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Gellert P, Lech S, Hoppmann F, O'Sullivan JL, Kessler EM. Effectiveness of Psychotherapy for Community-Dwelling Vulnerable Older Adults with Depression and Care Needs: Findings from the PSY-CARE Trial. Clin Gerontol 2024:1-15. [PMID: 38773916 DOI: 10.1080/07317115.2024.2353702] [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] [Indexed: 05/24/2024]
Abstract
BACKGROUND For older adults with care needs, evidence for the effectiveness of psychotherapy on depression is scarce. METHODS In PSY-CARE, a pragmatic randomized controlled trial, N = 197 home-living older adults with depression and care needs were randomized into outpatient psychotherapy or an active control condition. Residential psychotherapists offered age-sensitive cognitive-behavioral psychotherapy (at-home if needed). Control group participants received telephone counseling and a self-help guide. Outcomes were assessed at baseline (T1), after (T2), 3 months after (T3), and 12 months after the intervention (T4). RESULTS There was a significant decrease in depressive symptoms across both arms with Cohen's d T4-T1 = .52 in the psychotherapy and .55 in the control group. Mixed models revealed no statistically significant difference in primary and secondary outcomes between interventions. Posthoc, we found control group participants with greater ADL limitations experienced significantly increased depressive symptoms compared to those reporting lower limitations. CONCLUSIONS Interventions were successful in reducing depressive symptoms, even though treatment fidelity was decreased due to the COVID-19 pandemic. We could not demonstrate superior effectiveness of psychotherapy for older adults with care needs. CLINICAL IMPLICATIONS Findings suggest that psychotherapy may be an important and superior treatment to circumvent aggravation of depression in older patients with high functional limitations. TRIAL REGISTRATION The trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN55646265, February 15, 2019).
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Affiliation(s)
- Paul Gellert
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Mental Health (DZPG), partner site Berlin/Potsdam, Berlin, Germany
| | - Sonia Lech
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felicia Hoppmann
- Department of Psychology MSB Medical School Berlin, Berlin, Germany
| | - Julie Lorraine O'Sullivan
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Mental Health (DZPG), partner site Berlin/Potsdam, Berlin, Germany
| | - Eva-Marie Kessler
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Moreno X, Moreno F. Attitudes towards seeking psychological help among community dwelling older adults enrolled in primary care in Chile. BMC Geriatr 2024; 24:386. [PMID: 38693485 PMCID: PMC11064339 DOI: 10.1186/s12877-024-04986-3] [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: 01/06/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Depression and anxiety are common mental disorders among older adults, but they are frequently underdiagnosed. Attitudes towards seeking professional mental health care is one of the barriers to access to treatment. This study was aimed at assessing the attitudes towards seeking psychological help among older adults who are enrolled in primary care in Chile, and to determine the associated factors. METHODS This cross-sectional study recruited 233 primary care users aged 65 or more years. The Attitudes Towards Seeking Professional Psychological Help was used. Reliability and factor analysis of this scale were carried out. The average scores of the scale and factors were calculated and compared, by selected variables. Multivariate linear regression was estimated to determine factors associated with attitudes towards seeking psychological help. RESULTS Three factors were identified in the attitudes towards seeking psychological help: confidence in psychologists, coping alone with emotional problems, and predisposition to seek psychological help. On average, participants had a favorable attitude towards seeking psychological help, compared with previous research. Lower level of education, and risk of social isolation were inversely associated with these attitudes. CONCLUSION Strategies to improve mental health literacy and social connection among older adults, could have an impact on factors that mediate the access to mental health care, such as attitudes towards seeking psychological help, among people who have a lower level of education or are at risk of social isolation.
