1
|
Kendrick T, Dowrick C, Lewis G, Moore M, Leydon GM, Geraghty AW, Griffiths G, Zhu S, Yao GL, May C, Gabbay M, Dewar-Haggart R, Williams S, Bui L, Thompson N, Bridewell L, Trapasso E, Patel T, McCarthy M, Khan N, Page H, Corcoran E, Hahn JS, Bird M, Logan MX, Ching BCF, Tiwari R, Hunt A, Stuart B. Depression follow-up monitoring with the PHQ-9: an open cluster-randomised controlled trial. Br J Gen Pract 2024; 74:e456-e465. [PMID: 38408790 PMCID: PMC11221421 DOI: 10.3399/bjgp.2023.0539] [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: 10/17/2023] [Accepted: 02/19/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Outcome monitoring of depression treatment is recommended but there is a lack of evidence on patient benefit in primary care. AIM To test monitoring depression using the Patient Health Questionnaire (PHQ-9) with patient feedback. DESIGN AND SETTING An open cluster-randomised controlled trial was undertaken in 141 group practices. METHOD Adults with new depressive episodes were recruited through record searches and opportunistically. The exclusion criteria were as follows: dementia; psychosis; substance misuse; and suicide risk. The PHQ-9 was administered soon after diagnosis, and 10-35 days later. The primary outcome was the Beck Depression Inventory (BDI-II) score at 12 weeks. The secondary outcomes were as follows: BDI-II at 26 weeks; Work and Social Adjustment Scale (WSAS) and EuroQol EQ-5D-5L quality of life at 12 and 26 weeks; antidepressant treatment; mental health and social service contacts; adverse events, and Medical Interview Satisfaction Scale (MISS) over 26 weeks. RESULTS In total, 302 patients were recruited to the intervention arm and 227 to the controls. At 12 weeks, 254 (84.1%) and 199 (87.7%) were followed-up, respectively. Only 40.9% of patients in the intervention had a GP follow-up PHQ-9 recorded. There was no significant difference in BDI-II score at 12 weeks (mean difference -0.46; 95% confidence interval [CI] = -2.16 to 1.26; adjusted for baseline depression, baseline anxiety, sociodemographic factors, and clustering by practice). EQ-5D-5L quality-of-life scores were higher in the intervention arm at 26 weeks (adjusted mean difference 0.053; 95% CI = 0.013 to 0.093. A clinically significant difference in depression at 26 weeks could not be ruled out. No significant differences were found in social functioning, adverse events, or satisfaction. In a per-protocol analysis, antidepressant use and mental health contacts were significantly greater in patients in the intervention arm with a recorded follow-up PHQ-9 (P = 0.025 and P = 0.010, respectively). CONCLUSION No evidence was found of improved depression outcome at 12 weeks from monitoring. The findings of possible benefits over 26 weeks warrant replication, investigating possible mechanisms, preferably with automated delivery of monitoring and more instructive feedback.
Collapse
Affiliation(s)
- Tony Kendrick
- School of Primary Care, Population Science, and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool
| | - Glyn Lewis
- Division of Psychiatry, University College London, London. Division of Psychiatry, University College London, London
| | - Michael Moore
- School of Primary Care, Population Science, and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton
| | - Geraldine M Leydon
- School of Primary Care, Population Science, and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton
| | - Adam Wa Geraghty
- School of Primary Care, Population Science, and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton
| | - Shihua Zhu
- School of Primary Care, Population Science, and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton
| | - Guiqing Lily Yao
- Leicester Clinical Trials Unit, University of Leicester, Leicester
| | - Carl May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London
| | - Mark Gabbay
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool
| | - Rachel Dewar-Haggart
- School of Primary Care, Population Science, and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton
| | - Samantha Williams
- School of Primary Care, Population Science, and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton
| | - Lien Bui
- School of Primary Care, Population Science, and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton
| | - Natalie Thompson
- School of Primary Care, Population Science, and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton
| | - Lauren Bridewell
- School of Primary Care, Population Science, and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton
| | - Emilia Trapasso
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool
| | - Tasneem Patel
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool
| | - Molly McCarthy
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool
| | - Naila Khan
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool
| | - Helen Page
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool
| | - Emma Corcoran
- Division of Psychiatry, University College London, London. Division of Psychiatry, University College London, London
| | - Jane Sungmin Hahn
- Division of Psychiatry, University College London, London. Division of Psychiatry, University College London, London
| | - Molly Bird
- Division of Psychiatry, University College London, London. Division of Psychiatry, University College London, London
| | - Mekeda X Logan
- Division of Psychiatry, University College London, London. Division of Psychiatry, University College London, London
| | - Brian Chi Fung Ching
- Division of Psychiatry, University College London, London. Division of Psychiatry, University College London, London
| | - Riya Tiwari
