spain (Conejo-Cerón, Moreno-Peral, Navas-Campaña, Bellón); Red de Investigación en Actividades Preventivas y de Promoción de la Salud (redIAPP), Barcelona, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Motrico, Navas-Campaña, Rigabert, Martín-Pérez, Rodríguez-Bayón, Ballesta-Rodríguez, Luna, García-Campayo, Roca, Bellón); Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Bellón); Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Malaga, Spain (Rodríguez-Morejón); Departamento de Psicología, Universidad Loyola Andalucía, Sevilla, Spain (Motrico, Rigabert); Centro de Salud Marquesado, Área Nordeste de Granada, Granada, Spain (Martín-Pérez); Centro de Salud San José, Linares, Jaén, Spain (Rodríguez-Bayón); Centro de Salud Federico del Castillo, Jaén, Spain (Ballesta-Rodríguez); Departamento de Bioestadística. Universidad de Granada, Granada, Spain (Luna); Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain (Luna); Departamento de Psiquiatría, Hospital Universitario Miguel Servet, Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain (García-Campayo); Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain (Roca); Centro de Salud El Palo, Málaga, Spain (Bellón); Departamento de Medicina Preventiva, Salud Pública y Psiquiatría, Universidad de Málaga, Málaga, Spain (Bellón)
| | - Emma Motrico
- Unidad de Investigación, Distrito de Atención Primaria Málaga-Guadalhorce, Málaga, Spain (Conejo-Cerón, Moreno-Peral, Navas-Campaña, Bellón); Red de Investigación en Actividades Preventivas y de Promoción de la Salud (redIAPP), Barcelona, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Motrico, Navas-Campaña, Rigabert, Martín-Pérez, Rodríguez-Bayón, Ballesta-Rodríguez, Luna, García-Campayo, Roca, Bellón); Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Bellón); Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Malaga, Spain (Rodríguez-Morejón); Departamento de Psicología, Universidad Loyola Andalucía, Sevilla, Spain (Motrico, Rigabert); Centro de Salud Marquesado, Área Nordeste de Granada, Granada, Spain (Martín-Pérez); Centro de Salud San José, Linares, Jaén, Spain (Rodríguez-Bayón); Centro de Salud Federico del Castillo, Jaén, Spain (Ballesta-Rodríguez); Departamento de Bioestadística. Universidad de Granada, Granada, Spain (Luna); Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain (Luna); Departamento de Psiquiatría, Hospital Universitario Miguel Servet, Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain (García-Campayo); Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain (Roca); Centro de Salud El Palo, Málaga, Spain (Bellón); Departamento de Medicina Preventiva, Salud Pública y Psiquiatría, Universidad de Málaga, Málaga, Spain (Bellón)
| | - Desirée Navas-Campaña
- Unidad de Investigación, Distrito de Atención Primaria Málaga-Guadalhorce, Málaga, Spain (Conejo-Cerón, Moreno-Peral, Navas-Campaña, Bellón); Red de Investigación en Actividades Preventivas y de Promoción de la Salud (redIAPP), Barcelona, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Motrico, Navas-Campaña, Rigabert, Martín-Pérez, Rodríguez-Bayón, Ballesta-Rodríguez, Luna, García-Campayo, Roca, Bellón); Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Bellón); Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Malaga, Spain (Rodríguez-Morejón); Departamento de Psicología, Universidad Loyola Andalucía, Sevilla, Spain (Motrico, Rigabert); Centro de Salud Marquesado, Área Nordeste de Granada, Granada, Spain (Martín-Pérez); Centro de Salud San José, Linares, Jaén, Spain (Rodríguez-Bayón); Centro de Salud Federico del Castillo, Jaén, Spain (Ballesta-Rodríguez); Departamento de Bioestadística. Universidad de Granada, Granada, Spain (Luna); Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain (Luna); Departamento de Psiquiatría, Hospital Universitario Miguel Servet, Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain (García-Campayo); Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain (Roca); Centro de Salud El Palo, Málaga, Spain (Bellón); Departamento de Medicina Preventiva, Salud Pública y Psiquiatría, Universidad de Málaga, Málaga, Spain (Bellón)
| | - Alina Rigabert
- Unidad de Investigación, Distrito de Atención Primaria Málaga-Guadalhorce, Málaga, Spain (Conejo-Cerón, Moreno-Peral, Navas-Campaña, Bellón); Red de Investigación en Actividades Preventivas y de Promoción de la Salud (redIAPP), Barcelona, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Motrico, Navas-Campaña, Rigabert, Martín-Pérez, Rodríguez-Bayón, Ballesta-Rodríguez, Luna, García-Campayo, Roca, Bellón); Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Bellón); Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Malaga, Spain (Rodríguez-Morejón); Departamento de Psicología, Universidad Loyola Andalucía, Sevilla, Spain (Motrico, Rigabert); Centro de Salud Marquesado, Área Nordeste de Granada, Granada, Spain (Martín-Pérez); Centro de Salud San José, Linares, Jaén, Spain (Rodríguez-Bayón); Centro de Salud Federico del Castillo, Jaén, Spain (Ballesta-Rodríguez); Departamento de Bioestadística. Universidad de Granada, Granada, Spain (Luna); Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain (Luna); Departamento de Psiquiatría, Hospital Universitario Miguel Servet, Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain (García-Campayo); Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain (Roca); Centro de Salud El Palo, Málaga, Spain (Bellón); Departamento de Medicina Preventiva, Salud Pública y Psiquiatría, Universidad de Málaga, Málaga, Spain (Bellón)
| | - Carlos Martín-Pérez
- Unidad de Investigación, Distrito de Atención Primaria Málaga-Guadalhorce, Málaga, Spain (Conejo-Cerón, Moreno-Peral, Navas-Campaña, Bellón); Red de Investigación en Actividades Preventivas y de Promoción de la Salud (redIAPP), Barcelona, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Motrico, Navas-Campaña, Rigabert, Martín-Pérez, Rodríguez-Bayón, Ballesta-Rodríguez, Luna, García-Campayo, Roca, Bellón); Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Bellón); Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Malaga, Spain (Rodríguez-Morejón); Departamento de Psicología, Universidad Loyola Andalucía, Sevilla, Spain (Motrico, Rigabert); Centro de Salud Marquesado, Área Nordeste de Granada, Granada, Spain (Martín-Pérez); Centro de Salud San José, Linares, Jaén, Spain (Rodríguez-Bayón); Centro de Salud Federico del Castillo, Jaén, Spain (Ballesta-Rodríguez); Departamento de Bioestadística. Universidad de Granada, Granada, Spain (Luna); Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain (Luna); Departamento de Psiquiatría, Hospital Universitario Miguel Servet, Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain (García-Campayo); Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain (Roca); Centro de Salud El Palo, Málaga, Spain (Bellón); Departamento de Medicina Preventiva, Salud Pública y Psiquiatría, Universidad de Málaga, Málaga, Spain (Bellón)
| | - Antonina Rodríguez-Bayón
- Unidad de Investigación, Distrito de Atención Primaria Málaga-Guadalhorce, Málaga, Spain (Conejo-Cerón, Moreno-Peral, Navas-Campaña, Bellón); Red de Investigación en Actividades Preventivas y de Promoción de la Salud (redIAPP), Barcelona, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Motrico, Navas-Campaña, Rigabert, Martín-Pérez, Rodríguez-Bayón, Ballesta-Rodríguez, Luna, García-Campayo, Roca, Bellón); Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Bellón); Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Malaga, Spain (Rodríguez-Morejón); Departamento de Psicología, Universidad Loyola Andalucía, Sevilla, Spain (Motrico, Rigabert); Centro de Salud Marquesado, Área Nordeste de Granada, Granada, Spain (Martín-Pérez); Centro de Salud San José, Linares, Jaén, Spain (Rodríguez-Bayón); Centro de Salud Federico del Castillo, Jaén, Spain (Ballesta-Rodríguez); Departamento de Bioestadística. Universidad de Granada, Granada, Spain (Luna); Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain (Luna); Departamento de Psiquiatría, Hospital Universitario Miguel Servet, Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain (García-Campayo); Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain (Roca); Centro de Salud El Palo, Málaga, Spain (Bellón); Departamento de Medicina Preventiva, Salud Pública y Psiquiatría, Universidad de Málaga, Málaga, Spain (Bellón)
| | - María Isabel Ballesta-Rodríguez
- Unidad de Investigación, Distrito de Atención Primaria Málaga-Guadalhorce, Málaga, Spain (Conejo-Cerón, Moreno-Peral, Navas-Campaña, Bellón); Red de Investigación en Actividades Preventivas y de Promoción de la Salud (redIAPP), Barcelona, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Motrico, Navas-Campaña, Rigabert, Martín-Pérez, Rodríguez-Bayón, Ballesta-Rodríguez, Luna, García-Campayo, Roca, Bellón); Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Bellón); Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Malaga, Spain (Rodríguez-Morejón); Departamento de Psicología, Universidad Loyola Andalucía, Sevilla, Spain (Motrico, Rigabert); Centro de Salud Marquesado, Área Nordeste de Granada, Granada, Spain (Martín-Pérez); Centro de Salud San José, Linares, Jaén, Spain (Rodríguez-Bayón); Centro de Salud Federico del Castillo, Jaén, Spain (Ballesta-Rodríguez); Departamento de Bioestadística. Universidad de Granada, Granada, Spain (Luna); Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain (Luna); Departamento de Psiquiatría, Hospital Universitario Miguel Servet, Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain (García-Campayo); Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain (Roca); Centro de Salud El Palo, Málaga, Spain (Bellón); Departamento de Medicina Preventiva, Salud Pública y Psiquiatría, Universidad de Málaga, Málaga, Spain (Bellón)
| | - Juan de Dios Luna
