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Garr K, Odar Stough C, Godfrey LM, Ley SL. Weight change predicts college adjustment and depressive symptoms among first-year college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1651-1657. [PMID: 34379558 DOI: 10.1080/07448481.2021.1950729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 05/08/2021] [Accepted: 06/25/2021] [Indexed: 06/13/2023]
Abstract
ObjectiveWeight change is common during the first year of college and may be related to different outcomes for men and women. This study examined the moderating effects of gender on the association between weight change and college adjustment and depressive symptoms. Participants: One-hundred and eighty-one 18-19-year-old college freshmen (56.9% female; 84.5% Caucasian). Methods: Students completed a one-time survey about demographics, weight, college adjustment, and depressive symptoms during their second semester of college. Results: Increased weight change was associated with fewer depressive symptoms for both men and women (p < .04). For men, increased weight change was associated with better overall college adjustment, more positivity about college, less negativity about college, and less homesickness (all p < .02). Conclusions: Universities could target men and women differently in regard to weight, college adjustment, and mental health to promote a positive college experience and optimal mental health.
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Affiliation(s)
- Katlyn Garr
- Department of Psychology, University of Cincinnati, Arts & Sciences, Psychology, Cincinnati, Ohio, USA
| | - Cathleen Odar Stough
- Department of Psychology, University of Cincinnati, Arts & Sciences, Psychology, Cincinnati, Ohio, USA
| | - Lisa M Godfrey
- Department of Psychology, University of Cincinnati, Arts & Sciences, Psychology, Cincinnati, Ohio, USA
| | - Sanita L Ley
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Landes SJ, Jaffe AE, McBain SA, Feinstein BA, Rhew IC, Kaysen DL. Prospective Predictors of Work Limitations in Young Adult Lesbian and Bisexual Women: An Examination of Minority Stress, Trauma Exposure, and Mental Health. STIGMA AND HEALTH 2023; 8:232-242. [PMID: 38516361 PMCID: PMC10956643 DOI: 10.1037/sah0000292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Trauma exposure and mental health problems adversely affect work functioning. Sexual minority women are at increased risk for trauma exposure, depression, and PTSD. Sexual minority women also experience unique stressors related to their sexual orientation, which can directly impact work functioning. However, little research to date has examined the impact of trauma exposure and mental health problems among sexual minority women on their occupational outcomes. The goal of the current study was to examine whether trauma exposure, mental health problems, and minority stressors were associated with occupational functioning one year later in a large sample of young adult lesbian and bisexual women. The study utilized a subset of data (N = 304) from a larger longitudinal study on health risk behaviors among young adult lesbian and bisexual women. Results indicated that trauma exposure, posttraumatic stress, depression, and perceived heterosexism were each associated with subsequent work limitations, but after accounting for shared variance between predictors, only perceived heterosexism and depression were uniquely associated with subsequent work functioning. These findings highlight the roles of mental health and sexual orientation-related stress in the challenges that lesbian and bisexual women experience at work and point to a need for additional research to better understand risk and protective factors related to negative employment outcomes among lesbian and bisexual women.
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Affiliation(s)
- Sara J. Landes
- Department of Psychiatry, University of Arkansas for Medical Sciences
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System
- South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System
| | - Anna E. Jaffe
- Department of Psychiatry and Behavioral Sciences, University of Washington
- Department of Psychology, University of Nebrask-Lincoln
| | - Sacha A. McBain
- Department of Psychiatry, University of Arkansas for Medical Sciences
- South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System
| | - Brian A. Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science
| | - Isaac C. Rhew
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Debra L. Kaysen
- Department of Psychiatry and Behavioral Sciences, University of Washington
- Department of Psychiatry and Behavioral Sciences, Stanford University
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Keefe JR, Rodriguez-Seijas C, Jackson SD, Bränström R, Harkness A, Safren SA, Hatzenbuehler ML, Pachankis JE. Moderators of LGBQ-affirmative cognitive behavioral therapy: ESTEEM is especially effective among Black and Latino sexual minority men. J Consult Clin Psychol 2023; 91:150-164. [PMID: 36780265 PMCID: PMC10276576 DOI: 10.1037/ccp0000799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
OBJECTIVE Lesbian, gay, bisexual, and queer (LGBQ)-affirmative cognitive behavioral therapy (CBT) focused on minority stress processes can address gay and bisexual men's transdiagnostic mental and behavioral health concerns. Identifying moderators of treatment outcomes may inform the mechanisms of LGBQ-affirmative CBT and subpopulations who may derive particular benefit. METHOD Data were from a clinical trial in which gay and bisexual men with mental and behavioral health concerns were randomized to receive Effective Skills to Empower Effective Men (ESTEEM; an LGBQ-affirmative transdiagnostic CBT; n = 100) or one of two control conditions (n = 154): LGBQ-affirmative community mental health treatment (CMHT) or HIV counseling and testing (HCT). The preregistered outcome was a comorbidity index of depression, anxiety, alcohol/drug problems, and human immunodeficiency virus (HIV) transmission risk behavior at 8-month follow-up (i.e., 4 months postintervention). A two-step exploratory machine learning process was employed for 20 theoretically informed baseline variables identified by study