- School of Primary Care, Population Science, and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton
| | - Anna Hunt
- School of Primary Care, Population Science, and Medical Education, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, Southampton
| | - Beth Stuart
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London
| |
Collapse
|
2
|
Kendrick T, Dowrick C, Lewis G, Moore M, Leydon GM, Geraghty AW, Griffiths G, Zhu S, Yao GL, May C, Gabbay M, Dewar-Haggart R, Williams S, Bui L, Thompson N, Bridewell L, Trapasso E, Patel T, McCarthy M, Khan N, Page H, Corcoran E, Hahn JS, Bird M, Logan MX, Ching BCF, Tiwari R, Hunt A, Stuart B. Patient-reported outcome measures for monitoring primary care patients with depression: the PROMDEP cluster RCT and economic evaluation. Health Technol Assess 2024; 28:1-95. [PMID: 38551155 PMCID: PMC11017630 DOI: 10.3310/plrq4216] [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] [Indexed: 04/02/2024] Open
Abstract
Background Guidelines on the management of depression recommend that practitioners use patient-reported outcome measures for the follow-up monitoring of symptoms, but there is a lack of evidence of benefit in terms of patient outcomes. Objective To test using the Patient Health Questionnaire-9 questionnaire as a patient-reported outcome measure for monitoring depression, training practitioners in interpreting scores and giving patients feedback. Design Parallel-group, cluster-randomised superiority trial; 1 : 1 allocation to intervention and control. Setting UK primary care (141 group general practices in England and Wales). Inclusion criteria Patients aged ≥ 18 years with a new episode of depressive disorder or symptoms, recruited mainly through medical record searches, plus opportunistically in consultations. Exclusions Current depression treatment, dementia, psychosis, substance misuse and risk of suicide. Intervention Administration of the Patient Health Questionnaire-9 questionnaire with patient feedback soon after diagnosis, and at follow-up 10-35 days later, compared with usual care. Primary outcome Beck Depression Inventory, 2nd edition, symptom scores at 12 weeks. Secondary outcomes Beck Depression Inventory, 2nd edition, scores at 26 weeks; antidepressant drug treatment and mental health service contacts; social functioning (Work and Social Adjustment Scale) and quality of life (EuroQol 5-Dimension, five-level) at 12 and 26 weeks; service use over 26 weeks to calculate NHS costs; patient satisfaction at 26 weeks (Medical Informant Satisfaction Scale); and adverse events. Sample size The original target sample of 676 patients recruited was reduced to 554 due to finding a significant correlation between baseline and follow-up values for the primary outcome measure. Randomisation Remote computerised randomisation with minimisation by recruiting university, small/large practice and urban/rural location. Blinding Blinding of participants was impossible given the open cluster design, but self-report outcome measures prevented observer bias. Analysis was blind to allocation. Analysis Linear mixed models were used, adjusted for baseline depression, baseline anxiety, sociodemographic factors, and clustering including practice as random effect. Quality of life and costs were analysed over 26 weeks. Qualitative interviews Practitioner and patient interviews were conducted to reflect on trial processes and use of the Patient Health Questionnaire-9 using the Normalization Process Theory framework. Results Three hundred and two patients were recruited in intervention arm practices and 227 patients were recruited in control practices. Primary outcome data were collected for 252 (83.4%) and 195 (85.9%), respectively. No significant difference in Beck Depression Inventory, 2nd edition, score was found at 12 weeks (adjusted mean difference -0.46, 95% confidence interval -2.16 to 1.26). Nor were significant differences found in Beck Depression Inventory, 2nd Edition, score at 26 weeks, social functioning, patient satisfaction or adverse events. EuroQol-5 Dimensions, five-level version, quality-of-life scores favoured the intervention arm at 26 weeks (adjusted mean difference 0.053, 95% confidence interval 0.013 to 0.093). However, quality-adjusted life-years over 26 weeks were not significantly greater (difference 0.0013, 95% confidence interval -0.0157 to 0.0182). Costs were lower in the intervention arm but, again, not significantly (-£163, 95% confidence interval -£349 to £28). Cost-effectiveness and cost-utility analyses, therefore, suggested that the intervention was dominant over usual care, but with considerable uncertainty around the point estimates. Patients valued using the Patient Health Questionnaire-9 to compare scores at baseline and follow-up, whereas practitioner views were more mixed, with some considering it too time-consuming. Conclusions We found no evidence of improved depression management or outcome at 12 weeks from using the Patient Health Questionnaire-9, but patients' quality of life was better at 26 weeks, perhaps because feedback of Patient Health Questionnaire-9 scores increased their awareness of improvement in their depression and reduced their anxiety. Further research in primary care should evaluate patient-reported outcome measures including anxiety symptoms, administered remotely, with algorithms delivering clear recommendations for changes in treatment. Study registration This study is registered as IRAS250225 and ISRCTN17299295. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 17/42/02) and is published in full in Health Technology Assessment; Vol. 28, No. 17. See the NIHR Funding and Awards website for further award information.