- Unidad de Investigación, Distrito de Atención Primaria Málaga-Guadalhorce, Málaga, Spain (Conejo-Cerón, Moreno-Peral, Navas-Campaña, Bellón); Red de Investigación en Actividades Preventivas y de Promoción de la Salud (redIAPP), Barcelona, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Motrico, Navas-Campaña, Rigabert, Martín-Pérez, Rodríguez-Bayón, Ballesta-Rodríguez, Luna, García-Campayo, Roca, Bellón); Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Bellón); Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Malaga, Spain (Rodríguez-Morejón); Departamento de Psicología, Universidad Loyola Andalucía, Sevilla, Spain (Motrico, Rigabert); Centro de Salud Marquesado, Área Nordeste de Granada, Granada, Spain (Martín-Pérez); Centro de Salud San José, Linares, Jaén, Spain (Rodríguez-Bayón); Centro de Salud Federico del Castillo, Jaén, Spain (Ballesta-Rodríguez); Departamento de Bioestadística. Universidad de Granada, Granada, Spain (Luna); Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain (Luna); Departamento de Psiquiatría, Hospital Universitario Miguel Servet, Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain (García-Campayo); Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain (Roca); Centro de Salud El Palo, Málaga, Spain (Bellón); Departamento de Medicina Preventiva, Salud Pública y Psiquiatría, Universidad de Málaga, Málaga, Spain (Bellón)
| | - Javier García-Campayo
- Unidad de Investigación, Distrito de Atención Primaria Málaga-Guadalhorce, Málaga, Spain (Conejo-Cerón, Moreno-Peral, Navas-Campaña, Bellón); Red de Investigación en Actividades Preventivas y de Promoción de la Salud (redIAPP), Barcelona, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Motrico, Navas-Campaña, Rigabert, Martín-Pérez, Rodríguez-Bayón, Ballesta-Rodríguez, Luna, García-Campayo, Roca, Bellón); Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Bellón); Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Malaga, Spain (Rodríguez-Morejón); Departamento de Psicología, Universidad Loyola Andalucía, Sevilla, Spain (Motrico, Rigabert); Centro de Salud Marquesado, Área Nordeste de Granada, Granada, Spain (Martín-Pérez); Centro de Salud San José, Linares, Jaén, Spain (Rodríguez-Bayón); Centro de Salud Federico del Castillo, Jaén, Spain (Ballesta-Rodríguez); Departamento de Bioestadística. Universidad de Granada, Granada, Spain (Luna); Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain (Luna); Departamento de Psiquiatría, Hospital Universitario Miguel Servet, Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain (García-Campayo); Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain (Roca); Centro de Salud El Palo, Málaga, Spain (Bellón); Departamento de Medicina Preventiva, Salud Pública y Psiquiatría, Universidad de Málaga, Málaga, Spain (Bellón)
| | - Miquel Roca
- Unidad de Investigación, Distrito de Atención Primaria Málaga-Guadalhorce, Málaga, Spain (Conejo-Cerón, Moreno-Peral, Navas-Campaña, Bellón); Red de Investigación en Actividades Preventivas y de Promoción de la Salud (redIAPP), Barcelona, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Motrico, Navas-Campaña, Rigabert, Martín-Pérez, Rodríguez-Bayón, Ballesta-Rodríguez, Luna, García-Campayo, Roca, Bellón); Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Bellón); Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Malaga, Spain (Rodríguez-Morejón); Departamento de Psicología, Universidad Loyola Andalucía, Sevilla, Spain (Motrico, Rigabert); Centro de Salud Marquesado, Área Nordeste de Granada, Granada, Spain (Martín-Pérez); Centro de Salud San José, Linares, Jaén, Spain (Rodríguez-Bayón); Centro de Salud Federico del Castillo, Jaén, Spain (Ballesta-Rodríguez); Departamento de Bioestadística. Universidad de Granada, Granada, Spain (Luna); Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain (Luna); Departamento de Psiquiatría, Hospital Universitario Miguel Servet, Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain (García-Campayo); Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain (Roca); Centro de Salud El Palo, Málaga, Spain (Bellón); Departamento de Medicina Preventiva, Salud Pública y Psiquiatría, Universidad de Málaga, Málaga, Spain (Bellón)
| | - Juan Ángel Bellón
- Unidad de Investigación, Distrito de Atención Primaria Málaga-Guadalhorce, Málaga, Spain (Conejo-Cerón, Moreno-Peral, Navas-Campaña, Bellón); Red de Investigación en Actividades Preventivas y de Promoción de la Salud (redIAPP), Barcelona, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Motrico, Navas-Campaña, Rigabert, Martín-Pérez, Rodríguez-Bayón, Ballesta-Rodríguez, Luna, García-Campayo, Roca, Bellón); Instituto de Investigación Biomédica de Málaga (IBIMA), Malaga, Spain (Conejo-Cerón, Moreno-Peral, Rodríguez-Morejón, Bellón); Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Málaga, Malaga, Spain (Rodríguez-Morejón); Departamento de Psicología, Universidad Loyola Andalucía, Sevilla, Spain (Motrico, Rigabert); Centro de Salud Marquesado, Área Nordeste de Granada, Granada, Spain (Martín-Pérez); Centro de Salud San José, Linares, Jaén, Spain (Rodríguez-Bayón); Centro de Salud Federico del Castillo, Jaén, Spain (Ballesta-Rodríguez); Departamento de Bioestadística. Universidad de Granada, Granada, Spain (Luna); Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain (Luna); Departamento de Psiquiatría, Hospital Universitario Miguel Servet, Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain (García-Campayo); Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca, Spain (Roca); Centro de Salud El Palo, Málaga, Spain (Bellón); Departamento de Medicina Preventiva, Salud Pública y Psiquiatría, Universidad de Málaga, Málaga, Spain (Bellón)
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Landreville P, Gosselin P, Grenier S, Hudon C, Lorrain D. Guided self-help for generalized anxiety disorder in older adults. Aging Ment Health 2016; 20:1070-83. [PMID: 26158374 DOI: 10.1080/13607863.2015.1060945] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The main objective of this study was to examine the efficacy of a guided self-help treatment based on cognitive behavioral principles (CBT-GSH) for generalized anxiety disorder (GAD) in older adults. METHODS Three older adults aged from 66 to 70 and diagnosed with GAD were included in a single-case experimental multiple-baseline protocol. Data were collected using daily self-monitoring, standardized clinician ratings, and self-report questionnaires at pretest, posttest, and 6-month and 12-month follow-ups. Treatment consisted of awareness training, worry interventions, relaxation training, pleasant activities scheduling, and relapse prevention. Participants used a manual presenting weekly readings and at-home practice exercises. They also received weekly supportive phone calls from a therapist. RESULTS At posttest, participants showed improvement on worries and GAD severity, on psychological process variables targeted by treatment (intolerance of uncertainty, negative problem orientation, cognitive avoidance, and perceived usefulness of worry), and on secondary variables associated with GAD (anxiety, depression, sleep difficulties, cognitive functioning, and disability). These results were generally maintained at 12 months after the end of treatment. Participants had favorable opinions toward the treatment. CONCLUSION The results of this study suggest that CBT-GSH is both feasible and effective for the treatment of GAD in older adults.
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Affiliation(s)
- Philippe Landreville
- a School of Psychology , Université Laval , Quebec , Canada.,b Centre de recherche du CHU de Québec , Quebec , Canada
| | - Patrick Gosselin
- c Department of Psychology , Université de Sherbrooke , Sherbrooke , Canada.,d Institut universitaire de première ligne en santé et services sociaux-Centre intégré universitaire en santé et services sociaux de l'Estrie-CHUS(CIUSSS de l'Estrie-CHUS) , Sherbrooke , Canada
| | - Sébastien Grenier
- e Department of Psychology , Université de Montréal , Montreal , Canada.,f Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal , Montreal , Canada
| | - Carol Hudon
- g School of Psychology , Université Laval , Quebec , Canada.,h Centre de recherche de l'Institut universitaire en santé mentale de Québec , Quebec , Canada
| | - Dominique Lorrain
- i Department of Psychology , Université de Sherbrooke , Sherbrooke , Canada.,j Centre de recherche sur le vieillissement , CSSS-IUGS , Sherbrooke , Canada
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Jeuring HW, Huisman M, Comijs HC, Stek ML, Beekman ATF. The long-term outcome of subthreshold depression in later life. Psychol Med 2016; 46:2855-2865. [PMID: 27468780 DOI: 10.1017/s0033291716001549] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Subthreshold depression (SUBD) in later life is common and important as prodromal state and prominent risk factor in the development of major depressive disorder (MDD). Indicated prevention can reduce the incidence of MDD among people with SUBD substantially, but needs to be targeted to those that are truly at risk of developing MDD. METHOD N = 341 eligible participants with SUBD were included from the first (1992/1993), second (1995/1996) and third (1998/1999) cycle from the Longitudinal Aging Study Amsterdam (LASA) by using a two-stage screening design. LASA is an ongoing prospective cohort study in The Netherlands among the older population (55-85 years). At baseline (1992/1993) N = 3107 participants were interviewed and follow-up cycles were conducted every 3 years until 2008/2009, resulting in maximal 17 years of observational period. The proportion of people that developed MDD, remained SUBD, or recovered from SUBD was measured and Cox proportional regression analyses were performed to investigate 29 putative predictors of MDD and recovery from SUBD. RESULTS N = 153 (44.9%) recovered from SUBD, N = 138 (40.5%) remained chronically SUBD, and N = 50 (14.7%) developed MDD (incidence rate 15.1/1000 person-years). Women, high neuroticism, more chronic diseases, high body mass index, smoking and less social support predicted conversion to MDD. Men, low neuroticism and absence of pain predicted recovery from SUBD. CONCLUSIONS Although older people with SUBD are clearly at risk of developing MDD, the majority did not, even after a long and thorough follow-up. Given the risk factors that were uncovered, targeting and prevention of MDD in those at very high risk is feasible.