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Affiliation(s)
- Ximena Moreno
- Facultad de Psicología y Humanidades, Universidad San Sebastián, Lota 2465 Providencia, Santiago, Chile.
| | - Francisco Moreno
- Department of Mathematics and Computer Science, University of Santiago, Las Sophoras 175, Oficina 420, Estación Central, Santiago, Chile
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Peters M, Becker T, Jeschke K. [Clinical Judgement and Relational Competence in the Psychotherapy of Older Patients]. Psychother Psychosom Med Psychol 2024; 74:103-111. [PMID: 38552616 DOI: 10.1055/a-2250-5405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The negative attitude of psychotherapists towards the treatment of older patients in the past has weakened in the recent past. Nevertheless, the question remains as to how therapists perceive older patients in comparison to younger patients, what clinical judgements they arrive at and how they perceive the relationship with them. In the present study, which was conducted as part of the ÄPP study (Older Patients in Psychotherapy), therapists were asked to assess a self-selected younger (<40 years) or an older patient (>65) with regard to various variables. A total of 527 completed questionnaires were available. Two-factor analyses of variance were used to show, among other things, that younger therapists (compared to their older colleagues) rate older patients more negatively in terms of suitability for psychotherapy, the patient's ability to establish a therapeutic working relationship and other parameters. In comparison with their older colleagues, younger therapists perceive themselves as less competent in their relationships with older patients. There are only slight differences with younger patients.
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Affiliation(s)
- Meinolf Peters
- FB Erziehungswissenschaften, Institut für Alterspsychotherapie und Angewandte Gerontologie, Universität Marburg
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McLaren T, Peter LJ, Tomczyk S, Muehlan H, Schomerus G, Schmidt S. The differential influence of self-construal on the effect of self-efficacy on the help-seeking process: A quasi-experimental online study among people with untreated depressive symptoms. Acta Psychol (Amst) 2024; 242:104119. [PMID: 38157750 DOI: 10.1016/j.actpsy.2023.104119] [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: 07/27/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Despite available professional healthcare, people often delay or avoid help-seeking. Understanding the underlying reasons is crucial and research has explored the role of self-efficacy in this context. Additionally, studies have highlighted the significance of culturally influenced self-construals in individuals' health behaviour. There seems to be a relationship between self-efficacy and self-construal. The aim of the study is to explore the influence of self-efficacy on help-seeking, considering self-construal as a moderator. Differential experiences of self-efficacy and varying associations among help-seeking variables based on self-construal are posited. METHODS A quasi-experimental online study is conducted with a baseline assessment, including self-efficacy interventions, and follow-ups at three and six months. Self-construal groups are compared, i.e., independent vs. interdependent individuals. A series of multi-group path analyses are conducted to examine potential variations in the interventional effects and among the help-seeking variables respective of help-seeking instance, i.e. professional mental health care or informal care. Self-construal functions as the global moderator. RESULTS The study included N = 1'368 participants, 65.6 % identifying as female and an average age of 42.38 (SD = 15.22). More independent compared to more interdependent individuals were older, more frequently identified as male, had higher socioeconomic status, fewer depressive symptoms, and greater self-efficacy. Multi-group path analyses for professional mental health care (CFI = 0.992, RMSEA = 0.018, SRMR = 0.004) and informal help (CFI = 0.999, RMSEA = 0.004, SRMR = 0.006) demonstrated excellent model fits. The analysis for informal help was interpretable, as the unconstrained model had a significantly better fit than the constrained model. There were varying associations among help-seeking variables based on self-construals. The intervention effect was differential, with independent participants benefiting significantly (β = 0.203), while the effect was non-significant for interdependent participants. DISCUSSION The study's findings, strengths, and limitations are discussed in relation to current research. Results indicate differential experiences of self-efficacy interventions based on individuals' self-construal. Moreover, varying associations among help-seeking variables suggest self-construal-based differences in their interrelationships. These findings highlight the importance of considering self-construal in health related research.