therapists as potential moderators of ESTEEM efficacy. Potential moderators included demographic factors, pretreatment comorbidities, clinical facilitators, and minority stress factors. RESULTS Racial/ethnic minority identification, namely as Black or Latino, was the only statistically significant moderator of treatment efficacy (B = -3.23, 95% CI [-5.03, -1.64]), t(197) = -3.88, p < .001. Racially/ethnically minoritized recipients (d = -0.71, p < .001), but not White/non-Latino recipients (d = 0.22, p = .391), had greater reductions in comorbidity index scores in ESTEEM compared to the control conditions. This moderation was driven by improvements in anxiety and alcohol/drug use problems. DISCUSSION Black and Latino gay and bisexual men experiencing comorbid mental and behavioral health risks might particularly benefit from a minority stress-focused LGBQ-affirmative CBT. Future research should identify mechanisms for this moderation to inform targeted treatment delivery and dissemination. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- John R. Keefe
- Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, New York, USA
| | | | - Skyler D. Jackson
- Yale School of Public Health, Department of Social and Behavioral Sciences, New Haven, Connecticut, USA
| | - Richard Bränström
- Karolinska Instituet, Department of Clinical Neuroscience, Stockholm, Sweden
| | - Audrey Harkness
- University of Miami, Department of Psychology, Miami, FL, USA
| | | | | | - John E. Pachankis
- Yale School of Public Health, Department of Social and Behavioral Sciences, New Haven, Connecticut, USA
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The Italian consensus conference on psychological therapies for anxiety and depressive disorders: findings and recommendations. Epidemiol Psychiatr Sci 2022; 31:e89. [PMID: 36511136 PMCID: PMC9762139 DOI: 10.1017/s2045796022000713] [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: 12/15/2022] Open
Abstract
A Consensus Conference of clinicians, researchers, public health specialists and users was convened in Italy to review efficacy, effectiveness, treatment appropriateness and access to care for anxiety and depression, and to consider the role of psychological therapies. Expert opinion was sought concerning identification of people requiring psychological therapies according to levels of symptom severity matched to corresponding levels of treatment intensity, suitability of psychological therapies for subclinical anxiety or depression, definition of a minimum level of information on evidence-based psychotherapies to be provided by university medical and psychology courses, initiatives to raise awareness among potential users and decision makers on the role and effectiveness of psychological therapies in healthcare. The expert jury concluded that a number of psychological therapy models endorsed by most authoritative guidelines are supported by research showing their effectiveness at least equal to the drugs used in common mental disorders (CMDs). Such therapies are under-represented in the Italian public health system, leading many people to resort to the private sector, resulting in unacceptable wealth discrimination. The difficulty of accessing psychological treatments often entails the use of drug therapies in cases where they are not indicated. Starting from these assumptions, the experts recommended the promotion of better and timely recognition of anxiety and depressive disorders and their classification in terms of symptom intensity and functional impairment, differentiating subthreshold mood swings from clinical forms, to foster outcome studies of psychotherapies in CMDs in Italy, to introduce a stepped care model structured according to levels of intensity of treatment, based on wellbeing support strategies in nonmedical contexts for subthreshold situations, self-help, support and psychoeducation as frontline interventions in mild clinical forms, evidence-based psychotherapies in moderate and severe forms, with the option of combining psychological treatment and appropriate drug therapy in the most severe cases.
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Peutere L, Ravaska T, Bӧckerman P, Vӓӓnӓnen A, Virtanen P. Effects of rehabilitative psychotherapy on labour market success: Evaluation of a nationwide programme. Scand J Public Health 2022:14034948221074974. [PMID: 35120421 DOI: 10.1177/14034948221074974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS Psychotherapy is a widely used treatment for mental disorders, but whether it also improves employment and other labour market outcomes remains inconclusive. This study examined the effectiveness of a nationwide subsidized psychotherapy programme using extensive register-based data. METHODS The sample consisted of individuals who applied for rehabilitative psychotherapy in Finland in 2009-2012 (n = 35,083). Prior to 2011, some applications were rejected due to the limited budget that the central government provided for the programme. From 2011, all eligible applicants were granted rehabilitation. We used propensity score matching to create balanced samples of those who received a negative decision in 2009-2010 (n = 2047) and those who were granted rehabilitative psychotherapy in 2011-2012 (n = 12,046) in terms of their sociodemographic background characteristics, prior labour market attachment and health status. RESULTS We found that compared to the applicants who were not accepted to the programme, the granted applicants with similar background characteristics had, on average, a six-percentage-point higher employment rate, €2100 higher annual earnings and a six-percentage-point lower probability of becoming a disability benefit recipient five years after their first application. Further sensitivity analyses confirmed that these results were not biased, for example, by differences in macroeconomic conditions during the follow-up. CONCLUSIONS Quasi-experimental research design showed that rehabilitative psychotherapy was significantly associated with better labour market outcomes. Although several relevant background factors were included in the matching analysis, it is possible that some unobserved factors explain both access to psychotherapy and subsequent labour market outcomes.