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Affiliation(s)
- H W Jeuring
- Department of Psychiatry and the EMGO Institute for Health and Care Research,GGZ inGeest - VU University Medical Center,Amsterdam,The Netherlands
| | - M Huisman
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research,VU University Medical Center,Amsterdam,The Netherlands
| | - H C Comijs
- Department of Psychiatry and the EMGO Institute for Health and Care Research,GGZ inGeest - VU University Medical Center,Amsterdam,The Netherlands
| | - M L Stek
- Department of Psychiatry and the EMGO Institute for Health and Care Research,GGZ inGeest - VU University Medical Center,Amsterdam,The Netherlands
| | - A T F Beekman
- Department of Psychiatry and the EMGO Institute for Health and Care Research,GGZ inGeest - VU University Medical Center,Amsterdam,The Netherlands
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The Efficacy and Cost-Effectiveness of Stepped Care Prevention and Treatment for Depressive and/or Anxiety Disorders: A Systematic Review and Meta-Analysis. Sci Rep 2016; 6:29281. [PMID: 27377429 PMCID: PMC4932532 DOI: 10.1038/srep29281] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/16/2016] [Indexed: 11/22/2022] Open
Abstract
Stepped care is an increasingly popular treatment model for common mental health disorders, given the large discrepancy between the demand and supply of healthcare service available. In this review, we aim to compare the efficacy and cost-effectiveness of stepped care prevention and treatment with care-as-usual (CAU) or waiting-list control for depressive and/or anxiety disorders. 5 databases were utilized from its earliest available records up until April 2015. 10 randomized controlled trials were included in this review, of which 6 examined stepped care prevention and 4 examined stepped care treatment, specifically including ones regarding depressive and/or anxiety disorders. Only trials with self-help as a treatment component were included. Results showed stepped care treatment revealed a significantly better performance than CAU in reducing anxiety symptoms, and the treatment response rate of anxiety disorders was significantly higher in stepped care treatment than in CAU. No significant difference was found between stepped care prevention/treatment and CAU in preventing anxiety and/or depressive disorders and improving depressive symptoms. In conclusion, stepped care model appeared to be better than CAU in treating anxiety disorders. The model has the potential to reduce the burden on existing resources in mental health and increase the reach and availability of service.
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van der Aa HPA, van Rens GHMB, Comijs HC, Margrain TH, Gallindo-Garre F, Twisk JWR, van Nispen RMA. Stepped care for depression and anxiety in visually impaired older adults: multicentre randomised controlled trial. BMJ 2015; 351:h6127. [PMID: 26597263 PMCID: PMC4655616 DOI: 10.1136/bmj.h6127] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
STUDY QUESTION Is stepped care compared with usual care effective in preventing the onset of major depressive, dysthymic, and anxiety disorders in older people with visual impairment (caused mainly by age related eye disease) and subthreshold depression and/or anxiety? METHODS 265 people aged ≥50 were randomly assigned to a stepped care programme plus usual care (n=131) or usual care only (n=134). Supervised occupational therapists, social workers, and psychologists from low vision rehabilitation organisations delivered the stepped care programme, which comprised watchful waiting, guided self help based on cognitive behavioural therapy, problem solving treatment, and referral to a general practitioner. The primary outcome was the 24 month cumulative incidence (seven measurements) of major depressive dysthymic and/or anxiety disorders (panic disorder, agoraphobia, social phobia, and generalised anxiety disorder). Secondary outcomes were change in symptoms of depression and anxiety, vision related quality of life, health related quality of life, and adaptation to vision loss over time up to 24 months' follow-up. STUDY ANSWER AND LIMITATIONS 62 participants (46%) in the usual care group and 38 participants (29%) from the stepped care group developed a disorder. The intervention was associated with a significantly reduced incidence (relative risk 0.63, 95% confidence interval 0.45 to 0.87; P=0.01), even if time to the event was taken into account (adjusted hazard ratio 0.57, 0.35 to 0.93; P=0.02). The number needed to treat was 5.8 (3.5 to 17.3). The dropout rate was fairly high (34.3%), but rates were not significantly different for the two groups, indicating that the intervention was as acceptable as usual care. Participants who volunteered and were selected for this study might not be representative of visually impaired older adults in general (responders were significantly younger than non-responders), thereby reducing the generalisability of the outcomes. WHAT THIS STUDY ADDS Stepped care seems to be a promising way to deal with depression and anxiety in visually impaired older adults. This approach could lead to standardised strategies for the screening, monitoring, treatment, and referral of visually impaired older adults with depression and anxiety. FUNDING, COMPETING INTERESTS, DATA SHARING Funded by ZonMw InZicht, the Dutch Organisation for Health Research and Development-InSight Society. There are no competing interests. Full dataset and statistical code are available from the corresponding author.Study registration www.trialregister.nl NTR3296.
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Affiliation(s)
- Hilde P A van der Aa
- Department of Ophthalmology and EMGO+ Institute for Health and Care Research (EMGO+), VU University Medical Centre, 1081 HV, Amsterdam, Netherlands
| | - Ger H M B van Rens
- Department of Ophthalmology and EMGO+ Institute for Health and Care Research (EMGO+), VU University Medical Centre, 1081 HV, Amsterdam, Netherlands
| | - Hannie C Comijs
- Department of Psychiatry VUmc/GGZinGeest, 1081HL Amsterdam, Netherlands
| | - Tom H Margrain
- School of Optometry and Vision Sciences, Cardiff University, Cardiff CF24 4HQ, United Kingdom
| | - Francisca Gallindo-Garre
- Department of Epidemiology and Biostatistics, VU University Medical Centre, 1081 HV, Amsterdam, Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Centre, 1081 HV, Amsterdam, Netherlands
| | - Ruth M A van Nispen
- Department of Ophthalmology and EMGO+ Institute for Health and Care Research (EMGO+), VU University Medical Centre, 1081 HV, Amsterdam, Netherlands
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van Beljouw IMJ, van Exel E, van de Ven PM, Joling KJ, Dhondt TDF, Stek ML, van Marwijk HWJ. Does an outreaching stepped care program reduce depressive symptoms in community-dwelling older adults? A randomized implementation trial. Am J Geriatr Psychiatry 2015; 23:807-17. [PMID: 25499673 DOI: 10.1016/j.jagp.2014.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 09/25/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To examine the effects of an outreaching stepped care intervention program (Lust for Life) compared with usual care on depressive symptoms in older adults living in the community. DESIGN Randomized clinical implementation trial. SETTING 18 general practices and a home care organization in the Netherlands. PARTICIPANTS 263 community-dwelling 65+-year-olds with depressive symptoms according to the Patient Health Questionnaire-9 (PHQ-9). INTERVENTION After three months of watchful waiting, participants could sequentially choose between the following evidence-based interventions: 1) guided self-help or an exercise program, 2) problem solving treatment or life review, and 3) a referral to their general practitioner. MEASUREMENTS The outcome measure was depression severity (PHQ-9), measured every three months over 2 years. RESULTS After the provision of the stepped care program, a significant short-term positive effect on depressive symptoms was found in the first three months after implementation, in which average PHQ-9 scores dropped from 9.34 (SE: 0.61, 95% CI: 8.14-10.5) to 7.83 (SE: 0.51, 95% CI: 6.84-8.81). CONCLUSIONS The Lust for Life program has a promising potential to relieve depressive symptoms of older adults in primary care in the short term. Providing one single clinical intervention in accordance with participants' choices instead of stepped care could be sufficient.
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Affiliation(s)
- Ilse M J van Beljouw
- Department of Psychiatry, VU University Medical Center / GGZ inGeest, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Eric van Exel
- Department of Psychiatry, VU University Medical Center / GGZ inGeest, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center / GGZ inGeest, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Karlijn J Joling
- Department of General Practice, VU University Medical Center / GGZ inGeest, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
| | | | - Max L Stek
- Department of Psychiatry, VU University Medical Center / GGZ inGeest, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands.
| | - Harm W J van Marwijk
- Department of General Practice, VU University Medical Center / GGZ inGeest, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
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Interventions for preventing relapse or recurrence of depression in primary health care settings: A systematic review. Prev Med 2015; 76 Suppl:S16-21. [PMID: 25192769 DOI: 10.1016/j.ypmed.2014.07.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/04/2014] [Accepted: 07/23/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE A systematic review was conducted to assess the efficacy of pharmacological and psychological interventions for preventing relapse or recurrence of depression in adults with depression in primary care. METHOD Papers published from inception to January 28th 2014 were identified searching the electronic databases MEDLINE, EMBASE, PsycINFO, and CENTRAL. Randomized controlled trials of any pharmacological, psychological or psychosocial intervention or combination of interventions delivered in primary care settings were included, with relapse or recurrence of a depressive disorder as a main outcome. The Cochrane Collaboration risk of bias tool was used to assess study quality. RESULTS Only three studies with a small number of patients fulfilled the inclusion criteria. None of the three randomized controlled trials included in our review showed a statistically significant superiority of an intervention for the prevention of depression relapse or recurrence. CONCLUSIONS There is limited evidence to inform relapse or recurrence prevention strategies specifically in primary care.