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Affiliation(s)
- Thomas McLaren
- Department of Health and Prevention, Institute of Psychology, University of Greifswald, Germany.
| | - Lina-Jolien Peter
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Leipzig, Leipzig, Germany
| | - Samuel Tomczyk
- Department of Health and Prevention, Institute of Psychology, University of Greifswald, Germany
| | - Holger Muehlan
- Department of Health and Prevention, Institute of Psychology, University of Greifswald, Germany
| | - Georg Schomerus
- Department of Psychiatry and Psychotherapy, Medical Faculty, University Leipzig, Leipzig, Germany
| | - Silke Schmidt
- Department of Health and Prevention, Institute of Psychology, University of Greifswald, Germany
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Spahlholz J, Baumann E, Müller-Hilmer R, Hilmer R, Sander C, Schindler S, Speerforck S, Angermeyer MC, Schomerus G. Do values and political attitudes affect help-seeking? Exploring reported help-seeking for mental health problems in a general population sample using a milieu framework. Epidemiol Psychiatr Sci 2023; 32:e49. [PMID: 37539697 PMCID: PMC10465317 DOI: 10.1017/s2045796023000641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 07/03/2023] [Accepted: 07/13/2023] [Indexed: 08/05/2023] Open
Abstract
AIMS Help-seeking for mental health problems is facilitated and hindered by several factors at the individual, interpersonal and community level. The most frequently researched factors contributing to differences in help-seeking behaviour are based on classical socio-demographic variables, such as age, gender and education, but explanations for the observed differences are often absent or remain vague. The present study complements traditional approaches in help-seeking research by introducing a milieu approach, focusing on values and political attitudes as a possible explanation for differences in help-seeking for emotional mental health problems. METHODS A representative cross-sectional survey of N = 3,042 respondents in Germany was conducted through face-to-face interviews about past help-seeking for mental health problems, socio-demographic characteristics and values and political attitudes. RESULTS Multivariate logistic regression analyses indicated that belonging to a cosmopolitan intellectual milieu group was significantly associated with an increased likelihood of past help-seeking for mental health issues (psychotherapeutic/psychological help-seeking [OR = 2.09, 95% CI: 1.11-3.93, p < 0.05) and primary care (OR = 2.21, 95% CI: 1.15-4.24, p < 0.05]), whereas members of individualist and conservative milieu groups were less likely to report having sought help from a psychotherapist, but not from a general practitioner. Increased odds ratios were also found for a number of socio-demographic variables, such as being aged 26 years and over, a female gender and more than 12 years of formal education. Associations between socio-demographic variables remained significant, and the explained variance of the used models improved considerably when milieu variables were added. CONCLUSIONS We discuss how milieu-specific patterns were relevant for explaining differences in mental health service use in addition to socio-demographic factors. It seems promising to consider help-seeking from a milieu perspective to improve disparities in access to and the use of psychotherapy as well as to resource allocation.
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Affiliation(s)
- J. Spahlholz
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - E. Baumann
- Department of Journalism and Communication Research, Hanover University of Music, Drama, and Media, Hannover, Germany
| | - R. Müller-Hilmer
- pmg – Policy Matters, Political Research and Consulting mbH, Berlin, Germany
| | - R. Hilmer
- pmg – Policy Matters, Political Research and Consulting mbH, Berlin, Germany
| | - C. Sander
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - S. Schindler
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - S. Speerforck
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | | | - G. Schomerus
- Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
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Pinilla S, Lerch S, Nendaz M, Huwendiek S, Klöppel S. [Graduate medical education in old age psychiatry: a scoping literature review]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023. [PMID: 37327816 DOI: 10.1055/a-2053-8274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Gerontopsychiatry will become increasingly relevant as a discipline for primary care based on current demographic forecasts, destigmatization of mental illness and specific diagnostic and therapeutic developments. Hence, high quality graduate medical training in old age psychiatry is needed. Objectives The goal of this review was to summarize the literature on medical education relevant to residency training in old age psychiatry and to contrast the findings with international developments in competency-based medical education. MATERIALS AND METHODS The authors used the scoping review method of Arksey and O'Malley. RESULTS The initial search yielded 913 hits. After full text screening, 20 original articles were used for data extraction. The study content was summarized under three categories: trainee recruitment, length and structure of graduate training curricula in old age psychiatry, and learning goals and competencies in old age psychiatry training. Surveys and expert consensus were mostly used as study methods. High-quality clinical training experience with gerontopsychiatric patients and supervision of residents was an important factor for stimulating interest in old age psychiatry. Few studies provided evidence for educational benefit of digital learning and teaching formats and simulation training in old age psychiatry. Overall, there were no studies in old age psychiatry with explicit reference to concepts of competency-based graduate medical education. CONCLUSIONS Clinical rotations and mentoring foster interest of clinical residents in the discipline of old age psychiatry. Systematically introducing clinical rotations in old age psychiatry in general psychiatry residency programs seems necessary to enable residents to gain relevant knowledge and skills. Educational research in old age psychiatry considering patient outcomes seems to be a meaningful next step.