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Affiliation(s)
- Laura Peutere
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Terhi Ravaska
- VATT Institute for Economic Research, Helsinki, Finland
| | - Petri Bӧckerman
- University of Jyväskylä, School of Business and Economics, Jyväskylä, Finland.,Labour Institute for Economic Research, Helsinki, Finland
| | - Ari Vӓӓnӓnen
- Finnish Institute of Occupational Health, Helsinki, Finland.,School of Social Policy, Sociology and Social Research, Cornwallis North East, University of Kent, Canterbury, Kent, UK
| | - Pekka Virtanen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
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Rush AJ, Sackeim HA, Conway CR, Bunker MT, Hollon SD, Demyttenaere K, Young AH, Aaronson ST, Dibué M, Thase ME, McAllister-Williams RH. Clinical research challenges posed by difficult-to-treat depression. Psychol Med 2022; 52:419-432. [PMID: 34991768 PMCID: PMC8883824 DOI: 10.1017/s0033291721004943] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 12/13/2022]
Abstract
Approximately one-third of individuals in a major depressive episode will not achieve sustained remission despite multiple, well-delivered treatments. These patients experience prolonged suffering and disproportionately utilize mental and general health care resources. The recently proposed clinical heuristic of 'difficult-to-treat depression' (DTD) aims to broaden our understanding and focus attention on the identification, clinical management, treatment selection, and outcomes of such individuals. Clinical trial methodologies developed to detect short-term therapeutic effects in treatment-responsive populations may not be appropriate in DTD. This report reviews three essential challenges for clinical intervention research in DTD: (1) how to define and subtype this heterogeneous group of patients; (2) how, when, and by what methods to select, acquire, compile, and interpret clinically meaningful outcome metrics; and (3) how to choose among alternative clinical trial design options to promote causal inference and generalizability. The boundaries of DTD are uncertain, and an evidence-based taxonomy and reliable assessment tools are preconditions for clinical research and subtyping. Traditional outcome metrics in treatment-responsive depression may not apply to DTD, as they largely reflect the only short-term symptomatic change and do not incorporate durability of benefit, side effect burden, or sustained impact on quality of life or daily function. The trial methodology will also require modification as trials will likely be of longer duration to examine the sustained impact, raising complex issues regarding control group selection, blinding and its integrity, and concomitant treatments.
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Affiliation(s)
- A. John Rush
- Duke-NUS Medical School, Singapore
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
- Department of Psychiatry, Texas Tech University, Permian Basin, TX, USA
| | - Harold A. Sackeim
- Departments of Psychiatry and Radiology, Columbia University, New York, NY, USA
| | - Charles R. Conway
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Steven D. Hollon
- Departments of Psychology and Psychiatry, Vanderbilt University, Nashville, TN, USA
| | - Koen Demyttenaere
- University Psychiatric Center, KU Leuven, Leuven, Belgium
- Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Scott T. Aaronson
- Department of Clinical Research, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Maxine Dibué
- Department of Neurosurgery, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Medical Affairs Europe, LivaNova Deutschland GmbH, Munich, Germany
| | - Michael E. Thase
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - R. Hamish McAllister-Williams
- Northern Centre for Mood Disorders, Newcastle University, Newcastle upon Tyne, UK
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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Abstract
Depression is a common and debilitating condition that adversely affects functioning and the capacity to work and establish economic stability. Women are disproportionately burdened by depression, and low-income pregnant and parenting women have particularly high rates of depression and often lack access to treatment. As depression can be treated, it is a modifiable risk factor for poor economic outcomes for women, and thus for children and families. Recent national and state health care policy changes offer the opportunity for community-based psychological and economic interventions that can reduce the number of pregnant and parenting women with clinically significant depressive symptoms. Moreover, there is strong evidence that in addition to benefiting women's well-being, such reforms bolster children's emotional and social development and learning and help families rise out of poverty. This review summarizes the mental health and economic literature regarding how maternal depression perpetuates intergenerational poverty and discusses recommendations regarding policies to treat maternal depression in large-scale social services systems.
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Affiliation(s)
- Megan V Smith
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06511, USA; .,The Child Study Center, Yale University School of Medicine, New Haven, Connecticut 06519, USA.,Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut 06510, USA.,Women's Health Research at Yale, Yale University School of Medicine, New Haven, Connecticut 06510, USA
| | - Carolyn M Mazure
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06511, USA; .,Women's Health Research at Yale, Yale University School of Medicine, New Haven, Connecticut 06510, USA.,Department of Psychology, Yale University, New Haven, Connecticut 06511, USA
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Tápias FS, Otani VHO, Vasques DAC, Otani TZS, Uchida RR. Costs associated with depression and obesity among cardiovascular patients: medical expenditure panel survey analysis. BMC Health Serv Res 2021; 21:433. [PMID: 33957919 PMCID: PMC8101168 DOI: 10.1186/s12913-021-06428-x] [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: 11/30/2020] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background There is a lack of information on the cost of depression associated with metabolic syndrome and cardiovascular diseases in the literature. Methods We evaluated the synergistic effects of depression and obesity on total expenditures for cardiovascular conditions using data from the Medical Expenditure Panel Survey (MEPS) database. We analyzed MEPS data from 1996 to 2017 comprising adult cardiovascular subjects. We categorized individuals following a combination of International Classification of Diseases ICD-9-CM and ICD-10 codes, and depression symptoms as evaluated using the Patient Health Questionnaire-2 (PHQ-2) depression screening tool. Our sample comprised cardiovascular patients aged 18 years and older, with a body mass index (BMI) between 18.5 and 60. Our study comprised unweighted sample of 96,697 (weighted sample of 938,835,031) adults, a US-nationwide representative sample of cardiovascular disease patients. The four response categories were: no depression; unrecognized depression; asymptomatic depression; and symptomatic depression. Our evaluated outcomes were total annual healthcare expenditures, including dental, emergency room, hospital outpatient, hospital inpatient, office-based, prescription, and home health care expenses. Results Asymptomatic and symptomatic depression was more frequent among obese individuals than in individuals with a normal BMI (p < 0.001). Total expenditure was highest among symptomatic depression individuals (17,536) and obese (9871) with cardiovascular disease. All the expenditure outcomes were significantly higher among symptomatic depression individuals than those without depression (p < 0.001), except for dental costs. All healthcare expenditures associated with obesity were higher compared to individuals with normal BMI with p < 0.001, except for emergency and home healthcare costs. Most importantly, among obese individuals, all healthcare expenditures were significantly higher (p < 0.001) in those with symptomatic depression than those without depression, except for dental costs, where the difference was not significant (0.899). Therefore, obesity and depression entail increased expenses in patients with cardiovascular disease. Conclusions We found incremental expenditures among unrecognized, asymptomatic, and symptomatic depressed individuals with obesity compared to non-depressed, non-obese subjects. However, these are preliminary results that should be further validated using different methodologies.