Collapse
Affiliation(s)
- Tony Kendrick
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Christopher Dowrick
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Glyn Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Michael Moore
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Geraldine M Leydon
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Adam Wa Geraghty
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Shihua Zhu
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Guiqing Lily Yao
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | - Carl May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark Gabbay
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Rachel Dewar-Haggart
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Samantha Williams
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Lien Bui
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Natalie Thompson
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Lauren Bridewell
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Emilia Trapasso
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Tasneem Patel
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Molly McCarthy
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Naila Khan
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Helen Page
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Emma Corcoran
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Jane Sungmin Hahn
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Molly Bird
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Mekeda X Logan
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Brian Chi Fung Ching
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Riya Tiwari
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Anna Hunt
- School of Primary Care, Population Health and Medical Education, University of Southampton, Southampton, UK
| | - Beth Stuart
- Centre for Evaluation and Methods, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| |
Collapse
|
3
|
Li Y, Wu J, Zhu G. Efficacy Analysis of Comprehensive Nursing in the Care of Ovarian Carcinoma Treated with Paclitaxel Combined with Nedaplatin. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9398823. [PMID: 36110573 PMCID: PMC9470341 DOI: 10.1155/2022/9398823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/05/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022]
Abstract
Objective To determine the effectiveness of comprehensive nursing in the care of ovarian carcinoma (OC) patients treated with paclitaxel (PTX) plus nedaplatin (NDP). Methods The research population comprised 180 advanced OC patients who received treatment in the Shaanxi Cancer Hospital between November 2018 and November 2021. The enrolled cases were assigned to two groups based on different nursing plans: an observation group (OG) with 100 cases treated with comprehensive nursing and a control group (CG) with 80 cases intervened by conventional nursing. Intergroup comparisons were performed to identify statistical significance in terms of the following parameters: serum NGF, TK1, and CA15-3 levels; VAS, SAS, and SDS scores; nursing compliance; incidence of adverse reactions; and nursing satisfaction. Results Compared with CG, OG showed the following: (1) lower posttreatment NGF, TK1, and CA15-3 levels; (2) lower scores of SAS and SDS; (3) higher nursing compliance; and (4) lower incidence of adverse reactions and higher nursing satisfaction after nursing. Conclusions Comprehensive nursing far outperformed conventional nursing in the care of advanced OC patients treated with PTX plus NDP, which is worth popularizing.
Collapse
Affiliation(s)
- Yahui Li
- Department of Gynecology and Oncology, Shaanxi Cancer Hospital, Xi'an, 710061 Shaanxi, China
| | - Jing Wu
- Department of General Surgery, Shaanxi Cancer Hospital, Xi'an, 710061 Shaanxi, China
| | - Gehong Zhu
- Department of Gynecology and Oncology, Shaanxi Cancer Hospital, Xi'an, 710061 Shaanxi, China
| |
Collapse
|
4
|
Hultqvist J, Bjerkeli P, Hensing G, Holmgren K. Does a brief work-stress intervention prevent sick-leave during the following 24 months? A randomized controlled trial in Swedish primary care. Work 2021; 70:1141-1150. [PMID: 34842202 PMCID: PMC8764599 DOI: 10.3233/wor-205029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND: Work-related stress (WRS) presents a risk for sick leave. However, effective methods to identify people at risk for sick leave due to WRS at an early stage are lacking in primary health care. OBJECTIVE: To evaluate whether a systematic early identification of WRS can prevent sick leave over 24 months after the intervention. METHODS: Study participants (n = 132 intervention; n = 139 control) were employed, non-sick-listed persons seeking care at primary health care centres. The intervention included early identification of WRS by a validated instrument, general practitioner (GP) awareness supported by a brief training session, patients’ self-reflection by instrument completion, GP giving the patient feedback at consultation and GP identifying preventive measures. The control group received treatment as usual. Outcome data were retrieved from the Swedish Social Insurance Agency. RESULTS: The intervention group had less registered median sick leave days (n = 56) than the control group (n = 65) but the difference was not statistically significant. CONCLUSIONS: The brief intervention was not proven effective in preventing sick leave in the following 24 months compared to treatment as usual. Further research on how to identify, advice and treat those at high risk for sick leave in primary health care is needed.
Collapse
Affiliation(s)
- Jenny Hultqvist
- Department of Health and Rehabilitation, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Göteborg, Sweden
| | | | - Gunnel Hensing
- Insurance Medicine, School of Public Health and Community Medicine, University of Gothenburg, Göteborg, Sweden
| | - Kristina Holmgren
- Department of Health and Rehabilitation, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg, Göteborg, Sweden
| |
Collapse
|
5
|