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Affiliation(s)
- Severin Pinilla
- Universitätsklinik für Alterspsychiatrie und Psychotherapie, Universität Bern, Bern, Switzerland
- Abteilung für Assessment und Evaluation, Institut für Medizinische Lehre (IML), Universität Bern, Bern, Switzerland
| | - Seraina Lerch
- Universitätsklinik für Alterspsychiatrie und Psychotherapie, Universität Bern, Bern, Switzerland
- Abteilung für Assessment und Evaluation, Institut für Medizinische Lehre (IML), Universität Bern, Bern, Switzerland
- Institut für Medizinische Psychologie Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Mathieu Nendaz
- Universitätsspital Genf (HUG), Universität Genf , Genf, Switzerland
| | - Sören Huwendiek
- Abteilung für Assessment und Evaluation, Institut für Medizinische Lehre (IML), Universität Bern, Bern, Switzerland
| | - Stefan Klöppel
- Universitätsklinik für Alterspsychiatrie und Psychotherapie, Universität Bern, Bern, Switzerland
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Husky MM, Léon C, du Roscoät E, Vasiliadis HM. Factors associated with past-year medication use and psychotherapy in adults with suicidal ideation in France. Int J Soc Psychiatry 2023:207640221148320. [PMID: 36629370 DOI: 10.1177/00207640221148320] [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] [Indexed: 01/12/2023]
Abstract
BACKGROUND The objective of the study is to assess the sociodemographic and clinical factors associated with past-year medication use and/or psychotherapy among adults with suicidal ideation in the past 12 months. METHODS Data were drawn from the 2017 Health Barometer survey, a large computer-assisted telephone survey on a representative sample of the general population aged 18 to 75 years living in metropolitan France (n = 25,319). Logistic and multinomial regression analyses were used to study past-year medication use and/or psychotherapy as a function of sociodemographic and clinical factors. Analyses were restricted to individuals reporting suicidal ideation in the past year (n = 1,148). RESULTS Overall, 43.6% of adults with suicidal ideation reported no treatment for a mental health reason in the past year; 36.6% reported using medication only, 4.8% psychotherapy only, and 15.0% both. Sociodemographic and clinical factors associated with increased probability of treatment varied as a function of the type of treatment received. Adjusting for key factors including clinical factors, older adults with suicidal ideation were more likely than younger adults to receive medication only. CONCLUSIONS The findings point to differential inequalities in access to medication and psychotherapy among adults with suicidal ideation in the general population of France.