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Affiliation(s)
- Felipe Saia Tápias
- University of Medical Sciences of Santa Casa de São Paulo, Dr. Cesário Motta Jr. Street, 61, São Paulo, SP, 01221-020, Brazil.
| | - Victor Henrique Oyamada Otani
- University of Medical Sciences of Santa Casa de São Paulo, Dr. Cesário Motta Jr. Street, 61, São Paulo, SP, 01221-020, Brazil
| | - Daniel Augusto Corrêa Vasques
- University of Medical Sciences of Santa Casa de São Paulo, Dr. Cesário Motta Jr. Street, 61, São Paulo, SP, 01221-020, Brazil
| | - Thais Zelia Santos Otani
- University of Medical Sciences of Santa Casa de São Paulo, Dr. Cesário Motta Jr. Street, 61, São Paulo, SP, 01221-020, Brazil
| | - Ricardo Riyoiti Uchida
- University of Medical Sciences of Santa Casa de São Paulo, Dr. Cesário Motta Jr. Street, 61, São Paulo, SP, 01221-020, Brazil
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Ezawa ID, Bartels GC, Strunk DR. Getting down to business: an examination of occupational outcomes in cognitive behavioral therapy for depression. Cogn Behav Ther 2021; 50:479-491. [PMID: 33544040 DOI: 10.1080/16506073.2021.1875039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Depression is associated with unemployment and poor occupational functioning. Although cognitive behavioral therapy (CBT) has been shown to reduce depressive symptoms, the degree to which it improves occupational outcomes has received little attention. We investigated change in job status and presenteeism (i.e., the inability to focus on and accomplish work) over the course of CBT. We assessed employment status, presenteeism, depressive symptoms, cognitive style, and CBT skills at intake and posttreatment in a sample of 126 participants enrolled in a 16-week course of CBT for depression. Employment status significantly improved from pre to posttreatment, with 11 of the 27 patients (41%) seeking to improve their employment status achieving this goal. Among the 59 consistently employed patients, presenteeism decreased significantly over the course of treatment (dz = 1.13). We also found, even after controlling for changes in symptoms, reductions in negative cognitive style (but not changes in CBT skills) were associated with reductions in presenteeism. Our findings suggest CBT patients experience positive changes in occupational outcomes, both in finding work and being more focused and productive at work. Changes in negative cognitive styles appeared to partly explain this latter change. We encourage future work examining CBT's impact on occupational outcomes.
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Affiliation(s)
- Iony D Ezawa
- Department of Psychology, The Ohio State University, Columbus, OH, USA
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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.
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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
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12
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Zhou J, Jiang X, He S, Jiang H, Feng F, Liu W, Qu W, Sun H. Rational Design of Multitarget-Directed Ligands: Strategies and Emerging Paradigms. J Med Chem 2019; 62:8881-8914. [PMID: 31082225 DOI: 10.1021/acs.jmedchem.9b00017] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Due to the complexity of multifactorial diseases, single-target drugs do not always exhibit satisfactory efficacy. Recently, increasing evidence indicates that simultaneous modulation of multiple targets may improve both therapeutic safety and efficacy, compared with single-target drugs. However, few multitarget drugs are on market or in clinical trials, despite the best efforts of medicinal chemists. This article discusses the systematic establishment of target combination, lead generation, and optimization of multitarget-directed ligands (MTDLs). Moreover, we analyze some MTDLs research cases for several complex diseases in recent years and the physicochemical properties of 117 clinical multitarget drugs, with the aim to reveal the trends and insights of the potential use of MTDLs.