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Zabaleta-del-Olmo E, Bolibar B, García-Ortíz L, García-Campayo J, Llobera J, Bellón JÁ, Ramos R. Building interventions in primary health care for long-term effectiveness in health promotion and disease prevention. A focus on complex and multi-risk interventions. Prev Med 2015; 76 Suppl:S1-4. [PMID: 25778858 DOI: 10.1016/j.ypmed.2015.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 03/08/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Edurne Zabaleta-del-Olmo
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Gran Via Corts Catalanes 587 àtic, 08007 Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain; Department of Nursing, Universitat de Girona, c/Emili Grahit 77, 17071 Girona, Spain.
| | - Bonaventura Bolibar
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Gran Via Corts Catalanes 587 àtic, 08007 Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Luis García-Ortíz
- Primary Care Research Unit, The Alamedilla Health Center, Salamanca Institute for Biomedical Research (IBSAL), Av. Comuneros 27-31, 37003 Salamanca, Spain; Department of Biomedical Sciences and Diagnostics, University of Salamanca, Miguel de Unamuno Campus, Calle Alfonso X El Sabio s/n, 37007 Salamanca, Spain
| | - Javier García-Campayo
- Department of Psychiatry, Miguel Servet University Hospital, University of Zaragoza, redIAPP, Isabel la Católica 1-3, 50009 Zaragoza, Spain
| | - Joan Llobera
- Research Unit, Primary Care Department of Mallorca, Ib-Salut Balears, IdISPa, Govern de les Illes Balear, C/Reina Esclaramunda 9, 07003 Palma, Spain
| | - Juan Ángel Bellón
- El Palo Health Centre, Avenida Salvador Allende 159, 20018 Málaga, Spain; Research Unit of Málaga Primary Care District, c/Sevilla 23, 3ª planta, 29009 Málaga, Spain; Department of Preventive Medicine and Public Health, University of Málaga, School of Medicine, Campus de Teatinos, 29071 Málaga, Spain; Málaga Biomedical Research Institute (IBIMA), Av. Jorge Luis Borges 15, Bl.3 Pl.3, 29010 Málaga, Spain
| | - Rafel Ramos
- Girona Research Unit, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), c/Maluquer Salvador 11, 17002 Girona, Spain; Department of Medical Sciences, School of Medicine, University of Girona, c/Emili Grahit, 77, 17071 Girona, Spain
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27
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Clinical staging and profiling of late-life anxiety disorders; the need for collaboration and a life-span perspective. Int Psychogeriatr 2015; 27:1057-9. [PMID: 25881981 DOI: 10.1017/s1041610215000599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Clinical staging and profiling is a diagnostic strategy that goes beyond the traditional dichotomy in medicine of merely focusing on the presence or absence of a disease. Disease staging extends this traditional dichotomy by defining where a patient lies along the continuum of the course of his or her particular illness. Successful examples include the general tumor, node, metastasis (TNM) classification in oncology, as well as the New York Heart Association (NYHA classes I-IV) functional classification system for patients with congestive heart failure. It enables clinicians to select treatments relevant to earlier stages because such interventions may be more effective and less harmful than treatments delivered later in the illness course. Profiling is a further refinement, as well as a necessary component of staging. Profiling refers to the characterization of a patient within a specific disease stage, which is relevant for its course and treatment choice. An example of profiling is estrogen receptor positivity in patients with breast cancer.
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García-Campayo J, del Hoyo YL, Valero MS, Yus MCP, Esteban EA, Guedea MP, Botaya RM. Primary prevention of anxiety disorders in primary care: A systematic review. Prev Med 2015; 76 Suppl:S12-5. [PMID: 25456801 DOI: 10.1016/j.ypmed.2014.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 08/27/2014] [Accepted: 10/09/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Anxiety disorders are the most prevalent psychiatric disorders in primary care and have significant social, economic, and interpersonal costs. Primary care is an ideal setting to prevent the appearance of anxiety disorders. The aim of this study was to evaluate the efficacy and cost-effectiveness of primary prevention interventions in anxiety disorders in the adult population receiving primary health care. METHODS A literature search was carried out in four databases-PubMed, PsycInfo, Cochrane, and Web of Science-from January 1980 to November 2013. Clinical trials and systematic reviews published in English and non-English languages and that evaluated the efficacy and/or cost-effectiveness of interventions of primary prevention for anxiety in primary care in the general adult population were included. Risk of bias was assessed by the Cochrane Risk Bias Tool and Overview Quality Assessment Questionnaire. RESULTS No high-quality research was identified that studied primary prevention of anxiety disorders in the adult population in the primary care setting. The few studies that exist focus on the child-adolescent population or on other types of interventions, usually as secondary prevention. CONCLUSION This study emphasizes the need for the development of high-quality clinical trials on the prevention of anxiety disorders in primary care.
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Affiliation(s)
- Javier García-Campayo
- Department of Psychiatry, Miguel Servet University Hospital, University of Zaragoza, REDIAPP, Isabel la Catolica, 1-3, 50009 Zaragoza, Spain.
| | - Yolanda López del Hoyo
- Department of Psychology & Sociology, University of Zaragoza, REDIAPP, Violante de Hungría, 23, 50009 Zaragoza, Spain
| | | | - Maria Cruz Pérez Yus
- Aragon Health Sciences Institute, REDIAPP, CS. Arrabal, Andador Aragues Puerto, 2-4, 50015 Zaragoza, Spain
| | - Eva Andrés Esteban
- 12 de Octubre Research Institute, Avda. de Córdoba, s/n, 28041 Madrid, Spain
| | | | - Rosa Magallón Botaya
- Health Aragon, REDIAPP, CS, Arrabal, Andador Aragues Puerto, 2-4, 50015 Zaragoza, Spain
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van der Aa HPA, Krijnen-de Bruin E, van Rens GHMB, Twisk JWR, van Nispen RMA. Watchful waiting for subthreshold depression and anxiety in visually impaired older adults. Qual Life Res 2015; 24:2885-93. [PMID: 26085328 PMCID: PMC4615663 DOI: 10.1007/s11136-015-1032-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2015] [Indexed: 12/21/2022]
Abstract
Purpose Immediate treatment of depression and anxiety may not always be necessary in resilient patients. This study aimed to determine remission rates of subthreshold depression and anxiety, incidence rates of major depressive and anxiety disorders, and predictors of these remission and incidence rates in visually impaired older adults after a three-month ‘watchful waiting’ period. Methods A pretest–posttest study in 265 visually impaired older adults (mean age 74 years), from outpatient low-vision rehabilitation services, with subthreshold depression and/or anxiety was performed as part of a randomised controlled trial on the cost-effectiveness of a stepped-care intervention. An ordinal logistic regression analysis was conducted. Main outcome measures were: (1) subthreshold depression and anxiety measured with the Centre for Epidemiologic Studies Depression Scale (CES-D) and the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), and (2) depressive and anxiety disorders measured with the Mini International Neuropsychiatric Interview. Results After a three-month watchful waiting period, depression and anxiety decreased significantly by 3.8 (CES-D) and 1.4 points (HADS-A) (p < 0.001). Of all participants, 34 % recovered from subthreshold depression and/or anxiety and 18 % developed a depressive and/or anxiety disorder. Female gender [odds ratio (OR) 0.49, 95 % confidence interval (CI) 0.28–0.86], more problems with adjustment to vision loss at baseline (OR 1.02, 95 % CI 1.00–1.03), more symptoms of depression and anxiety at baseline (OR 1.06, 95 % CI 1.02–1.10), and a history of major depressive, dysthymic, and/or panic disorder (OR 2.28, 95 % CI 1.28–4.07) were associated with lower odds of remitting from subthreshold depression and/or anxiety and higher odds of developing a disorder after watchful waiting. Conclusions Watchful waiting can be an appropriate step in managing depression and anxiety in visually impaired older adults. However, female gender, problems with adjustment to vision loss, higher depression and anxiety symptoms, and a history of a depressive or anxiety disorder confer a disadvantage. Screening tools may be used to identify patients with these characteristics, who may benefit more from higher intensity treatment or a shorter period of watchful waiting.
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Affiliation(s)
- Hilde P A van der Aa
- Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- EMGO+Institute for Health and Care Research (EMGO+), VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Esther Krijnen-de Bruin
- Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Ger H M B van Rens
- Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- EMGO+Institute for Health and Care Research (EMGO+), VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
- Department of Ophthalmology, Elkerliek Hospital, Wesselmanlaan 25, 5707 HA, Helmond, The Netherlands.
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Ruth M A van Nispen
- Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- EMGO+Institute for Health and Care Research (EMGO+), VU University Medical Centre, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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Cockayne NL, Duffy SL, Bonomally R, English A, Amminger PG, Mackinnon A, Christensen HM, Naismith SL, Hickie IB. The Beyond Ageing Project Phase 2--a double-blind, selective prevention, randomised, placebo-controlled trial of omega-3 fatty acids and sertraline in an older age cohort at risk for depression: study protocol for a randomized controlled trial. Trials 2015; 16:247. [PMID: 26037484 PMCID: PMC4469257 DOI: 10.1186/s13063-015-0762-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Late-life depression is associated with high rates of morbidity, premature mortality, disability, functional decline, caregiver burden and increased health care costs. While clinical and public health approaches are focused on prevention or early intervention strategies, the ideal method of intervention remains unclear. No study has set out to evaluate the role of neurobiological agents in preventing depressive symptoms in older populations at risk of depression. METHODS/DESIGN Subjects with previously reported sub-threshold depressive symptoms, aged 60 to 74 years, will be screened to participate in a single-centre, double-blind, randomised controlled trial with three parallel groups involving omega-3 fatty acid supplementation or sertraline hydrochloride, compared with matching placebo. Subjects will be excluded if they have current depression or suicide ideation; are taking antidepressants or any supplement containing omega-3 fatty acid; or have a prior history of stroke or other serious cerebrovascular or cardiovascular disease, neurological disease, significant psychiatric disease (other than depression) or neurodegenerative disease. The trial will consist of a 12 month treatment phase with follow-up at three months and 12 months to assess outcome events. At three months, subjects will undergo structural neuroimaging to assess whether treatment effects on depressive symptoms correlate with brain changes. Additionally, proton spectroscopy techniques will be used to capture brain-imaging markers of the biological effects of the interventions. The trial will be conducted in urban New South Wales, Australia, and will recruit a community-based sample of 450 adults. Using intention-to-treat methods, the primary endpoint is an absence of clinically relevant depression scores at 12 months between the omega-3 fatty acid and sertraline interventions and the placebo condition. DISCUSSION The current health, social and economic costs of late-life depression make prevention imperative from a public health perspective. This innovative trial aims to address the long-neglected area of prevention of depression in older adults. The interventions are targeted to the pathophysiology of disease, and regardless of the effect size of treatment, the outcomes will offer major scientific advances regarding the neurobiological action of these agents. The main results are expected to be available in 2017. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12610000032055 (12 January 2010).