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Affiliation(s)
- Mathilde M Husky
- Laboratoire de psychologie EA4139, Université de Bordeaux, France
| | | | - Enguerrand du Roscoät
- Laboratoire Parisien de Psychologie Sociale (LAPPS), EA 4386, Université Paris Nanterre, France
| | - Helen-Maria Vasiliadis
- Centre de recherche Charles-Le Moyne, Campus de Longueuil Université de Sherbrooke, Canada.,Département des sciences de la santé communautaire, Université de Sherbrooke, Canada
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Takase A, Matoba Y, Taga T, Ito K, Okamura T. Middle-aged and older people with urgent, unaware, and unmet mental health care needs: Practitioners' viewpoints from outside the formal mental health care system. BMC Health Serv Res 2022; 22:1400. [PMID: 36419047 PMCID: PMC9685835 DOI: 10.1186/s12913-022-08838-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Mental health challenges are highly significant among older individuals. However, the non-utilization of mental health services increases with age. Although universal health coverage (UHC) was reported to reduce unmet health care needs, it might not be sufficient to reduce unmet mental health care needs from a clinical perspective. Despite the existence of UHC in Japan, this study aimed to explore the factors related to the non-utilization of formal mental health care systems among middle-aged and older people with urgent, unaware, and unmet mental health care needs. METHODS Purposeful sampling was used as the sampling method in this study by combining snowball sampling and a specific criterion. The interviewees were nine practitioners from four sectors outside the mental health care system, including long-term care, the public and private sector, as well as general hospitals in one area of Tokyo, where we had conducted community-based participatory research for five years. The interviews were conducted by an interdisciplinary team, which comprised a psychiatrist, a public health nurse from a non-profit organization, and a Buddhist priest as well as a social researcher to cover the broader unmet health care needs, such as physical, psychosocial, and spiritual needs. The basic characteristics of the interviewees were enquired, followed by whether the interviewees had case of middle-aged or older individuals with urgent, unaware, and unmet mental health care needs. If the answer was yes, we asked the interviewees to describe the details. The interviews pertinent to this study were conducted between October 2021 and November 2021. In this study, we adopted a qualitative descriptive approach. First, we created a summary of each case. Next, we explored the factors related to the non-utilization of formal mental health care systems by conducting a thematic analysis to identify the themes in the data collected. RESULTS The over-arching category involving "the factors related to an individual person" included two categories, as follows: 1) "Individual intrinsic factors," which comprised two sub-categories, including "difficulty in seeking help" and "delusional disorders," and 2) "family factors," which comprised "discord between family members," "denial of service engagement," "multiple cases in one family," and "families' difficulty in seeking help." The over-arching category "the factors related to the systems" included four categories, as follows: 1) "Physical health system-related factors," which comprised "the indifference of physical healthcare providers regarding mental health" and "the discontinuation of physical health conditions," 2) "mental health system-related factors," which comprised "irresponsive mental health care systems" and "uncomfortable experiences in previous visits to clinics," and 3) "social service system-related factors," which comprised "the lack of time to provide care," "social service not allowed without diagnosis," and "no appropriate service in the community," as well as 4) " the lack of integration between the systems." Apart from the aforementioned factors, "the community people-related factor" and "factors related to inter-regional movements" also emerged in this study. CONCLUSIONS The results of this study suggest a specific intervention target, and they provide further directions for research and policy implementation. The suggested solutions to the issues pertinent to this study are as follows: the recognition of the ways in which older people may inadequately understand their health or be unaware of available services, the building of a therapeutic alliance for "the individual intrinsic factors." Regarding the "family factors," the solutions include the provision of particularly intensive care for families with family discords, families with multiple cases, and families who find it difficult to seek help, as well as making intensive efforts for ensuring early involvement after contact with health care services. Regarding the "the factors related to the systems," the solutions include the implementation of mental health education campaigns aimed at enhancing mental health knowledge among non-mental health professionals, as well as formulating and implementing reforms ensuring that such professionals are increasingly responsible especially with regard to emergency inpatient care. It also include listening without ageism in clinical practice, the expansion of social services regarding human resources and the flexibility of use which increases the breadth of the types of care, as well as facilitating the integration between the associated health care systems. Further suggestions include encouraging community residents to join social security systems as well as the provision of particularly intensive care for people who have just moved in.