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Affiliation(s)
- Junting Zhou
- Department of Medicinal Chemistry , China Pharmaceutical University , Nanjing 211198 , People's Republic of China.,Department of Natural Medicinal Chemistry , China Pharmaceutical University , Nanjing , 211198 , People's Republic of China
| | - Xueyang Jiang
- Department of Medicinal Chemistry , China Pharmaceutical University , Nanjing 211198 , People's Republic of China.,Department of Natural Medicinal Chemistry , China Pharmaceutical University , Nanjing , 211198 , People's Republic of China
| | - Siyu He
- Department of Medicinal Chemistry , China Pharmaceutical University , Nanjing 211198 , People's Republic of China
| | - Hongli Jiang
- Department of Medicinal Chemistry , China Pharmaceutical University , Nanjing 211198 , People's Republic of China.,Department of Natural Medicinal Chemistry , China Pharmaceutical University , Nanjing , 211198 , People's Republic of China
| | - Feng Feng
- Department of Natural Medicinal Chemistry , China Pharmaceutical University , Nanjing , 211198 , People's Republic of China.,Jiangsu Food and Pharmaceutical Science College , Huaian 223003 , People's Republic of China
| | - Wenyuan Liu
- Department of Analytical Chemistry , China Pharmaceutical University , Nanjing 210009 , People's Republic of China
| | - Wei Qu
- Department of Natural Medicinal Chemistry , China Pharmaceutical University , Nanjing , 211198 , People's Republic of China
| | - Haopeng Sun
- Department of Medicinal Chemistry , China Pharmaceutical University , Nanjing 211198 , People's Republic of China
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13
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Hollon SD, Cohen ZD, Singla DR, Andrews PW. Recent Developments in the Treatment of Depression. Behav Ther 2019; 50:257-269. [PMID: 30824244 DOI: 10.1016/j.beth.2019.01.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 01/22/2023]
Abstract
The cognitive and behavioral interventions can be as efficacious as antidepressant medications and more enduring, but some patients will be more likely to respond to one than the other. Recent work has focused on developing sophisticated selection algorithms using machine-learning approaches that answer the question, "What works best for whom?" Moreover, the vast majority of people suffering from depression reside in low- and middle-income countries where access to either psychotherapy or medications is virtually nonexistent. Great strides have been made in training nonspecialist providers (known as task sharing) to overcome this gap. Finally, recent work growing out of evolutionary psychology suggests that antidepressant medications may suppress symptoms at the expense of prolonging the underlying episode so as to increase the risk of relapse whenever someone tries to stop. We address each of these developments and their cumulative implications.
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14
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Lopes B, Kamau C, Jaspal R. The Roles of Socioeconomic Status, Occupational Health and Job Rank on the Epidemiology of Different Psychiatric Symptoms in a Sample of UK Workers. Community Ment Health J 2019; 55:336-349. [PMID: 29511997 DOI: 10.1007/s10597-018-0259-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 03/03/2018] [Indexed: 10/17/2022]
Abstract
There is a considerable gap in epidemiological literature about community mental health showing how psychiatric symptoms are associated with job rank, socioeconomic status, and occupational health. We examine data from 4596 employees collected in the United Kingdom's Psychiatric Morbidity among Adults Living in Private Households Survey. There were 939 workers in managerial jobs, 739 in supervisory jobs and 2918 employees in lower ranking jobs. Of the 4596 workers, 2463 had depressive symptoms and 2133 no depressive symptoms. Job rank, household gross income, social class, personal gross income and socio-economic group were significantly associated with general health, occupational health and depressive and avoidant symptoms. Job rank, occupational and physical health also explained the variance in paranoid and avoidant symptoms among the employees. This study shows that severe psychopathology is related to workers' job rank.
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Affiliation(s)
- B Lopes
- CINEICC, Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra, Rua do Colégio Novo, 3001-802, Coimbra, Portugal.
| | - C Kamau
- Department of Organisational Psychology, Birkbeck, University of London, London, UK
| | - R Jaspal
- Department of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
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15
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Steen S. A cost-benefit analysis of the Improving Access to Psychological Therapies programme using its key defining outcomes. J Health Psychol 2018; 25:2487-2498. [PMID: 30284915 DOI: 10.1177/1359105318803751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The economic argument underpinning the Improving Access to Psychological Therapy programme has been a central component in its initial and continued investment. Using open-access data, this article undertook a cost-benefit analysis using the programme's key defining outcomes to determine its return-on-investment. It was found that in terms of investment and efficiency gains, the programme was in the higher ends of the cost spectrum for delivering psychological therapies. Although cost-estimates appear promising at first, when set in the context of a lower number of treatment contacts and a high proportion of early disengagement, estimates increased sharply.
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16
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Øverland S, Grasdal AL, Reme SE. Long-term effects on income and sickness benefits after work-focused cognitive-behavioural therapy and individual job support: a pragmatic, multicentre, randomised controlled trial. Occup Environ Med 2018; 75:703-708. [DOI: 10.1136/oemed-2018-105137] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/11/2018] [Accepted: 06/25/2018] [Indexed: 11/04/2022]
Abstract
BackgroundThere is moderate quality evidence that integrating work-directed interventions and components from psychological therapies reduces sickness absence in the medium term. We aimed to extend this evidence by examining objectively ascertained income and work participation status up to 4 years after an intervention to improve outcomes among people who struggle with work from common mental disorder.MethodsThe intervention combined components from cognitive behavioural therapy with principles from supported employment, and compared its efficacy with usual care. Outcomes were derived from registry data with no attrition, in a pragmatic multisite randomised controlled trial (N=1193).ResultsThe intervention group had higher income, higher work participation and more months without receiving benefits over the 10-month to 46-month long-term follow-up period after end of treatment, but differences were not statistically significant. For the group on long-term benefits at inclusion, effect sizes were larger and statistically significant.ConclusionThere were no statistically significant differences between the two groups in the primary outcome in the total population. In a secondary analysis for the subgroup most at risk of permanent work exclusion, long-term outcomes were favourable in the intervention group compared with usual care. The results support integrated work and health services for people on the severe end of work participation challenges.Trial registration numberNCT01146730.