Gibbons C, Porter I, Gonçalves-Bradley DC, Stoilov S, Ricci-Cabello I, Tsangaris E, Gangannagaripalli J, Davey A, Gibbons EJ, Kotzeva A, Evans J, van der Wees PJ, Kontopantelis E, Greenhalgh J, Bower P, Alonso J, Valderas JM. Routine provision of feedback from patient-reported outcome measurements to healthcare providers and patients in clinical practice. Cochrane Database Syst Rev 2021; 10:CD011589. [PMID: 34637526 PMCID: PMC8509115 DOI: 10.1002/14651858.cd011589.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patient-reported outcomes measures (PROMs) assess a patient's subjective appraisal of health outcomes from their own perspective. Despite hypothesised benefits that feedback on PROMs can support decision-making in clinical practice and improve outcomes, there is uncertainty surrounding the effectiveness of PROMs feedback. OBJECTIVES To assess the effects of PROMs feedback to patients, or healthcare workers, or both on patient-reported health outcomes and processes of care. SEARCH METHODS We searched MEDLINE, Embase, CENTRAL, two other databases and two clinical trial registries on 5 October 2020. We searched grey literature and consulted experts in the field. SELECTION CRITERIA Two review authors independently screened and selected studies for inclusion. We included randomised trials directly comparing the effects on outcomes and processes of care of PROMs feedback to healthcare professionals and patients, or both with the impact of not providing such information. DATA COLLECTION AND ANALYSIS Two groups of two authors independently extracted data from the included studies and evaluated study quality. We followed standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the evidence. We conducted meta-analyses of the results where possible. MAIN RESULTS We identified 116 randomised trials which assessed the effectiveness of PROMs feedback in improving processes or outcomes of care, or both in a broad range of disciplines including psychiatry, primary care, and oncology. Studies were conducted across diverse ambulatory primary and secondary care settings in North America, Europe and Australasia. A total of 49,785 patients were included across all the studies. The certainty of the evidence varied between very low and moderate. Many of the studies included in the review were at risk of performance and detection bias. The evidence suggests moderate certainty that PROMs feedback probably improves quality of life (standardised mean difference (SMD) 0.15, 95% confidence interval (CI) 0.05 to 0.26; 11 studies; 2687 participants), and leads to an increase in patient-physician communication (SMD 0.36, 95% CI 0.21 to 0.52; 5 studies; 658 participants), diagnosis and notation (risk ratio (RR) 1.73, 95% CI 1.44 to 2.08; 21 studies; 7223 participants), and disease control (RR 1.25, 95% CI 1.10 to 1.41; 14 studies; 2806 participants). The intervention probably makes little or no difference for general health perceptions (SMD 0.04, 95% CI -0.17 to 0.24; 2 studies, 552 participants; low-certainty evidence), social functioning (SMD 0.02, 95% CI -0.06 to 0.09; 15 studies; 2632 participants; moderate-certainty evidence), and pain (SMD 0.00, 95% CI -0.09 to 0.08; 9 studies; 2386 participants; moderate-certainty evidence). We are uncertain about the effect of PROMs feedback on physical functioning (14 studies; 2788 participants) and mental functioning (34 studies; 7782 participants), as well as fatigue (4 studies; 741 participants), as the certainty of the evidence was very low. We did not find studies reporting on adverse effects defined as distress following or related to PROM completion. AUTHORS' CONCLUSIONS PROM feedback probably produces moderate improvements in communication between healthcare professionals and patients as well as in diagnosis and notation, and disease control, and small improvements to quality of life. Our confidence in the effects is limited by the risk of bias, heterogeneity and small number of trials conducted to assess outcomes of interest. It is unclear whether many of these improvements are clinically meaningful or sustainable in the long term. There is a need for more high-quality studies in this area, particularly studies which employ cluster designs and utilise techniques to maintain allocation concealment.
Collapse
Affiliation(s)
| | - Ian Porter
- Health Services & Policy Research, University of Exeter Medical School, Exeter, UK
| | - Daniela C Gonçalves-Bradley
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stanimir Stoilov
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ignacio Ricci-Cabello
- Primary Care Research Unit, Instituto de Investigación Sanitaria Illes Balears, Palma de Mallorca, Spain
| | | | | | - Antoinette Davey
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Elizabeth J Gibbons
- PROM Group, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anna Kotzeva
- Health Technology Assessment Department, Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain
| | - Jonathan Evans
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, Netherlands
| | - Evangelos Kontopantelis
- Centre for Health Informatics, Institute of Population Health, The University of Manchester, Manchester, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Jordi Alonso
- CIBER Epidemiologia y Salud Publica (CIBERESP), IMIM-Hospital del mar, Barcelona, Spain
| | - Jose M Valderas
- Health Services & Policy Research, Exeter Collaboration for Academic Primary Care (APEx), NIHR School for Primary Care Research, NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
| |
Collapse
|
6
|
Zhang Y, Lan R, Li P, Gong T, Wang M. The role of the humanoid diagram teaching strategy in the nursing of women undergoing caesarean section. Am J Transl Res 2021; 13:7983-7989. [PMID: 34377279 PMCID: PMC8340180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/23/2021] [Indexed: 06/13/2023]
Abstract
AIM To investigate the application of the humanoid diagram teaching strategy (HDTS) to the care of women undergoing caesarean section. METHODS 80 women undergoing caesarean section were recruited as the study cohort, with 37 patients who underwent caesarean section before the implementation of HDTS placed in the control group (CNG), and the other 43 cases, who underwent caesarean section after the implementation of HDTS, were placed in the study group (SG). We compared the two groups' incidences of postpartum complications, their pain levels, their negative moods, and their nursing satisfaction levels. RESULTS The total postoperative complication rates (uterine adhesions, infections, bleeding, etc.) were 2.33% in the SG and 16.22% in the CNG (P<0.05), and the pain levels were significantly lower in the SG than they were in the CNG (P<0.05). The self-assessment scale (SAS) and self-assessment scale (SDS) scores were lower in the SG than they were in the CNG (P<0.05). Meanwhile, 97.67% of the patients in the SG and 83.78% of the patients in the CNG were satisfied with the nursing care (P<0.05). CONCLUSION HDTS helps to reduce the complication rate following caesarean section, improves the postoperative pain levels and adverse moods, and improves the patients' satisfaction levels with the nursing interventions, so it is of positive significance for the doctor-patient relationship and worthy of clinical promotion and application.