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Affiliation(s)
- Akinori Takase
- grid.442973.f0000 0001 1464 9781Department of Public Policy, Faculty of Socio-Symbiosis, Taisho University, Toshima, Tokyo, Japan
| | | | - Tsutomu Taga
- grid.420122.70000 0000 9337 2516Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Itabashi, Tokyo, Japan
| | - Kae Ito
- grid.420122.70000 0000 9337 2516Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology, Itabashi, Tokyo, Japan
| | - Tsuyoshi Okamura
- grid.420122.70000 0000 9337 2516Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Itabashi, Tokyo, Japan
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Lech S, Herrmann W, Trautmann S, Schwantes U, Gellert P, Behr J, Buspavanich P. Depression in primary care and the role of evidence-based guidelines: cross-sectional data from primary care physicians in Germany. BMC Health Serv Res 2022; 22:1279. [PMID: 36280876 PMCID: PMC9594952 DOI: 10.1186/s12913-022-08631-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/30/2022] [Indexed: 11/14/2022] Open
Abstract
Background Depression is the most common mental health burden worldwide. Primary care physicians (PCPs) play a key role in the care provision for people with depression. The first objective of the present study was to examine the health care situation of depression in primary care, focusing on the cooperation between PCPs and mental health specialists. Secondly, we aimed at examining the role of the German S3 Guideline for Unipolar Depression in the primary care provision. Methods Data of N = 75 PCPs were analysed from a cross-sectional online survey. Analysis of descriptive information on the current status of primary health care and depression was conducted. Further, to examine factors that are related to the usage of guidelines, multiple regression was performed. Results Only 22.1% of PCPs described the quality of cooperation with ambulatory mental health specialist as good. The most frequent problems in the cooperation were of structural nature (49.3%, long waiting list, few therapy units, as well as barriers in the communication and the information exchange). With regard to the role of the guideline, 65% of PCPs reported never or seldom using the guideline and 31.7% of PCPs perceived the guideline as not useful at all. In addition, perceived usefulness of the S3 guideline was positively associated with the usage of the guideline. Results of the logistic regression revealed a significant association between the usage of the German S3 Guideline for Unipolar Depression and rating of perceived usefulness of the guideline (OR: 4.771; 95% CI: 2.15–10.59; p < 0.001). Conclusion This study highlights the central role of PCPs and demonstrates major barriers in the outpatient health care provision of depression. Present findings suggest a strong need for collaborative health care models to resolve obstacles resulting from fragmented mental health care systems. Finally, reported perceived barriers in the implementation of the German S3 Guideline for Unipolar Depression indicate the urge to involve PCPs in the development of evidence-based guidelines, in order to ensure a successful implementation and usage of guidelines in clinical practice.
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Affiliation(s)
- Sonia Lech
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany ,grid.473452.3Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany ,grid.6363.00000 0001 2218 4662Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Wolfram Herrmann
- grid.6363.00000 0001 2218 4662Institute of General Practice, Charité – Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Trautmann
- grid.461732.5ICPP Institute of Clinical Psychology and Psychotherapy, Medical School Hamburg, Hamburg, Germany ,grid.461732.5Department of Psychology, Faculty of Human Sciences, Medical School Hamburg, Hamburg, Germany
| | - Ulrich Schwantes
- grid.473452.3Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Paul Gellert
- grid.6363.00000 0001 2218 4662Institute for Medical Sociology and Rehabilitation Science, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Joachim Behr
- grid.473452.3Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany ,Faculty of Health Sciences Brandenburg, Joint Faculty of the University of Potsdam, Brandenburg University of Technology Cottbus-Senftenberg and Brandenburg Medical School, Potsdam, Germany ,grid.6363.00000 0001 2218 4662Research Department of Experimental and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Pichit Buspavanich
- grid.473452.3Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany ,Faculty of Health Sciences Brandenburg, Joint Faculty of the University of Potsdam, Brandenburg University of Technology Cottbus-Senftenberg and Brandenburg Medical School, Potsdam, Germany ,grid.6363.00000 0001 2218 4662Department of Psychiatry and Psychotherapy, Gender Research in Medicine & Institute of Sexology and Sexual Medicine, Charité – Universitätsmedizin Berlin, Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Leppänen H, Kampman O, Autio R, Karolaakso T, Näppilä T, Rissanen P, Pirkola S. Socioeconomic factors and use of psychotherapy in common mental disorders predisposing to disability pension. BMC Health Serv Res 2022; 22:983. [PMID: 35915437 PMCID: PMC9344663 DOI: 10.1186/s12913-022-08389-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Research in high-income countries has identified low socioeconomic status as a risk factor for disability pension (DP) due to common mental disorders (CMDs). Psychotherapy is an evidence-based treatment for the majority of CMDs along with medication and it is often targeted to prevent work disability. This study examines socioeconomic differences in the use of rehabilitative psychotherapy in Finland, where citizens have universal health coverage, but psychotherapy is partly dependent on personal finance. Methods The study subjects (N = 22,501) were all the Finnish citizens granted a DP due to CMD between 2010 and 2015 and a comparison group (N = 57,732) matched based on age, gender, and hospital district. Socioeconomic differences in psychotherapy use were studied using logistic regression models. Socioeconomic status was defined by education, income, and occupation. Age, gender, and family status were also examined. Results A lower level of education, lower occupational status (blue-collar worker), male gender, and older age, were associated with less frequent psychotherapy use, in both groups. Education was the strongest component of socioeconomic status associated with psychotherapy use, but the role of income was not straightforward. Unemployment when approaching DP, but not otherwise, was a risk factor for not receiving rehabilitative psychotherapy. Socioeconomic disparities were not any smaller among CMD patients approaching DP than in the comparison group. Conclusion This study demonstrates the disparity in the provision of psychotherapy for CMD patients, even on the verge of DP with an acute need for services. This disparity is partly related to a complex interplay of socioeconomic factors and the service system characteristics. Factors predisposing to unequal access to mental health services are presumably diverse and should be studied further. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08389-1.