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17
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Hengartner MP. Raising Awareness for the Replication Crisis in Clinical Psychology by Focusing on Inconsistencies in Psychotherapy Research: How Much Can We Rely on Published Findings from Efficacy Trials? Front Psychol 2018. [PMID: 29541051 PMCID: PMC5835722 DOI: 10.3389/fpsyg.2018.00256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael P Hengartner
- Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
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18
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Schröder A, Ørnbøl E, Jensen JS, Sharpe M, Fink P. Long-term economic evaluation of cognitive-behavioural group treatment versus enhanced usual care for functional somatic syndromes. J Psychosom Res 2017; 94:73-81. [PMID: 28183406 DOI: 10.1016/j.jpsychores.2017.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 01/05/2017] [Accepted: 01/07/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Patients with functional somatic syndromes (FSS) such as fibromyalgia and chronic fatigue syndrome have a poor outcome and can incur high healthcare and societal costs. We aimed to compare the medium-term (16months) cost-effectiveness and the long-term (40months) economic outcomes of a bespoke cognitive-behavioural group treatment (STreSS) with that of enhanced usual care (EUC). METHODS We obtained complete data on healthcare and indirect costs (i.e. labour marked-related and health-related benefits) from public registries for 120 participants from a randomised controlled trial. Costs were calculated as per capita public expenses in 2010 €. QALYs gained were estimated from the SF-6D. We conducted a medium-term cost-effectiveness analysis and a long-term cost-minimization analysis from both a healthcare (i.e. direct cost) and a societal (i.e. total cost) perspective. RESULTS In the medium term, the probability that STreSS was cost-effective at thresholds of 25,000 to 35,000 € per QALY was 93-95% from a healthcare perspective, but only 50-55% from a societal perspective. In the long term, however, STreSS was associated with increasing savings in indirect costs, mainly due to a greater number of patients self-supporting. When combined with stable long-term reductions in healthcare expenditures, there were total cost savings of 7184 € (95% CI 2271 to 12,096, p=0.004) during the third year after treatment. CONCLUSION STreSS treatment costs an average of 1545 €. This cost was more than offset by subsequent savings in direct and indirect costs. Implementation could both improve patient outcomes and reduce costs.
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Affiliation(s)
- Andreas Schröder
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
| | - Eva Ørnbøl
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Jens S Jensen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Sharpe
- Psychological Medicine Research, Department of Psychiatry, University of Oxford, UK
| | - Per Fink
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
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19
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Kuga A, Tsuji T, Hayashi S, Matsubara M, Fujikoshi S, Tokuoka H, Yoshikawa A, Escobar R, Tanaka K, Azekawa T. An observational study of duloxetine versus SSRI monotherapy for the treatment of painful physical symptoms in Japanese patients with major depressive disorder: primary analysis. Neuropsychiatr Dis Treat 2017; 13:2105-2114. [PMID: 28831259 PMCID: PMC5552143 DOI: 10.2147/ndt.s131438] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess the effectiveness of duloxetine monotherapy, in comparison with selective serotonin reuptake inhibitor (SSRI) monotherapy, in the treatment of painful physical symptoms (PPS) in Japanese patients with major depressive disorder (MDD) in real-world clinical settings. METHODS This was a multicenter, 12-week prospective, observational study. This study enrolled MDD patients with at least moderate PPS, defined as a Brief Pain Inventory-Short Form (BPI-SF) average pain score (item 5) ≥3. Patients were treated with duloxetine or SSRIs (escitalopram, sertraline, paroxetine, or fluvoxamine) for 12 weeks, and PPS were assessed by BPI-SF average pain score. The primary outcome was early improvement in the BPI-SF average pain score at 4 weeks post-baseline. RESULTS A total of 523 patients were evaluated for treatment effectiveness (duloxetine N=273, SSRIs N=250). The difference in BPI-SF average pain score between the two groups was not statistically significant at 4 weeks post-baseline, the primary endpoint (least-squares mean change from baseline [95% confidence interval]: duloxetine, -2.8 [-3.1, -2.6]; SSRIs, -2.5 [-2.8, -2.3]; P=0.166). There was a numerical advantage for duloxetine in improvement from 4 to 12 weeks post-baseline, and the difference was statistically significant at 8 weeks post-baseline (least-squares mean change from baseline [95% confidence interval]: duloxetine, -3.6 [-3.9, -3.3]; SSRIs, -3.1 [-3.4, -2.8]; P=0.023). The 30% and 50% responder rates were significantly higher in patients treated with duloxetine at 4 and 8 weeks post-baseline. There were no serious adverse events experienced by duloxetine-treated patients. The rate of discontinuations due to adverse events was similar for duloxetine and the SSRIs (1.0% and 0.8% of patients, respectively). CONCLUSION In this observational study, BPI-SF improvement was not significantly different at 4 weeks, the primary endpoint; however, patients treated with duloxetine tended to show better improvement in PPS compared to those treated with SSRIs.
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Affiliation(s)
- Atsushi Kuga
- Bio Medicine, Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan
| | - Toshinaga Tsuji
- Medical Affairs Department, Shionogi & Co. Ltd, Osaka, Japan
| | - Shinji Hayashi
- Medical Affairs Department, Shionogi & Co. Ltd, Osaka, Japan
| | - Mako Matsubara
- Pharmacovigilance Department, Shionogi & Co. Ltd, Osaka, Japan
| | - Shinji Fujikoshi
- Statistical Science, Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan
| | - Hirofumi Tokuoka
- Bio Medicine, Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan
| | - Aki Yoshikawa
- Scientific Communications, Medicines Development Unit Japan, Eli Lilly Japan K.K. Kobe, Japan
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20
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Steffen PR, Austin T, DeBarros A. Treating Chronic Stress to Address the Growing Problem of Depression and Anxiety. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/2372732216685333] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Depression and anxiety are undertreated and represent a growing health crisis and economic burden. Current treatment approaches (medications, psychotherapy) appear insufficient to resolve these problems. Difficulties with current treatment approaches include cost, side effects, and stigma. Given that depression and anxiety share significant features and a common etiology in chronic stress, an effective approach to reduce depression and anxiety may be to reduce chronic stress. Chronic stress is on the rise, with more than one third of Americans reporting high levels of stress with which they feel they cannot adequately cope. Treating chronic stress at the population level has the potential to reduce the rising tide of depression and anxiety. Biofeedback and mindfulness are two interventions that demonstrably reduce stress and negative mood, are cost and time-effective, have no side effects, and have minimal stigma relative to medications and psychotherapy.