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Affiliation(s)
- Nicole L Cockayne
- Healthy Brain Ageing Program, Brain and Mind Research Institute, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
| | - Shantel L Duffy
- Healthy Brain Ageing Program, Brain and Mind Research Institute, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
| | - Rosalind Bonomally
- Healthy Brain Ageing Program, Brain and Mind Research Institute, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
| | - Amelia English
- Healthy Brain Ageing Program, Brain and Mind Research Institute, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
| | - Paul G Amminger
- Orygen - The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Locked Bag 10, Parkville, VIC, 3052, Australia.
| | - Andrew Mackinnon
- Orygen - The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Locked Bag 10, Parkville, VIC, 3052, Australia.
| | - Helen M Christensen
- Black Dog Institute, University of New South Wales, Hospital Road, Prince of Wales Hospital, Randwick, NSW, 2031, Australia.
| | - Sharon L Naismith
- Healthy Brain Ageing Program, Brain and Mind Research Institute, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
| | - Ian B Hickie
- Healthy Brain Ageing Program, Brain and Mind Research Institute, University of Sydney, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
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Psychiatric assessment and screening for the elderly in primary care: design, implementation, and preliminary results. ACTA ACUST UNITED AC 2015; 2015. [PMID: 25954771 DOI: 10.1155/2015/792043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION We describe the design and implementation of a psychiatric collaborative care model in a University-based geriatric primary care practice. Initial results of screening for anxiety and depression are reported. METHODS AND MATERIALS Screens for anxiety and depression were administered to practice patients. A mental health team, consisting of a psychiatrist, mental health nurse practitioner and social worker, identified patients who on review of screening and chart data warranted evaluation or treatment. Referrals for mental health interventions were directed to members of the mental health team, primary care physicians at the practice, or community providers. RESULTS Subjects (N=1505) comprised 38.2% of the 3940 unique patients seen at the practice during the 4-year study period. 37.1% (N=555) screened positive for depression, 26.9 % (N=405) for anxiety, and 322 (21.4%) screened positive for both. Any positive score was associated with age (p<0.033), female gender (p<0.006), and a non-significant trend toward living alone (p<0.095). 8.87% had suicidal thoughts. CONCLUSIONS Screening captured the most affectively symptomatic patients, including those with suicidal ideation, for intervention. The partnering of mental health professionals and primary care physicians offers a workable model for addressing the scarcity of expertise in geriatric psychiatry.
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Samuels S, Abrams R, Shengelia R, Reid MC, Goralewicz R, Breckman R, Anderson MA, Snow CE, Woods EC, Stern A, Eimicke JP, Adelman RD. Integration of geriatric mental health screening into a primary care practice: a patient satisfaction survey. Int J Geriatr Psychiatry 2015; 30:539-46. [PMID: 25132003 PMCID: PMC4363083 DOI: 10.1002/gps.4180] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 07/02/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Colocation of mental health screening, assessment, and treatment in primary care reduces stigma, improves access, and increases coordination of care between mental health and primary care providers. However, little information exists regarding older adults' attitudes about screening for mental health problems in primary care. The objective of this study was to evaluate older primary care patients' acceptance of and satisfaction with screening for depression and anxiety. METHODS The study was conducted at an urban, academically affiliated primary care practice serving older adults. Study patients (N = 107) were screened for depression/anxiety and underwent a post-screening survey/interview to assess their reactions to the screening experience. RESULTS Most patients (88.6%) found the length of the screening to be "just right." A majority found the screening questions somewhat or very acceptable (73.4%) and not at all difficult (81.9%). Most participants did not find the questions stressful (84.9%) or intrusive (91.5%); and a majority were not at all embarrassed (93.4%), upset (93.4%), or uncomfortable (88.8%) during the screening process. When asked about frequency of screening, most patients (72.4%) desired screening for depression/anxiety yearly or more. Of the 79 patients who had spoken with their physicians about mental health during the visit, 89.8% reported that it was easy or very easy to talk with their physicians about depression/anxiety. Multivariate results showed that patients with higher anxiety had a lower positive reaction to the screen when controlling for gender, age, and patient-physician communication. CONCLUSIONS These results demonstrate strong patient support for depression and anxiety screening in primary care.
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Affiliation(s)
- S. Samuels
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY, USA
| | - R. Abrams
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - R. Shengelia
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY, USA
| | - M. C. Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY, USA
| | | | - R. Breckman
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY, USA
| | - M. A. Anderson
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY, USA
| | - C. E. Snow
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY, USA
| | - E. C. Woods
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY, USA
| | - A. Stern
- New York Presbyterian Hospital, New York, NY, USA
| | - J. P. Eimicke
- Research Division, Hebrew Home at Riverdale, Bronx, NY, USA
| | - R. D. Adelman
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY, USA
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Chen S, Conwell Y, He J, Lu N, Wu J. Depression care management for adults older than 60 years in primary care clinics in urban China: a cluster-randomised trial. Lancet Psychiatry 2015; 2:332-9. [PMID: 26360086 DOI: 10.1016/s2215-0366(15)00002-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/02/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND China's national health policy classifies depression as a chronic disease that should be managed in primary care settings. In some high-income countries use of chronic disease management principles and primary care-based collaborative-care models have improved outcomes for late-life depression; however, this approach has not yet been tested in China. We aimed to assess whether use of a collaborative-care depression care management (DCM) intervention could improve outcomes for Chinese adults with depression aged 60 years and older. METHODS Between Jan 17, 2011, [corrected] and Nov 30, 2013, we did a cluster-randomised trial in patients from primary care centre clinics in Shangcheng district of Hangzhou city in eastern China. We randomly assigned (1:1) clinics to either DCM (involving training for physicians in use of treatment guidelines, training for primary care nurses to function as care managers, and consultation with psychiatrists as support) or to give enhanced care as usual to all eligible patients aged 60 years and older with major depressive disorder. Clinics were chosen randomly for inclusion from all primary care clinics in the district by computer algorithm and then randomly allocated depression care interventions remotely by computer algorithm. Physicians, study personnel, and patients were not masked to clinic assignment. Our primary outcome was difference in Hamilton Depression Rating Scale (HAMD) score using data for clusters at baseline and 3, 6, and 12 month follow-up in a mixed-effects model of the intention-to-treat population. We originally aimed to analyse outcomes at 24 months, however the difference between groups at 12 months was large and funding was insufficient to continue to 24 months, therefore we decided to end the trial at 12 months. This trial is registered with ClinicalTrials.gov, number NCT01287494. FINDINGS Of 34 primary care clinics in Shangcheng district, 16 were randomly chosen. We randomly assigned eight clinics to the DCM intervention (164 patients enrolled) and eight primary care clinics to enhanced care as usual (162 patients). There were no major differences in baseline demographic and clinical variables between the groups of patients for each intervention. Over the 12 months, patients in clinics assigned to DCM had a significantly greater reduction in HAMD score than did those in practices assigned to enhanced care as usual (estimated between group difference -6·5 [95% CI -7·1 to -5·9]; Cohen's d 0·8 [95% CI 0·8-0·9]; p<0·0001). The intercluster correlation for change in HAMD total score was 0·07 (95% CI 0·06-0·08). There were no study-related adverse events in either group. INTERPRETATION Clinical outcomes of Chinese adults older than 60 years who had major depression were improved when their primary care clinic used DCM. Primary care-based collaborative management of depression is promising to address this pressing public health need in China. FUNDING National Institutes of Health, Program for New Century Excellent Talents in Universities of China, Ministry of Education, China.
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Affiliation(s)
- Shulin Chen
- Zhejiang University, Hangzhou, Zhejiang China
| | - Yeates Conwell
- University of Rochester School of Medicine, Rochester, NY, USA.
| | - Jin He
- Zhejiang University, Hangzhou, Zhejiang China
| | - Naiji Lu
- School of Management, Harbin Institute of Technology, Harbin, China
| | - Jiayan Wu
- Zhejiang University, Hangzhou, Zhejiang China
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Almeida OP, Yeap BB, Hankey GJ, Golledge J, Flicker L. Association of depression with sexual and daily activities: a community study of octogenarian men. Am J Geriatr Psychiatry 2015; 23:234-42. [PMID: 24200595 DOI: 10.1016/j.jagp.2013.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 09/10/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the association between clinically significant depressive symptoms, routine function, and sexual interest and practice in a community-derived sample of octogenarian men. METHODS Cross-sectional study of 1,649 community-dwelling men aged 80 years or over with no history of terminal illnesses or neurodegenerative diseases. Men with Patient Health Questionnaire (PHQ-9) scores greater than or equal to 10 were deemed to be clinically depressed. Scores between 5 and 9 were considered indicative of subthreshold depression. We used standard procedures to collect self-reported sociodemographic, lifestyle, and clinical data, as well as basic and instrumental activities of daily living, and a structured questionnaire to ask men about their 12-month interest in sex, frequency, past experiences, and current sexual problems. RESULTS 121 men (7.3%) had clinically significant depression and 239 (14.5%) had subthreshold depression. Depressive symptoms were associated with difficulties in basic and instrumental activities of daily living, but not with sexual practice. Decreased interest in sex and anxiety before sex were associated with subthreshold depression. Clinically significant depressive symptoms were independently and positively associated with past history of diabetes (odds ratio [OR]: 2.1, 95% confidence interval [CI]: 1.1-4.0), depression (OR: 9.0; 95% CI: 4.6-17.3), impaired ability to groom (OR: 3.7, 95% CI: 1.2-11.0), carry out heavy housework duties (OR: 2.4, 95% CI: 1.1-5.1), manage finances (OR: 2.5, 95% CI: 1.1-5.7), or engage in leisure activities (OR: 4.1, 95% CI: 2.0-8.2). CONCLUSIONS Ability to function effectively at home, financial autonomy, and leisure are associated with clinically significant depression in octogenarian men. Maintaining daily function and autonomy may be a suitable target for interventions that aim to reduce the prevalence and incidence of depression in older age.