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Affiliation(s)
- Helena Leppänen
- Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland. .,Pirkkala Municipal Health Centre, Pirkkala, Finland.
| | - Olli Kampman
- Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland.,Department of Psychiatry, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland
| | - Reija Autio
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
| | - Tino Karolaakso
- Faculty of Social Sciences (Psychology), Tampere University, Tampere, Finland
| | - Turkka Näppilä
- Tampere University Library, Tampere University, Tampere, Finland
| | - Päivi Rissanen
- Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
| | - Sami Pirkola
- Department of Psychiatry, Tampere University Hospital, Pirkanmaa Hospital District, Tampere, Finland.,Faculty of Social Sciences (Unit of Health Sciences), Tampere University, Tampere, Finland
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11
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Lenouvel E, Lornsen F, Schüpbach B, Mattson J, Klöppel S, Pinilla S. Evidence-oriented teaching of geriatric psychiatry: a narrative literature synthesis and pilot evaluation of a clerkship seminar. GMS JOURNAL FOR MEDICAL EDUCATION 2022; 39:Doc20. [PMID: 35692363 PMCID: PMC9174071 DOI: 10.3205/zma001541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/22/2021] [Accepted: 02/09/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The field of geriatric psychiatry has in recent decades developed into an independent discipline, incorporating elements of psychiatry, neurology and internal medicine. In view of demographic changes, this field is becoming increasingly relevant for primary care and undergraduate medical training. So far, however, there is little educational guidance for instructional design of geriatric psychiatry in undergraduate medical education. PROJECT DESCRIPTION A narrative literature review of medical education studies in the field of geriatric psychiatry was conducted. Student evaluations of a geriatric psychiatry clerkship seminar were analyzed, followed by a target group analysis. Results informed the iterative development of new clerkship seminar content and structure. This was implemented and evaluated over several academic cycles. Learning material was made available via the open-source learning management system "ILIAS". RESULTS A total of 29 medical education articles were identified and evaluated. The previous seminar in geriatric psychiatry at our university hospital was rated below average (Likert item overall rating of 4.3/6 compared to other seminars with an average overall rating of 5.2, p<0.001). An evidence-oriented revision of the content and instructional design was implemented. Activation of learners, self-reference effect, and audience questioning were used during the lecture. Additionally, two geriatric psychiatry case scenarios were adapted for discussion. We saw continuous improvement of student evaluations of the revised course, reaching a rating improvement of 5.3 out of 6 (p<0.01, U=135.5 Cohen's d=1.28). CONCLUSION A systematic approach was used to develop a geriatric psychiatry clerkship seminar, based on medical education evidence, for undergraduate medical students, resulting in better student evaluations. The teaching materials can be adapted for local implementation at other teaching hospitals. Future studies should also explore effects regarding higher learning outcomes.