Collapse
Affiliation(s)
- Yajing Zhang
- Nursing Department, Yichun People’s HospitalYichun 336000, Jiangxi, China
| | - Rongli Lan
- Nursing Department, Yichun People’s HospitalYichun 336000, Jiangxi, China
| | - Ping Li
- Internet Hospital Management Office, Yichun People’s HospitalYichun 336000, Jiangxi, China
| | - Ting Gong
- Department of Urology, Yichun People’s HospitalYichun 336000, Jiangxi, China
| | - Min Wang
- Nursing Department, Yichun People’s HospitalYichun 336000, Jiangxi, China
| |
Collapse
|
7
|
Hultén AM, Bjerkeli P, Holmgren K. Self-reported sick leave following a brief preventive intervention on work-related stress: a randomised controlled trial in primary health care. BMJ Open 2021; 11:e041157. [PMID: 33753430 PMCID: PMC7986880 DOI: 10.1136/bmjopen-2020-041157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of a brief intervention about early identification of work-related stress combined with feedback at consultation with a general practitioner (GP) on the number of self-reported sick leave days. DESIGN Randomised controlled trial. Prospective analyses of self-reported sick leave data collected between November 2015 and January 2017. SETTING Seven primary healthcare centres in western Sweden. PARTICIPANTS The study included 271 employed, non-sick-listed patients aged 18-64 years seeking care for mental and/or physical health complaints. Of these, 132 patients were allocated to intervention and 139 patients to control. INTERVENTIONS The intervention group received a brief intervention about work-related stress, including training for GPs, screening of patients' work-related stress, feedback to patients on screening results and discussion of measures at GP consultation. The control group received treatment as usual. OUTCOME MEASURES The number of self-reported gross sick leave days and the number of self-reported net sick leave days, thereby also considering part-time sick leave. RESULTS At 6 months' follow-up, 220/271 (81%) participants were assessed, while at 12 months' follow-up, 241/271 (89%) participants were assessed. At 6-month follow-up, 59/105 (56%) in the intervention group and 61/115 (53%) in the control group reported no sick leave. At 12-month follow-up, the corresponding numbers were 61/119 (51%) and 57/122 (47%), respectively. There were no statistically significant differences between the intervention group and the control group in the median number of self-reported gross sick leave days and the median number of self-reported net sick leave days. CONCLUSIONS The brief intervention showed no effect on the numbers of self-reported sick leave days for patients seeking care at the primary healthcare centres. Other actions and new types of interventions need to be explored to address patients' perceiving of ill health due to work-related stress. TRIAL REGISTRATION NUMBER NCT02480855.
Collapse
Affiliation(s)
- Anna-Maria Hultén
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pernilla Bjerkeli
- Department for Public Health Research, University of Skövde, Skövde, Sweden
| | - Kristina Holmgren
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
8
|
Nieuwenhuijsen K, Verbeek JH, Neumeyer-Gromen A, Verhoeven AC, Bültmann U, Faber B. Interventions to improve return to work in depressed people. Cochrane Database Syst Rev 2020; 10:CD006237. [PMID: 33052607 PMCID: PMC8094165 DOI: 10.1002/14651858.cd006237.pub4] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Work disability such as sickness absence is common in people with depression. OBJECTIVES To evaluate the effectiveness of interventions aimed at reducing work disability in employees with depressive disorders. SEARCH METHODS We searched CENTRAL (The Cochrane Library), MEDLINE, Embase, CINAHL, and PsycINFO until April 4th 2020. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs of work-directed and clinical interventions for depressed people that included days of sickness absence or being off work as an outcome. We also analysed the effects on depression and work functioning. DATA COLLECTION AND ANALYSIS Two review authors independently extracted the data and rated the certainty of the evidence using GRADE. We used standardised mean differences (SMDs) or risk ratios (RR) with 95% confidence intervals (CI) to pool study results in studies we judged to be sufficiently similar. MAIN RESULTS: In this update, we added 23 new studies. In total, we included 45 studies with 88 study arms, involving 12,109 participants with either a major depressive disorder or a high level of depressive symptoms. Risk of bias The most common types of bias risk were detection bias (27 studies) and attrition bias (22 studies), both for the outcome of sickness absence. Work-directed interventions Work-directed interventions combined with clinical interventions A combination of a work-directed intervention and a clinical intervention probably reduces days of sickness absence within the first year of follow-up (SMD -0.25, 95% CI -0.38 to -0.12; 9 studies; moderate-certainty evidence). This translates back to 0.5 fewer (95% CI -0.7 to -0.2) sick leave days in the past two weeks or 25 fewer days during one year (95% CI -37.5 to -11.8). The intervention does not lead to fewer persons being off work beyond one year follow-up (RR 0.96, 95% CI 0.85 to 1.09; 2 studies, high-certainty evidence). The intervention may reduce depressive symptoms (SMD -0.25, 95% CI -0.49 to -0.01; 8 studies, low-certainty evidence) and probably has a small effect on work functioning (SMD -0.19, 95% CI -0.42 to 0.06; 5 studies, moderate-certainty evidence) within the first year of follow-up. Stand alone work-directed interventions A specific work-directed intervention alone may increase the number of sickness absence days compared with work-directed care as usual (SMD 0.39, 95% CI 0.04 to 0.74; 2 studies, low-certainty evidence) but probably does not lead to more people being off work within the first year of follow-up (RR 0.93, 95% CI 0.77 to 1.11; 1 study, moderate-certainty evidence) or beyond (RR 1.00, 95% CI 0.82 to 1.22; 2 studies, moderate-certainty evidence). There is probably no effect on depressive symptoms (SMD -0.10, 95% -0.30 CI to 0.10; 4 studies, moderate-certainty evidence) within the first year of follow-up and there may be no effect on depressive symptoms beyond that time (SMD 0.18, 95% CI -0.13 to 0.49; 1 study, low-certainty evidence). The intervention may also not lead to better work functioning (SMD -0.32, 95% CI -0.90 to 0.26; 1 study, low-certainty evidence) within the first year of follow-up. Psychological interventions A psychological intervention, either face-to-face, or an E-mental health intervention, with or without professional guidance, may reduce the number of sickness absence days, compared with care as usual (SMD -0.15, 95% CI -0.28 to -0.03; 9 studies, low-certainty evidence). It may also reduce depressive symptoms (SMD -0.30, 95% CI -0.45 to -0.15, 8 studies, low-certainty