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Affiliation(s)
- Osvaldo P Almeida
- School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Western Australia, Australia; Western Australian Centre for Health & Ageing, Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia; Department of Psychiatry, Royal Perth Hospital, Perth, Western Australia, Australia.
| | - Bu B Yeap
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia; Department of Endocrinology and Diabetes, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Graeme J Hankey
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia; Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Leon Flicker
- Western Australian Centre for Health & Ageing, Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia; Department of Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
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van Zoonen K, Buntrock C, Ebert DD, Smit F, Reynolds CF, Beekman ATF, Cuijpers P. Preventing the onset of major depressive disorder: a meta-analytic review of psychological interventions. Int J Epidemiol 2014; 43:318-29. [PMID: 24760873 DOI: 10.1093/ije/dyt175] [Citation(s) in RCA: 268] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Depressive disorders are highly prevalent, have a detrimental impact on the quality of life of patients and their relatives and are associated with increased mortality rates, high levels of service use and substantial economic costs. Current treatments are estimated to only reduce about one-third of the disease burden of depressive disorders. Prevention may be an alternative strategy to further reduce the disease burden of depression. METHODS We conducted a meta-analysis of randomized controlled trials examining the effects of preventive interventions in participants with no diagnosed depression at baseline on the incidence of diagnosed depressive disorders at follow-up. We identified 32 studies that met our inclusion criteria. RESULTS We found that the relative risk of developing a depressive disorder was incidence rate ratio = 0.79 (95% confidence interval: 0.69-0.91), indicating a 21% decrease in incidence in prevention groups in comparison with control groups. Heterogeneity was low (I(2) = 24%). The number needed to treat (NNT) to prevent one new case of depressive disorder was 20. Sensitivity analyses revealed no differences between type of prevention (e.g. selective, indicated or universal) nor between type of intervention (e.g. cognitive behavioural therapy, interpersonal psychotherapy or other). However, data on NNT did show differences. CONCLUSIONS Prevention of depression seems feasible and may, in addition to treatment, be an effective way to delay or prevent the onset of depressive disorders. Preventing or delaying these disorders may contribute to the further reduction of the disease burden and the economic costs associated with depressive disorders.
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Affiliation(s)
- Kim van Zoonen
- Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands, Leuphana University Innovation Incubator, Division Health Trainings Online, Lüneburg, Germany, Philips University, Department of Psychology, Clinical Psychology and Psychotherapy, Marburg, Germany, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands, Department of Epidemiology and Biostastics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA and Department of Psychiatry and EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
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Zhang DX, Lewis G, Araya R, Tang WK, Mak WWS, Cheung FMC, Mercer SW, Griffiths SM, Woo J, Lee DTF, Kung K, Lam AT, Yip BHK, Wong SYS. Prevention of anxiety and depression in Chinese: a randomized clinical trial testing the effectiveness of a stepped care program in primary care. J Affect Disord 2014; 169:212-20. [PMID: 25216464 DOI: 10.1016/j.jad.2014.08.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 07/30/2014] [Accepted: 08/08/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Despite empirical evidence demonstrating the effectiveness of collaborative stepped care program (SCP) in Western countries, such programs have not been evaluated in the east, which has a different services system structure and cultural nuances in seeking help for mental illness. Furthermore, only a few studies have used SCP for depression and anxiety prevention. We conducted a trial to test its effectiveness in preventing major depressive disorder and generalized anxiety disorder among primary care patients with subthreshold depression and/or anxiety in Hong Kong. METHODS Subthreshold depression and/or anxiety patients were randomized into the SCP group (n=121) or care as usual (CAU) group (n=119). The SCP included watchful waiting, telephone counseling, problem solving therapy, and family doctor treatment within one year. The primary outcome was the onset of major depressive disorder or generalized anxiety disorder in 15 months. The secondary outcomes were depressive and anxiety symptoms, quality of life and time absent from work due to any illness. RESULTS Survival analysis showed no differences between the SCP and CAU groups (the cumulative probability of onset at 15 month was 23.1% in the SCP group and 20.5% in the CAU group; Hazard Ratio=1.62; 95% Confidence Interval: 0.82-3.18; p=0.16). No significant differences were found in secondary outcomes. LIMITATIONS Sample size might not have been large enough. CONCLUSIONS SCP did not show beneficial effect on depression/anxiety prevention compared with CAU in Hong Kong primary care. As a large majority of patients improved overtime without any intervention, we are not able to exclude the possibility that the intervention might be effective. Future studies would need to have a larger sample size and conduct on patients with more severe symptoms or perform a second screening.
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Affiliation(s)
- De Xing Zhang
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (HKSAR), Hong Kong, China
| | - Glyn Lewis
- Mental Health Sciences Unit, Faculty of Brain Sciences, University College London, United Kingdom
| | - Ricardo Araya
- Department of Population Health, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Wai Kwong Tang
- Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Winnie Wing Sze Mak
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | | | | | - Sian Meryl Griffiths
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (HKSAR), Hong Kong, China
| | - Jean Woo
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Diana Tze Fan Lee
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Kenny Kung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (HKSAR), Hong Kong, China
| | - Augustine Tsan Lam
- Department of Family Medicine, New Territories East Cluster, Hospital Authority, Hong Kong, China
| | - Benjamin Hon Kei Yip
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (HKSAR), Hong Kong, China
| | - Samuel Yeung Shan Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region (HKSAR), Hong Kong, China.
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Hall CA, Reynolds-Iii CF. Late-life depression in the primary care setting: challenges, collaborative care, and prevention. Maturitas 2014; 79:147-52. [PMID: 24996484 PMCID: PMC4169311 DOI: 10.1016/j.maturitas.2014.05.026] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 05/27/2014] [Accepted: 05/28/2014] [Indexed: 01/07/2023]
Abstract
Late-life depression is highly prevalent worldwide. In addition to being a debilitating illness, it is a risk factor for excess morbidity and mortality. Older adults with depression are at risk for dementia, coronary heart disease, stroke, cancer and suicide. Individuals with late-life depression often have significant medical comorbidity and, poor treatment adherence. Furthermore, psychosocial considerations such as gender, ethnicity, stigma and bereavement are necessary to understand the full context of late-life depression. The fact that most older adults seek treatment for depression in primary care settings led to the development of collaborative care interventions for depression. These interventions have consistently demonstrated clinically meaningful effectiveness in the treatment of late-life depression. We describe three pivotal studies detailing the management of depression in primary care settings in both high and low-income countries. Beyond effectively treating depression, collaborative care models address additional challenges associated with late-life depression. Although depression treatment interventions are effective compared to usual care, they exhibit relatively low remission rates and small to medium effect sizes. Several studies have demonstrated that depression prevention is possible and most effective in at-risk older adults. Given the relatively modest effects of treatment in averting years lived with disability, preventing late-life depression at the primary care level should be highly prioritized as a matter of health policy.
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Affiliation(s)
- Charles A Hall
- SUNY Downstate Medical Center, College of Medicine, University of Pittsburgh School of Medicine, Department of Psychiatry, United States
| | - Charles F Reynolds-Iii
- NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh School of Medicine and Graduate School of Public Health, United States.
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Moreno-Peral P, Luna JDD, Marston L, King M, Nazareth I, Motrico E, GildeGómez-Barragán MJ, Torres-González F, Montón-Franco C, Sánchez-Celaya M, Díaz-Barreiros MÁ, Vicens C, Muñoz-Bravo C, Bellón JÁ. Predicting the onset of anxiety syndromes at 12 months in primary care attendees. The predictA-Spain study. PLoS One 2014; 9:e106370. [PMID: 25184313 PMCID: PMC4153639 DOI: 10.1371/journal.pone.0106370] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 07/25/2014] [Indexed: 01/07/2023] Open
Abstract
Background There are no risk algorithms for the onset of anxiety syndromes at 12 months in primary care. We aimed to develop and validate internally a risk algorithm to predict the onset of anxiety syndromes at 12 months. Methods A prospective cohort study with evaluations at baseline, 6 and 12 months. We measured 39 known risk factors and used multilevel logistic regression and inverse probability weighting to build the risk algorithm. Our main outcome was generalized anxiety, panic and other non-specific anxiety syndromes as measured by the Primary Care Evaluation of Mental Disorders, Patient Health Questionnaire (PRIME-MD-PHQ). We recruited 3,564 adult primary care attendees without anxiety syndromes from 174 family physicians and 32 health centers in 6 Spanish provinces. Results The cumulative 12-month incidence of anxiety syndromes was 12.2%. The predictA-Spain risk algorithm included the following predictors of anxiety syndromes: province; sex (female); younger age; taking medicines for anxiety, depression or stress; worse physical and mental quality of life (SF-12); dissatisfaction with paid and unpaid work; perception of financial strain; and the interactions sex*age, sex*perception of financial strain, and age*dissatisfaction with paid work. The C-index was 0.80 (95% confidence interval = 0.78–0.83) and the Hedges' g = 1.17 (95% confidence interval = 1.04–1.29). The Copas shrinkage factor was 0.98 and calibration plots showed an accurate goodness of fit. Conclusions The predictA-Spain risk algorithm is valid to predict anxiety syndromes at 12 months. Although external validation is required, the predictA-Spain is available for use as a predictive tool in the prevention of anxiety syndromes in primary care.