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Affiliation(s)
- Eric Lenouvel
- University of Bern, University Hospital of Old Age Psychiatry and Psychotherapy, Bern, Switzerland
| | - Finn Lornsen
- University of Bern, University Hospital of Old Age Psychiatry and Psychotherapy, Bern, Switzerland
| | - Brigitte Schüpbach
- University of Bern, University Hospital of Old Age Psychiatry and Psychotherapy, Bern, Switzerland
| | - Janet Mattson
- Karolinska Institute, LIME, Department of Learning, Informatics, Management and Ethics, Solna, Sweden
| | - Stefan Klöppel
- University of Bern, University Hospital of Old Age Psychiatry and Psychotherapy, Bern, Switzerland
| | - Severin Pinilla
- University of Bern, University Hospital of Old Age Psychiatry and Psychotherapy, Bern, Switzerland
- University of Bern, Institute for Medical Education, Department for Assessment and Evaluation, Bern, Switzerland
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12
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Peurois M, Chopin M, Texier-Legendre G, Angoulvant C, Bellanger W, Bègue C, Ramond-Roquin A. To which non-physician health professionals do French general practitioners refer their patients to and what factors are associated with these referrals? Secondary analysis of the French national cross-sectional ECOGEN study. BMC Health Serv Res 2022; 22:25. [PMID: 34983505 PMCID: PMC8729109 DOI: 10.1186/s12913-021-07285-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Multiprofessional practice is a key component in primary care. Examining general practitioner (GP) referral frequency to non-physician health professionals (NPHP) can provide information about how primary care is organised and works which is useful for policymakers. Our study aimed to describe French GP referral frequency to various NPHPs in France and identify associated factors. Methods This is an ancillary study to the observational, cross-sectional (ECOGEN) study conducted in 2011/2012 in France among 128 GPs. Data about consultations using the standardised International Classification of Primary Care (ICPC-2), and patient and GP characteristics were collected from 20,613 GP consultations. Referrals were identified through inductive and deductive approaches using ICPC-2 codes, keywords, and deep, open manual searches. Referral frequency was described overall and per NPHP. Patient, GP, and consultation-related factors associated with referral rates were described for the three most frequently identified NPHPs. To minimise potential sources of bias, this observational study followed the STROBE guidelines. Results French GPs referred 6.8% of patients to NPHPs, with physiotherapists, podiatrists, and nurses accounting for 85.2% of referrals. Older patients, retired patients, multiple health problems managed, and longer consultation durations were found to be associated with higher referral rates (p < 0.001). Specific trends were observed for nurse, physiotherapist, and podiatrist referrals. Women (p < 0.001) and regular patients (p = 0.002) were more likely to receive physiotherapy referrals while people with no professional activity were less likely (p < 0.001). Female GPs and those working in urban practices were more likely to issue a physiotherapy referral (p < 0.001), while GPs working in rural practices (p < 0.001) and those with higher annual consultation numbers (p = 0.002) were more likely to refer to a nurse. Working in multiprofessional centres appeared to have little impact on referral rates, being only slightly associated with podiatrist referrals (p = 0.003). Conclusions Referral frequency is more associated with patient characteristics and clinical situations than GP-related factors suggesting patients needing referral most are most often referred. Furthermore, the three NPHPs that GPs refer to the most are those for which a referral is required for reimbursement in France, suggesting that health system legislation and NPHP reimbursement are strong determinants for referrals.
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Affiliation(s)
- Matthieu Peurois
- Département de médecine générale, Univ Angers, F-49000, Angers, France
| | - Matthieu Chopin
- Département de médecine générale, Univ Angers, F-49000, Angers, France
| | | | - Cécile Angoulvant
- Département de médecine générale, Univ Angers, F-49000, Angers, France
| | - William Bellanger
- Département de médecine générale, Univ Angers, F-49000, Angers, France
| | - Cyril Bègue
- Département de médecine générale, Univ Angers, F-49000, Angers, France.,Univ Angers, Univ Rennes, EHESP, Inserm, IRSET-ESTER, SFR ICAT, F-49000, Angers, France
| | - Aline Ramond-Roquin
- Département de médecine générale, Univ Angers, F-49000, Angers, France. .,Univ Angers, Univ Rennes, EHESP, Inserm, IRSET-ESTER, SFR ICAT, F-49000, Angers, France. .,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Québec, Canada.
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