evidence). We are uncertain whether these psychological interventions improve work ability (SMD -0.15 95% CI -0.46 to 0.57; 1 study; very low-certainty evidence). Psychological intervention combined with antidepressant medication Two studies compared the effect of a psychological intervention combined with antidepressants to antidepressants alone. One study combined psychodynamic therapy with tricyclic antidepressant (TCA) medication and another combined telephone-administered cognitive behavioural therapy (CBT) with a selective serotonin reuptake inhibitor (SSRI). We are uncertain if this intervention reduces the number of sickness absence days (SMD -0.38, 95% CI -0.99 to 0.24; 2 studies, very low-certainty evidence) but found that there may be no effect on depressive symptoms (SMD -0.19, 95% CI -0.50 to 0.12; 2 studies, low-certainty evidence). Antidepressant medication only Three studies compared the effectiveness of SSRI to selective norepinephrine reuptake inhibitor (SNRI) medication on reducing sickness absence and yielded highly inconsistent results. Improved care Overall, interventions to improve care did not lead to fewer days of sickness absence, compared to care as usual (SMD -0.05, 95% CI -0.16 to 0.06; 7 studies, moderate-certainty evidence). However, in studies with a low risk of bias, the intervention probably leads to fewer days of sickness absence in the first year of follow-up (SMD -0.20, 95% CI -0.35 to -0.05; 2 studies; moderate-certainty evidence). Improved care probably leads to fewer depressive symptoms (SMD -0.21, 95% CI -0.35 to -0.07; 7 studies, moderate-certainty evidence) but may possibly lead to a decrease in work-functioning (SMD 0.5, 95% CI 0.34 to 0.66; 1 study; moderate-certainty evidence). Exercise Supervised strength exercise may reduce sickness absence, compared to relaxation (SMD -1.11; 95% CI -1.68 to -0.54; one study, low-certainty evidence). However, aerobic exercise probably is not more effective than relaxation or stretching (SMD -0.06; 95% CI -0.36 to 0.24; 2 studies, moderate-certainty evidence). Both studies found no differences between the two conditions in depressive symptoms. AUTHORS' CONCLUSIONS A combination of a work-directed intervention and a clinical intervention probably reduces the number of sickness absence days, but at the end of one year or longer follow-up, this does not lead to more people in the intervention group being at work. The intervention may also reduce depressive symptoms and probably increases work functioning more than care as usual. Specific work-directed interventions may not be more effective than usual work-directed care alone. Psychological interventions may reduce the number of sickness absence days, compared with care as usual. Interventions to improve clinical care probably lead to lower sickness absence and lower levels of depression, compared with care as usual. There was no evidence of a difference in effect on sickness absence of one antidepressant medication compared to another. Further research is needed to assess which combination of work-directed and clinical interventions works best.
Collapse
Affiliation(s)
- Karen Nieuwenhuijsen
- Department of Public and Occupational Health, Coronel Institute of Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Academic Medical Center, Amsterdam, Netherlands
| | - Jos H Verbeek
- Cochrane Work Review Group, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Academic Medical Center, Amsterdam, Netherlands
| | | | | | - Ute Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Babs Faber
- Coronel Institute of Occupational Health/Dutch Research Center for Insurance Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
9
|
Affiliation(s)
- Tony Kendrick
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Emma Maund
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
10
|
Kendrick T, Moore M, Leydon G, Stuart B, Geraghty AWA, Yao G, Lewis G, Griffiths G, May C, Dewar-Haggart R, Williams S, Zhu S, Dowrick C. Patient-reported outcome measures for monitoring primary care patients with depression (PROMDEP): study protocol for a randomised controlled trial. Trials 2020; 21:441. [PMID: 32471492 PMCID: PMC7257549 DOI: 10.1186/s13063-020-04344-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Benefits to patients from reduced depression have been shown from monitoring progress with patient-reported outcome measures (PROMs) in psychological therapy and mental health settings. This approach has not yet been researched in the United Kingdom for primary care, which is where most people with depression are treated in the United Kingdom. METHODS This is a parallel-group cluster randomised trial with 1:1 allocation to intervention and control. Patients who are age 18+ years, with a new episode of depressive disorder/symptoms, meet the inclusion criteria. Patients with current depression treatment, comorbid dementia/psychosis/substance misuse/suicidal ideas are excluded. The intervention includes the Administration of Patient Health Questionnaire (PHQ-9) as a PROM within 2 weeks of diagnosis and at follow-up 4 weeks later. General practitioners are trained in interpreting scores and asked to take them into account in their treatment decisions. Patients are given written feedback on scores and suggested treatments. The primary outcome measure is Depression on the Beck Depression Inventory BDI-II at 12 weeks. Secondary outcomes include BDI-II at 26 weeks, changes in drug treatments and referrals, social functioning (Work & Social Adjustment Scale) and quality of life (EQ-5D) at 12 and 26 weeks, service use over 26 weeks (modified Client Services Receipt Inventory) to calculate NHS costs, and patient satisfaction at 26 weeks (Medical Informant Satisfaction Scale). The sample includes 676 total participants from 113 practices across three centres. Randomisation is achieved by computerised sequence generation. Blinding is impossible given the nature of the intervention (self-report outcome measures prevent rating bias). Differences at 12 and 26 weeks between intervention and controls in depression, social functioning and quality of life are analysed using linear mixed models, adjusted for socio-demographics, baseline depression, anxiety, and clustering, while including practice as a random effect. Patient satisfaction, quality of life (QALYs) and costs over 26 weeks will be compared between arms. Qualitative process analysis includes interviews with 15-20 GP/NPs and 15-20 patients per arm to reflect trial results and implementation issues, using Normalization Process Theory as a theoretical framework. DISCUSSION If PROMs are helpful in improving patient outcomes for depression even to a small extent, then they are likely to be good value for money, given their low cost. The benefits could be considerable, given that depression is common, disabling, and costly. TRIAL REGISTRATION ISRCTN no: 17299295. Registered 1st October 2018.