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Affiliation(s)
- Patricia Moreno-Peral
- Unidad de Investigación del Distrito Sanitario Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Juan de Dios Luna
- Departamento de Bioestadística, Universidad de Granada, Granada, Spain
| | - Louise Marston
- Department of Primary care and Population Health, University College London, London, United Kingdom
| | - Michael King
- Mental Health Sciences, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Irwin Nazareth
- Department of Primary care and Population Health, University College London, London, United Kingdom
| | - Emma Motrico
- Unidad de Investigación del Distrito Sanitario Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Universidad Loyola Andalucía, Sevilla, Spain
| | | | | | - Carmen Montón-Franco
- Centro de Salud Casablanca, Instituto Aragonés de Ciencias de la Salud, Zaragoza, Spain. Departamento de Medicina y Psiquiatría, Universidad de Zaragoza, Zaragoza, Spain
| | - Marta Sánchez-Celaya
- Directora Continuidad Asistencial Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Miguel Ángel Díaz-Barreiros
- Centro de Salud Vecindario, Gerencia de Atención Primaria de Gran Canaria, Servicio Canario de Salud, Las Palmas, Spain
| | - Catalina Vicens
- Centro de Salud son Serra-La Vileta, Unidad Docente de Medicina Familiar y Comunitaria de Mallorca, Instituto Balear de la Salud, Palma de Mallorca, Illes Balears, Spain
| | - Carlos Muñoz-Bravo
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Málaga, Málaga, Spain
| | - Juan Ángel Bellón
- Unidad de Investigación del Distrito Sanitario Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Málaga, Málaga, Spain
- Centro de Salud El Palo, Servicio Andaluz de Salud, Málaga, Spain
- * E-mail:
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Christensen H, Batterham P, Mackinnon A, Griffiths KM, Kalia Hehir K, Kenardy J, Gosling J, Bennett K. Prevention of generalized anxiety disorder using a web intervention, iChill: randomized controlled trial. J Med Internet Res 2014; 16:e199. [PMID: 25270886 PMCID: PMC4211086 DOI: 10.2196/jmir.3507] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 06/30/2014] [Accepted: 08/04/2014] [Indexed: 01/22/2023] Open
Abstract
Background Generalized Anxiety Disorder (GAD) is a high prevalence, chronic disorder. Web-based interventions are acceptable, engaging, and can be delivered at scale. Few randomized controlled trials evaluate the effectiveness of prevention programs for anxiety, or the factors that improve effectiveness and engagement. Objective The intent of the study was to evaluate the effectiveness of a Web-based program in preventing GAD symptoms in young adults, and to determine the role of telephone and email reminders. Methods A 5-arm randomized controlled trial with 558 Internet users in the community, recruited via the Australian Electoral Roll, was conducted with 6- and 12-month follow-up.
Five interventions were offered over a 10-week period. Group 1 (Active website) received a combined intervention of psycho-education, Internet-delivered Cognitive Behavioral Therapy (ICBT) for anxiety, physical activity promotion, and relaxation. Group 2 (Active website with telephone) received the identical Web program plus weekly telephone reminder calls. Group 3 (Active website with email) received the identical Web program plus weekly email reminders. Group 4 (Control) received a placebo website. Group 5 (Control with telephone) received the placebo website plus telephone calls.
Main outcome measures were severity of anxiety symptoms as measured by the GAD 7-item scale (GAD-7) (at post-test, 6, and 12 months). Secondary measures were GAD caseness, measured by the Mini International Neuropsychiatric Interview (MINI) at 6 months, Centre for Epidemiologic Studies-Depression scale (CES-D), Anxiety Sensitivity Index (ASI), Penn State Worry Questionnaire (PSWQ), and Days out of Role. Results GAD-7 symptoms reduced over post-test, 6-month, and 12-month follow-up. There were no significant differences between Group 4 (Control) and Groups 1 (Active website), 2 (Active website with telephone), 3 (Active website with email), or 5 (Control with telephone) at any follow-up. A total of 16 cases of GAD were identified at 6 months, comprising 6.7% (11/165) from the Active groups (1, 2, 3) and 4.5% (5/110) from the Control groups (4, 5), a difference that was not significant. CES-D, ASI, and PSWQ scores were significantly lower for the active website with email reminders at post-test, relative to the control website condition. Conclusions Indicated prevention of GAD was not effective in reducing anxiety levels, measured by GAD-7. There were significant secondary effects for anxiety sensitivity, worry, and depression. Challenges for indicated prevention trials are discussed. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 76298775; http://www.controlled-trials.com/ISRCTN76298775 (Archived by WebCite at http://www.webcitation.org/6S9aB5MAq).
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Affiliation(s)
- Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, Australia.
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Okereke OI. Racial and ethnic diversity in studies of late-life mental health. Am J Geriatr Psychiatry 2014; 22:637-41. [PMID: 24927878 DOI: 10.1016/j.jagp.2014.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 03/06/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Olivia I Okereke
- Channing Division of Network Medicine, Department of Medicine, and Department of Psychiatry, Brigham and Women's Hospital, and Harvard Medical School, and Department of Epidemiology, Harvard School of Public Health, Boston, MA.
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The prevalence and burden of subthreshold generalized anxiety disorder: a systematic review. BMC Psychiatry 2014; 14:128. [PMID: 24886240 PMCID: PMC4048364 DOI: 10.1186/1471-244x-14-128] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 04/23/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To review the prevalence and impact of generalized anxiety disorder (GAD) below the diagnostic threshold and explore its treatment needs in times of scarce healthcare resources. METHODS A systematic literature search was conducted until January 2013 using PUBMED/MEDLINE, PSYCINFO, EMBASE and reference lists to identify epidemiological studies of subthreshold GAD, i.e. GAD symptoms that do not reach the current thresholds of DSM-III-R, DSM-IV or ICD-10. Quality of all included studies was assessed and median prevalences of subthreshold GAD were calculated for different subpopulations. RESULTS Inclusion criteria led to 15 high-quality and 3 low-quality epidemiological studies with a total of 48,214 participants being reviewed. Whilst GAD proved to be a common mental health disorder, the prevalence for subthreshold GAD was twice that for the full syndrome. Subthreshold GAD is typically persistent, causing considerably more suffering and impairment in psychosocial and work functioning, benzodiazepine and primary health care use, than in non-anxious individuals. Subthreshold GAD can also increase the risk of onset and worsen the course of a range of comorbid mental health, pain and somatic disorders; further increasing costs. Results are robust against bias due to low study quality. CONCLUSIONS Subthreshold GAD is a common, recurrent and impairing disease with verifiable morbidity that claims significant healthcare resources. As such, it should receive additional research and clinical attention.
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Prevention of depression in older age. Maturitas 2014; 79:136-41. [PMID: 24713453 DOI: 10.1016/j.maturitas.2014.03.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 03/11/2014] [Accepted: 03/13/2014] [Indexed: 01/17/2023]
Abstract
Depression is a common disorder in later life that is associated with increased disability and costs, and negative health outcomes over time. Antidepressant treatments in the form of medications or psychotherapy are available, but a large proportion of those treated fail to respond fully, and relapse or recurrence of symptoms is frequent among those who recover. Hence, successful prevention would avoid these negative outcomes. This paper selectively reviews currently available observational and trial data on the prevention of depression. It initially reviews risk factors associated with depression, and then discusses strategies for primary (including universal, selective and indicated), secondary and tertiary prevention. Currently available evidence suggests that selective and indicated preventive interventions are feasible and initial results look promising. Existing trial data indicate that ongoing antidepressant treatments reduce the risk of relapse and recurrence of symptoms, but benefits may not extend beyond two or three years. At this point in time, no interventions have been shown to reduce the long term complications associated with depression. Mental health professionals will need to work collaboratively to develop primary, secondary and tertiary preventive interventions that are effective at targeting relevant risk factors systematically and that can be easily adopted into clinical practice.
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Improving the cost-effectiveness of a healthcare system for depressive disorders by implementing telemedicine: a health economic modeling study. Am J Geriatr Psychiatry 2014; 22:253-62. [PMID: 23759290 PMCID: PMC4096928 DOI: 10.1016/j.jagp.2013.01.058] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 12/09/2012] [Accepted: 01/15/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Depressive disorders are significant causes of disease burden and are associated with substantial economic costs. It is therefore important to design a healthcare system that can effectively manage depression at sustainable costs. This article computes the benefit-to-cost ratio of the current Dutch healthcare system for depression, and investigates whether offering more online preventive interventions improves the cost-effectiveness overall. METHODS A health economic (Markov) model was used to synthesize clinical and economic evidence and to compute population-level costs and effects of interventions. The model compared a base case scenario without preventive telemedicine and alternative scenarios with preventive telemedicine. The central outcome was the benefit-to-cost ratio, also known as return-on-investment (ROI). RESULTS In terms of ROI, a healthcare system with preventive telemedicine for depressive disorders offers better value for money than a healthcare system without Internet-based prevention. Overall, the ROI increases from €1.45 ($1.72) in the base case scenario to €1.76 ($2.09) in the alternative scenario in which preventive telemedicine is offered. In a scenario in which the costs of offering preventive telemedicine are balanced by reducing the expenditures for curative interventions, ROI increases to €1.77 ($2.10), while keeping the healthcare budget constant. CONCLUSIONS For a healthcare system for depressive disorders to remain economically sustainable, its cost-benefit ratio needs to be improved. Offering preventive telemedicine at a large scale is likely to introduce such an improvement.
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van Schaik DJF, Dozeman E, van Marwijk HWJ, Stek ML, Smit F, Beekman ATF, van der Horst HE. Preventing depression in homes for older adults: are effects sustained over 2 years? Int J Geriatr Psychiatry 2014; 29:191-7. [PMID: 23737075 DOI: 10.1002/gps.3989] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 05/02/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the 2-year effects of a stepped-care programme to prevent the onset of a major depressive disorder (MDD) in older people living in residential homes. METHODS A 2-year follow-up study of a pragmatic randomised controlled trial was conducted in 14 residential homes in the Netherlands. A total of 185 residents (Center for Epidemiologic Studies Depression Scale score >7), who did not meet the diagnostic criteria for MDD, were randomised to a stepped-care programme (n = 93) or to usual care (n = 92). Stepped-care participants sequentially underwent watchful waiting, a self-help intervention, life review and a consultation with the general practitioner. The primary outcome measure was the incidence of MDD during a period of 2 years, according to the Mini International Neuropsychiatric Interview. RESULTS After 2 years, the incidence of MDD was not significantly reduced in the intervention group compared with the control group (incidence rate ratio: 0.98; 95% confidence interval (CI) [0.54, 1.81]). However, in the completer analysis, on the basis of 79 residents who completed the 2-year measurements, there was a significant difference in favour of the intervention group (incidence rate ratio: 0.53; 95% CI [0.32, 0.87]). Dropout percentages were high (44%), mostly accounted for by illness and death (68%). CONCLUSION A minority of residents had benefit from the intervention that sustained after 2 years in the completer group. Yet, these findings cannot be generalised as the majority of the residents did not opt for participation in the project and many dropped out. Ways should be sought to motivate residents with depressive symptoms to engage in preventive interventions.