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21
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Gratzer D, Goldbloom D. Making Evidence-Based Psychotherapy More Accessible in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:618-23. [PMID: 27310234 PMCID: PMC5348091 DOI: 10.1177/0706743716642416] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- David Gratzer
- The Scarborough Hospital, Toronto, Ontario Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - David Goldbloom
- Department of Psychiatry, University of Toronto, Toronto, Ontario Centre for Addiction and Mental Health, Toronto, Ontario
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22
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O'Dea B, Lee RSC, McGorry PD, Hickie IB, Scott J, Hermens DF, Mykletun A, Purcell R, Killackey E, Pantelis C, Amminger GP, Glozier N. A prospective cohort study of depression course, functional disability, and NEET status in help-seeking young adults. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1395-1404. [PMID: 27498112 DOI: 10.1007/s00127-016-1272-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 08/01/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the associations between depression course, functional disability, and Not in Education or Training (NEET) status in a clinical sample of young adults with mental health problems. METHODS Young adults aged 15-25 years seeking help from four primary mental health services were invited to participate in a prospective cohort study evaluating the course of psychiatric disorders in youth. Demographic and clinical characteristics, including depressive symptomatology and functioning, were evaluated through clinical interview and self-report at baseline and 12 month follow-up. RESULTS A total of 448 young adults participated (70 % female; M: 20.05 years, SD = 2.85). A significant interaction effect for time and depression course was found, such that those who became depressed reported an increase in functional disability and those whose depression remitted reported a significant reduction in functional disability. Developing depression was not a significant predictor of becoming NEET and vice versa: remitted depression did not make a person more likely to reengage in employment or education. CONCLUSIONS This is the first study to examine the course of depression, functional disability, and NEET rates among help-seeking young adults. This study confirms the importance of symptom reduction for improved functioning; however, functional disability remained greater than that seen in young people in the community and there was no association between a change in depression and a change in NEET status. These results argue that services need to address functional outcomes and reengagement with education and employment in addition to symptom reduction.
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Affiliation(s)
- Bridianne O'Dea
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia. .,Black Dog Institute, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - Rico S C Lee
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | - Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle-upon-Tyne, UK
| | - Daniel F Hermens
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
| | | | - Rosemary Purcell
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.,Centre for Forensic Behavioural Science, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Eoin Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne and Melbourne Health, Melbourne, VIC, Australia
| | - G Paul Amminger
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Nicholas Glozier
- Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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23
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Parikh SV, Quilty LC, Ravitz P, Rosenbluth M, Pavlova B, Grigoriadis S, Velyvis V, Kennedy SH, Lam RW, MacQueen GM, Milev RV, Ravindran AV, Uher R. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 2. Psychological Treatments. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2016; 61:524-39. [PMID: 27486150 PMCID: PMC4994791 DOI: 10.1177/0706743716659418] [Citation(s) in RCA: 199] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) has revised its 2009 guidelines for the management of major depressive disorder (MDD) in adults by updating the evidence and recommendations. The target audiences for these 2016 guidelines are psychiatrists and other mental health professionals. METHODS Using the question-answer format, we conducted a systematic literature search focusing on systematic reviews and meta-analyses. Evidence was graded using CANMAT-defined criteria for level of evidence. Recommendations for lines of treatment were based on the quality of evidence and clinical expert consensus. "Psychological Treatments" is the second of six sections of the 2016 guidelines. RESULTS Evidence-informed responses were developed for 25 questions under 5 broad categories: 1) patient characteristics relevant to using psychological interventions; 2) therapist and health system characteristics associated with optimizing outcomes; 3) descriptions of major psychotherapies and their efficacy; 4) additional psychological interventions, such as peer interventions and computer- and technology-delivered interventions; and 5) combining and/or sequencing psychological and pharmacological interventions. CONCLUSIONS First-line psychological treatment recommendations for acute MDD include cognitive-behavioural therapy (CBT), interpersonal therapy (IPT), and behavioural activation (BA). Second-line recommendations include computer-based and telephone-delivered psychotherapy. Where feasible, combining psychological treatment (CBT or IPT) with antidepressant treatment is recommended because combined treatment is superior to either treatment alone. First-line psychological treatments for maintenance include CBT and mindfulness-based cognitive therapy (MBCT). Patient preference, in combination with evidence-based treatments and clinician/system capacity, will yield the optimal treatment strategies for improving individual outcomes in MDD.