Collapse
Affiliation(s)
- Tony Kendrick
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, UK.
| | - Michael Moore
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, UK
| | - Geraldine Leydon
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, UK
| | - Beth Stuart
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, UK
| | - Adam W A Geraghty
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, UK
| | - Guiqing Yao
- Department of Health Sciences, University of Leicester, George Davies Centre, University Road Leicester, Leicester, LE1 7RH, UK
| | - Glyn Lewis
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6th Floor, Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Carl May
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Rachel Dewar-Haggart
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, UK
| | - Samantha Williams
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, UK
| | - Shihua Zhu
- Primary Care, Population Sciences, and Medical Education, University of Southampton, Aldermoor Health Centre, Southampton, SO16 5ST, UK
| | - Christopher Dowrick
- Institute of Psychology Health and Society, University of Liverpool, Liverpool, L69 3GL, UK
| |
Collapse
|
11
|
Holmgren K, Hensing G, Bültmann U, Hadzibajramovic E, Larsson MEH. Does early identification of work-related stress, combined with feedback at GP-consultation, prevent sick leave in the following 12 months? a randomized controlled trial in primary health care. BMC Public Health 2019; 19:1110. [PMID: 31412832 PMCID: PMC6694585 DOI: 10.1186/s12889-019-7452-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 08/07/2019] [Indexed: 11/16/2022] Open
Abstract
Background Experiencing work-related stress constitutes an obvious risk for becoming sick-listed. In primary health care, no established method to early identify, advise and treat people with work-related stress exists. The aim was to evaluate if the use of the Work Stress Questionnaire (WSQ) brief intervention, including feedback from the general practitioner (GP), had an impact on the level of sickness absence. Method/design In total 271 (intervention group, n = 132, control group, n = 139) non-sick-listed employed women and men, aged 18 to 64 years, who had mental and physical health complaints and sought care at primary health care centers participated in this two-armed randomized controlled trial. The main outcomes were the number of registered sick leave days and episodes, and time to first sick leave during the 12-months follow-up. The intervention included early identification of work-related stress by the WSQ, GP awareness supported by a brief training session, patients’ self-reflection by WSQ completion, GP feedback at consultation, and initiation of preventive measures. Results The mean days registered for the WSQ intervention group and the control group were 39 and 45 gross days respectively, and 31 and 39 net days respectively (ns). No statistical significant difference for the number of sick leave episodes or time to first day of sick leave episode were found between the groups. Conclusions The WSQ brief intervention combined with feedback and suggestions of measures at patient–GP-consultation was not proven effective in preventing sick leave in the following 12 months compared to treatment as usual. More research is needed on methods to early identify, advise and treat people with work-related stress in primary health care, and on how and when GPs and other professionals in primary health care can be trained to understand this risk of sick leave due to work-related stress, on how to prevent it, and on how to advise and treat employees at risk. Trial registration ClinicalTrials.gov. Identifier: NCT02480855. Registered 20 May 2015.
Collapse
Affiliation(s)
- K Holmgren
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
| | - G Hensing
- Section for Epidemiology and Social Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - U Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - E Hadzibajramovic
- Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden.,Health Metrics, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - M E H Larsson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Närhälsan Research and Development, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| |
Collapse
|
12
|
Lyu D, Wu Z, Wang Y, Huang Q, Wu Z, Cao T, Zhao J, Cao Y, Hu Y, Chen J, Wang Y, Su Y, Zhang C, Peng D, Li Z, Cao L, Hong W, Fang Y. Disagreement and factors between symptom on self-report and clinician rating of major depressive disorder: A report of a national survey in China. J Affect Disord 2019; 253:141-146. [PMID: 31035214 DOI: 10.1016/j.jad.2019.04.073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/21/2019] [Accepted: 04/17/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Measurement-based care (MBC) is a popular strategy of clinical management for patients with major depressive disorder (MDD). The consistency of self-report and clinical measurements is of importance, but whether individual symptom severity is in agreement for both self-report and clinician rating in MDD has not been comprehensively tested. This study aimed to test whether individual symptom severity of MDD was in agreement between self-report and clinician rating, and to explore factors affecting the agreement. METHODS In the National Survey on Symptomatology of Depression (NSSD) of China, 3275 patients with a major depressive episode were evaluated by both self-report and a clinician-rated version of 62 questions. RESULTS On average, 59% of all patients reached absolute agreement with their research clinicians. Among all questions, 73% returned with moderate positive strength of correlation, followed by 27% with low positive correlation. In 77% of the total questions, there was a tendency to rate higher in the self-report version compared with the clinician-rated version. After classifying the symptoms by six major domains, it was found that patients and clinicians showed more consistent answers in history and somatic questions (81% and 65% reached agreement), and that there were more differences in mood, energy, and anxiety questions (up to 56% in full agreement). "Outpatient", "high financial status", "poor working condition", and "high education level" were found to be significant positive predictors for patients rating higher than clinicians or patients and clinicians reaching agreement as opposed to clinicians rating higher than patients. LIMITATIONS The cross-sectional nature of our study undermines the interpretation of the results across the MDD treatment course. CONCLUSIONS It is sufficient to use the self-report version of a questionnaire to screen, monitor, and detect remission for MDD symptoms. Complete assessment of depression severity should take both clinician-rated scales and self-reported measures into consideration. Factors other than source of admission, financial status, working condition, and education level should be further investigated for the discrepancy between self-report and clinician rating.