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Affiliation(s)
- Digna J F van Schaik
- Department of General Practice, VU University Medical Centre, Amsterdam, The Netherlands; EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands
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Bosmans JE, Dozeman E, van Marwijk HWJ, van Schaik DJF, Stek ML, Beekman ATF, van der Horst HE. Cost-effectiveness of a stepped care programme to prevent depression and anxiety in residents in homes for the older people: a randomised controlled trial. Int J Geriatr Psychiatry 2014; 29:182-90. [PMID: 23765874 DOI: 10.1002/gps.3987] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 04/24/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Depression and anxiety are common in residents of elderly homes. Both disorders have negative effects on functioning, well-being and health-care utilisation. Besides treatment, prevention can be an option to reduce the burden of mental disorders. The objective of this study was to evaluate the cost-effectiveness of a stepped care programme to prevent the onset of depression and anxiety disorders in residents of elderly homes compared with usual care from a societal perspective. METHODS Outcomes were incidence of depression and/or anxiety, severity of depressive and anxiety symptoms and quality-adjusted life years. Health-care utilisation was measured during interviews. Multiple imputation was used to impute missing cost and effect data. Uncertainty around cost differences and incremental cost-effectiveness ratios was estimated using bootstrapping. Cost-effectiveness planes and acceptability curves were created. RESULTS The incidence of depression and anxiety combined in the intervention group was not reduced in comparison with the usual care group. There was also no effect on the other outcomes. Mean total costs in the intervention group were €838 higher than in the usual care group, but this difference was not statistically significant (95% confidence interval, -593 to 2420). Cost-effectiveness planes showed that there was considerable uncertainty. Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective in comparison with usual care was 0.46 for reducing the incidence of depression and anxiety combined. CONCLUSION A stepped care programme to prevent depression and anxiety in older people living in elderly homes was not considered cost-effective in comparison with usual care.
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Affiliation(s)
- J E Bosmans
- Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
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Randomised controlled trial of group cognitive behavioural therapy for comorbid anxiety and depression in older adults. Behav Res Ther 2013; 51:779-86. [DOI: 10.1016/j.brat.2013.09.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 09/02/2013] [Accepted: 09/04/2013] [Indexed: 11/20/2022]
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Stepped-care to prevent depression and anxiety in visually impaired older adults--design of a randomised controlled trial. BMC Psychiatry 2013; 13:209. [PMID: 23937975 PMCID: PMC3751101 DOI: 10.1186/1471-244x-13-209] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 08/07/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Subthreshold depression and anxiety are common in the growing population of visually impaired older adults and increase the risk of full-blown depressive or anxiety disorders. Adequate treatment may prevent the development of depression or anxiety in this high risk group. METHOD/DESIGN A stepped-care programme was developed based on other effective interventions and focus groups with professionals and patient representatives of three low vision rehabilitation organisations in The Netherlands and Belgium. The final programme consists of four steps: 1) watchful waiting, 2) guided self-help, 3) problem solving treatment, 4) referral to general practitioner. The (cost-)effectiveness of this programme is evaluated in a randomised controlled trial. Patients (N = 230) are randomly assigned to either a treatment group (stepped-care) or a control group (usual care). The primary outcome is the incidence of depressive and anxiety disorders, measured with the Mini International Neuropsychiatric Interview (MINI). DISCUSSION Preventive interventions for depression and anxiety have received little attention in the field of low vision. A stepped-care programme that focuses on both depression and anxiety has never been investigated in visually impaired older adults before. If the intervention is shown to be effective, this study will result in an evidence based treatment programme to prevent depression or anxiety in patients from low vision rehabilitation organisations. The pragmatic design of the study greatly enhances the generalisability of the results. However, a possible limitation is the difficulty to investigate the contribution of each individual step. TRIAL REGISTRATION Identifier: NTR3296.
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Wilkes CM, Wilson HW, Woodard JL, Calamari JE. Do negative affect characteristics and subjective memory concerns increase risk for late life anxiety? J Anxiety Disord 2013; 27:608-18. [PMID: 23623610 PMCID: PMC3773246 DOI: 10.1016/j.janxdis.2013.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 03/23/2013] [Accepted: 03/27/2013] [Indexed: 11/28/2022]
Abstract
To better understand the development and exacerbation of late-life anxiety, we tested a risk model positing that trait negative affect (NA) characteristics would interact with cognitive functioning, thereby increasing some older adults' risk for increased anxiety symptoms. The moderator-mediator model consisted of measures of NA, cognitive functioning, and their interaction, as predictors of later Hamilton Anxiety Rating Scale scores (HARS) via a mediational process, subjective memory concerns (SMCs). Older adults (aged 65-years and over; M(age)=76.7 years, SD=6.90 years) completed evaluations four times over approximately 18 months. A latent growth curve model including Anxiety Sensitivity Index total score (ASI), Mattis Dementia Rating Scale-2 (DRS) total raw score, the ASI×DRS interaction, a SMC measure as mediator, HARS intercept (scores at times 3 and 4), and HARS slope provided good fit. The ASI×DRS-2 interaction at Time 1 predicted HARS slope score (β=-.34, p<.05). When ASI score was high, stronger cognitive functioning was associated with fewer anxiety symptoms. The indirect effect of ASI score predicting HARS score 18-months later through the SMC mediator was statistically significant (β=.08, p<.05). Results suggest that the cognitive functioning changes associated with aging might contribute to the development of anxiety symptoms in older adults with specific NA traits. Implications for predicting and preventing late life anxiety disorders are discussed.
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Affiliation(s)
- Chelsey M. Wilkes
- Department of Psychology, Rosalind Franklin University of Medicine and Science
| | - Helen W. Wilson
- Department of Psychology, Rosalind Franklin University of Medicine and Science
| | | | - John E. Calamari
- Department of Psychology, Rosalind Franklin University of Medicine and Science
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Johnco C, Wuthrich VM, Rapee RM. The role of cognitive flexibility in cognitive restructuring skill acquisition among older adults. J Anxiety Disord 2013; 27:576-84. [PMID: 23253357 DOI: 10.1016/j.janxdis.2012.10.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 10/11/2012] [Accepted: 10/13/2012] [Indexed: 10/27/2022]
Abstract
Cognitive flexibility is one aspect of executive functioning that encompasses the ability to produce diverse ideas, consider response alternatives, and modify behaviors to manage changing circumstances. These processes are likely to be important for implementing cognitive restructuring. The present study investigated the impact of cognitive flexibility on older adults' ability to learn cognitive restructuring. Neuropsychological measures of cognitive flexibility were administered to 40 normal community-dwelling older adult volunteers and their ability to implement cognitive restructuring was coded and analyzed. Results indicated that the majority of participants showed good cognitive restructuring skill acquisition with brief training. The multiple regression analysis suggested that those with poorer cognitive flexibility on neuropsychological testing demonstrated poorer quality cognitive restructuring. In particular, perseverative thinking styles appear to negatively impact the ability to learn cognitive restructuring. Further research is needed to clarify whether older adults with poor cognitive flexibility can improve their cognitive restructuring skills with repetition over treatment or whether alternative skills should be considered.
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Affiliation(s)
- C Johnco
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney 2109, Australia.
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Cost-effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression: design of a cluster-randomized controlled trial. BMC Psychiatry 2013; 13:128. [PMID: 23651614 PMCID: PMC3654943 DOI: 10.1186/1471-244x-13-128] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 04/24/2013] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Co-morbid major depression is a significant problem among patients with type 2 diabetes mellitus and/or coronary heart disease and this negatively impacts quality of life. Subthreshold depression is the most important risk factor for the development of major depression. Given the highly significant association between depression and adverse health outcomes and the limited capacity for depression treatment in primary care, there is an urgent need for interventions that successfully prevent the transition from subthreshold depression into a major depressive disorder. Nurse led stepped-care is a promising way to accomplish this. The aim of this study is to evaluate the cost-effectiveness of a nurse-led indicated stepped-care program to prevent major depression among patients with type 2 diabetes mellitus and/or coronary heart disease in primary care who also have subthreshold depressive symptoms. METHODS/DESIGN An economic evaluation will be conducted alongside a cluster-randomized controlled trial in approximately thirty general practices in the Netherlands. Randomization takes place at the level of participating practice nurses. We aim to include 236 participants who will either receive a nurse-led indicated stepped-care program for depressive symptoms or care as usual. The stepped-care program consists of four sequential but flexible treatment steps: 1) watchful waiting, 2) guided self-help treatment, 3) problem solving treatment and 4) referral to the general practitioner. The primary clinical outcome measure is the cumulative incidence of major depressive disorder as measured with the Mini International Neuropsychiatric Interview. Secondary outcomes include severity of depressive symptoms, quality of life, anxiety and physical outcomes. Costs will be measured from a societal perspective and include health care utilization, medication and lost productivity costs. Measurements will be performed at baseline and 3, 6, 9 and 12 months. DISCUSSION The intervention being investigated is expected to prevent new cases of depression among people with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression, with subsequent beneficial effects on quality of life, clinical outcomes and health care costs. When proven cost-effective, the program provides a viable treatment option in the Dutch primary care system. TRIAL REGISTRATION Dutch Trial Register NTR3715.
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