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Affiliation(s)
- Sagar V Parikh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Lena C Quilty
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Paula Ravitz
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | | | - Barbara Pavlova
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
| | | | | | - Sidney H Kennedy
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | | | - Roumen V Milev
- Department of Psychiatry, Queen's University, Kingston, Ontario
| | - Arun V Ravindran
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
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Evaluating the economic impact of screening and treatment for depression in the workplace. Eur Neuropsychopharmacol 2016; 26:1004-13. [PMID: 27085517 DOI: 10.1016/j.euroneuro.2016.03.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/11/2016] [Accepted: 03/18/2016] [Indexed: 12/28/2022]
Abstract
Depression is the most common psychiatric illness and cause of disability, and associated with durable impacts on productivity and represents one of the major causes of workplace absenteeism and presenteeism. Few studies, however, examine the economic impact of treatment of depression in the workplace, particularly from the perspective of the employer. We estimated the relative cost-effectiveness of treatment for employees with depression in the workplace. We used a decision-analytic model to estimate the relative cost-effectiveness of (i) psychotherapy, (ii) pharmacotherapy and (iii) combination of psychotherapy and pharmacotherapy and whether they reduce sickness, absenteeism and presenteeism for people with depression. Costs and savings to the employer were also estimated, and policy recommendations made about how best to translate this evidence into practice. Both pharmacotherapy treatment and psychotherapy treatment were found to be cost-saving from the perspective of the employer. Psychotherapy was found to be the most cost-effective option with an incremental cost-effectiveness ratio of €22,225. This study provides evidence that screening and treatment for depression in the workplace is cost-effective and represents a worthwhile investment from the business perspective.
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25
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Pfeifer BJ, Strunk DR. Getting Back to Work: Cognitive Behavioral Predictors of Depressive Symptoms and Job Search Success. J Clin Psychol 2016; 72:591-605. [PMID: 26990532 DOI: 10.1002/jclp.22279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 12/08/2015] [Accepted: 01/10/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Little is known about how cognitive behavioral approaches to depression might explain functional impairments associated with the disorder, such as extended periods of unemployment. To address this issue, we examined 5 cognitive behavioral predictors of depressive symptom change and job search outcome. METHOD Using a sample of 75 unemployed adults, we examined cognitive style, brooding, dysfunctional attitudes, avoidance, and cognitive behavioral (CB) skills as predictors of change in depressive symptoms, job search self-efficacy, and receipt of a job offer over a 3-month period. RESULTS CB skills predicted lower depressive symptoms and increased odds of having received a job offer at the follow-up. Brooding predicted change in job search self-efficacy, but not in the expected direction. CONCLUSION CB skills appear to predict job search outcomes as well as depressive symptoms. We encourage future work examining how CB skills may affect depressive symptoms, job search behaviors, and other areas of functioning.
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26
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Uher R, Pavlova B. Long-term effects of depression treatment. Lancet Psychiatry 2016; 3:95-6. [PMID: 26777772 DOI: 10.1016/s2215-0366(15)00578-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 12/16/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia B3H 2E2, Canada; Nova Scotia Health Authority, Nova Scotia, Canada.
| | - Barbara Pavlova
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia B3H 2E2, Canada; Nova Scotia Health Authority, Nova Scotia, Canada
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27
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Koeser L, Donisi V, Goldberg DP, McCrone P. Modelling the cost-effectiveness of pharmacotherapy compared with cognitive-behavioural therapy and combination therapy for the treatment of moderate to severe depression in the UK. Psychol Med 2015; 45:3019-3031. [PMID: 26040631 DOI: 10.1017/s0033291715000951] [Citation(s) in RCA: 16] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND The National Institute of Health and Care Excellence (NICE) in England and Wales recommends the combination of pharmacotherapy and psychotherapy for the treatment of moderate to severe depression. However, the cost-effectiveness analysis on which these recommendations are based has not included psychotherapy as monotherapy as a potential option. For this reason, we aimed to update, augment and refine the existing economic evaluation. METHOD We constructed a decision analytic model with a 27-month time horizon. We compared pharmacotherapy with cognitive-behavioural therapy (CBT) and combination treatment for moderate to severe depression in secondary care from a healthcare service perspective. We reviewed the literature to identify relevant evidence and, where possible, synthesized evidence from clinical trials in a meta-analysis to inform model parameters. RESULTS The model suggested that CBT as monotherapy was most likely to be the most cost-effective treatment option above a threshold of £ 22,000 per quality-adjusted life year (QALY). It dominated combination treatment and had an incremental cost-effectiveness ratio of £ 20,039 per QALY compared with pharmacotherapy. There was significant decision uncertainty in the probabilistic and deterministic sensitivity analyses. CONCLUSIONS Contrary to previous NICE guidance, the results indicated that even for those patients for whom pharmacotherapy is acceptable, CBT as monotherapy may be a cost-effective treatment option. However, this conclusion was based on a limited evidence base, particularly for combination treatment. In addition, this evidence cannot easily be transferred to a primary care setting.
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Affiliation(s)
- L Koeser
- Institute of Psychiatry, King's College London,London,UK
| | - V Donisi
- Department of Public Health and Community Medicine, Section of Psychiatry,University of Verona,Verona,Italy
| | - D P Goldberg
- Institute of Psychiatry, King's College London,London,UK
| | - P McCrone
- Institute of Psychiatry, King's College London,London,UK
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Sockalingam S, Wnuk S, Kantarovich K, Meaney C, Okrainec A, Hawa R, Cassin S. Employment Outcomes One Year after Bariatric Surgery: the Role of Patient and Psychosocial Factors. Obes Surg 2014; 25:514-22. [DOI: 10.1007/s11695-014-1443-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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