Collapse
Affiliation(s)
- Dongbin Lyu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Zhiguo Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yun Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Qinte Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Zhenling Wu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Tongdan Cao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Huangpu District Mental Health Center, Shanghai, PR China
| | - Jie Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Huangpu District Mental Health Center, Shanghai, PR China
| | - Yonghua Cao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yingyan Hu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Jun Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yong Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Yousong Su
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Chen Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Daihui Peng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Zezhi Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Lan Cao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China.
| | - Wu Hong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai, PR China.
| | - Yiru Fang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai, PR China; Chinese Academy of Sciences (CAS) Center for Excellence in Brain Science and Intelligence Technology, Shanghai, PR China.
| |
Collapse
|
13
|
Skoglund I, Björkelund C, Svenningsson I, Petersson EL, Augustsson P, Nejati S, Ariai N, Hange D. Influence of antidepressant therapy on sick leave in primary care: ADAS, a comparative observational study. Heliyon 2019; 5:e01101. [PMID: 30627686 PMCID: PMC6321886 DOI: 10.1016/j.heliyon.2018.e01101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/30/2018] [Accepted: 12/24/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Compared to other European countries, Sweden's yearly sick leave expenditures are moderate. Common mental disorders (CMD) are important causes of sick leave, affecting 10-15% of the adult population. A Swedish register based study indicates that antidepressant therapy for patients on long-term sick leave for CMD leads to longer sick leave and higher frequency of non-time-limited sickness compensation as compared to psychotherapy, work oriented rehabilitation, and other therapies. AIM To verify if patients on antidepressant therapy and on long-term sick leave for depression, anxiety and stress-related mental disorders have a longer sick leave than patients treated with other therapies. METHOD Prospective, observational study at 28 primary health care centers in the Region Västra Götaland, Sweden, including 192 patients on sick leave for CMD. Outcome measures were gross and net sick leave days. INTERPRETATION There were no significant differences in sick leave days (gross or net) due to CMD when comparing the patients treated and not treated with antidepressants during the 12 month observation period. The groups differed at baseline only concerning frequency of exhaustion disorder, with a higher frequency of exhaustion disorder in the group without antidepressants. Analysis of other possible factors associated with shorter or longer sick leave only showed associations with the patient's own perception of possibility of returning to work in near and distant future. An important factor associated with longer sick leave was the patient's own perception of possibility of return to present workplace. As CMD are important causes of sick leave and sick leave costs, this factor should be highlighted in future research on the rehabilitation process.
Collapse
Affiliation(s)
- Ingmarie Skoglund
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- The Research and Development Department, Södra Älvsborg, Sven Eriksonsplatsen 4, 503 38 Borås, Sweden
| | - Cecilia Björkelund
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Irene Svenningsson
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Sweden
| | - Eva-Lisa Petersson
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Sweden
| | - Pia Augustsson
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Sweden
| | - Shabnam Nejati
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Sweden
| | - Nashmil Ariai
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Sweden
| | - Dominique Hange
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Sweden
| |
Collapse
|
14
|
Petersson EL, Wikberg C, Westman J, Ariai N, Nejati S, Björkelund C. Effects on work ability, job strain and quality of life of monitoring depression using a self-assessment instrument in recurrent general practitioner consultations: A randomized controlled study. Work 2018; 60:63-73. [PMID: 29733038 PMCID: PMC6027947 DOI: 10.3233/wor-182717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND: Depression reduces individuals’ function and work ability and is associated with both frequent and long-term sickness absence. OBJECTIVE: Investigate if monitoring of depression course using a self-assessment instrument in recurrent general practitioner (GP) consultations leads to improved work ability, decreased job strain, and quality of life among primary care patients. METHODS: Primary care patients n = 183, who worked. In addition to regular treatment (control group), intervention patients received evaluation and monitoring and used the MADRS-S depression scale during GP visit at baseline and at visits 4, 8, and 12 weeks. Work ability, quality of life and job strain were outcome measures. RESULTS: Depression symptoms decreased in all patients. Significantly steeper increase of WAI at 3 months in the intervention group. Social support was perceived high in a significantly higher frequency in intervention group compared to control group. CONCLUSIONS: Monitoring of depression course using a self-assessment instrument in recurrent GP consultations seems to lead to improved self-assessed work ability and increased high social support, but not to reduced job strain or increased quality of life compared to TAU. Future studies concerning rehabilitative efforts that seek to influence work ability probably also should include more active interventions at the workplace.
Collapse
Affiliation(s)
- E-L Petersson
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden
| | - C Wikberg
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - J Westman
- Department of Neurobiology, Division for Family Medicine, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - N Ariai
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - S Nejati
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - C Björkelund
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| |
Collapse
|