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Cations M, Wilton-Harding B, Laver KE, Brodaty H, Low LF, Collins N, Lie D, McKellar D, Macfarlane S, Draper B. Psychiatric service delivery for older people in hospital and residential aged care: An updated systematic review. Aust N Z J Psychiatry 2022; 57:811-833. [PMID: 36317325 DOI: 10.1177/00048674221134510] [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: 11/06/2022]
Abstract
OBJECTIVE To review studies reporting on the effectiveness of psychiatry service delivery for older people and people with dementia in hospital and residential aged care. METHODS A systematic search of four databases was conducted to obtain peer-reviewed literature reporting original research published since June 2004 evaluating a psychiatry service for older people (aged 60 years and over) or people with dementia in inpatient or residential aged care settings. RESULTS From the 38 included studies, there was consistent low-to-moderate quality evidence supporting the effectiveness of inpatient older persons' mental health wards (n = 14) on neuropsychiatric symptoms, mood, anxiety and quality of life. Inpatient consultation/liaison old age psychiatry services (n = 9) were not associated with improved depression, quality of life or mortality in high-quality randomised studies. However, low-quality evidence demonstrated improved patient satisfaction with care and reduced carer stress. The highest quality studies demonstrated no effect of psychiatric in-reach services to residential aged care (n = 9) on neuropsychiatric symptoms but a significant reduction in depressive symptoms among people with dementia. There was low-quality evidence that long-stay intermediate care wards (n = 6) were associated with reduced risk for dangerous behavioural incidents and reduced costs compared to residential aged care facilities. There was no effect of these units on neuropsychiatric symptoms or carer stress. CONCLUSIONS AND IMPLICATIONS The scarcity of high-quality studies examining the effectiveness of old age psychiatry services leaves providers and policy-makers to rely on low-quality evidence when designing services. Future research should consider carefully which outcomes to include, given that staff skill and confidence, length of stay, recommendation uptake, patient- and family-reported experiences, and negative outcomes (i.e. injuries, property damage) are as important as clinical outcomes.
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Affiliation(s)
- Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Bethany Wilton-Harding
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Kate E Laver
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, Discipline of Psychiatry & Mental Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia.,Discipline of Psychiatry & Mental Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Lee-Fay Low
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Noel Collins
- Great Southern Mental Health Service, Albany, WA, Australia.,West Australian Country Health Service, Albany, WA, Australia.,The Rural Clinical School of Western Australia, The University of Western Australia, Albany, WA, Australia
| | - David Lie
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia.,The University of Queensland, Brisbane, QLD, Australia
| | - Duncan McKellar
- Northern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia.,Office of the Chief Psychiatrist, SA Health, Adelaide, SA, Australia
| | - Steve Macfarlane
- Department of Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Brian Draper
- Discipline of Psychiatry & Mental Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
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A Systematic Review of the Current Evidence from Randomised Controlled Trials on the Impact of Medication Optimisation or Pharmacological Interventions on Quantitative Measures of Cognitive Function in Geriatric Patients. Drugs Aging 2022; 39:863-874. [PMID: 36284081 PMCID: PMC9626423 DOI: 10.1007/s40266-022-00980-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/25/2022]
Abstract
Background Cognitive decline is common in older people. Numerous studies point to the detrimental impact of polypharmacy and inappropriate medication on older people’s cognitive function. Here we aim to systematically review evidence on the impact of medication optimisation and drug interventions on cognitive function in older adults. Methods A systematic review was performed using MEDLINE and Web of Science on May 2021. Only randomised controlled trials (RCTs) addressing the impact of medication optimisation or pharmacological interventions on quantitative measures of cognitive function in older adults (aged > 65 years) were included. Single-drug interventions (e.g., on drugs for dementia) were excluded. The quality of the studies was assessed by using the Jadad score. Results Thirteen studies met the inclusion criteria. In five studies a positive impact of the intervention on metric measures of cognitive function was observed. Only one study showed a significant improvement of cognitive function by medication optimisation. The remaining four positive studies tested methylphenidate, selective oestrogen receptor modulators, folic acid and antipsychotics. The mean Jadad score was low (2.7). Conclusion This systematic review identified a small number of heterogenous RCTs investigating the impact of medication optimisation or pharmacological interventions on cognitive function. Five trials showed a positive impact on at least one aspect of cognitive function, with comprehensive medication optimisation not being more successful than focused drug interventions. More prospective trials are needed to specifically assess ways of limiting the negative impact of certain medication in particular and polypharmacy in general on cognitive function in older patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-022-00980-9.
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Grigoroglou C, van der Feltz-Cornelis C, Hodkinson A, Coventry PA, Zghebi SS, Kontopantelis E, Bower P, Lovell K, Gilbody S, Waheed W, Dickens C, Archer J, Blakemore A, Adler DA, Aragones E, Björkelund C, Bruce ML, Buszewicz M, Carney RM, Cole MG, Davidson KW, Gensichen J, Grote NK, Russo J, Huijbregts K, Huffman JC, Menchetti M, Patel V, Richards DA, Rollman B, Smit A, Zijlstra-Vlasveld MC, Wells KB, Zimmermann T, Unutzer J, Panagioti M. Effectiveness of collaborative care in reducing suicidal ideation: An individual participant data meta-analysis. Gen Hosp Psychiatry 2021; 71:27-35. [PMID: 33915444 DOI: 10.1016/j.genhosppsych.2021.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
UNLABELLED To assess whether CC is more effective at reducing suicidal ideation in people with depression compared with usual care, and whether study and patient factors moderate treatment effects. METHOD We searched Medline, Embase, PubMed, PsycINFO, CINAHL, CENTRAL from inception to March 2020 for Randomised Controlled Trials (RCTs) that compared the effectiveness of CC with usual care in depressed adults, and reported changes in suicidal ideation at 4 to 6 months post-randomisation. Mixed-effects models accounted for clustering of participants within trials and heterogeneity across trials. This study is registered with PROSPERO, CRD42020201747. RESULTS We extracted data from 28 RCTs (11,165 patients) of 83 eligible studies. We observed a small significant clinical improvement of CC on suicidal ideation, compared with usual care (SMD, -0.11 [95%CI, -0.15 to -0.08]; I2, 0·47% [95%CI 0.04% to 4.90%]). CC interventions with a recognised psychological treatment were associated with small reductions in suicidal ideation (SMD, -0.15 [95%CI -0.19 to -0.11]). CC was more effective for reducing suicidal ideation among patients aged over 65 years (SMD, - 0.18 [95%CI -0.25 to -0.11]). CONCLUSION Primary care based CC with an embedded psychological intervention is the most effective CC framework for reducing suicidal ideation and older patients may benefit the most.
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Affiliation(s)
- Christos Grigoroglou
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England.
| | | | - Alexander Hodkinson
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Peter A Coventry
- Department of Health Sciences, University of York, York, England
| | - Salwa S Zghebi
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Evangelos Kontopantelis
- Faculty of Biology, Medicine and Health, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, England
| | - Peter Bower
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, England; Greater Manchester Mental Health NHS Foundation Trust, Manchester, England
| | - Simon Gilbody
- Department of Health Sciences, Hull York Medical School, HYMS, University of York, York, England
| | - Waquas Waheed
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
| | | | - Janine Archer
- School of Health and Society, School of Health and Society, University of Salford, England
| | - Amy Blakemore
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, England
| | - David A Adler
- Departments of Psychiatry and Medicine, Tufts Medical Center and Tufts University School of Medicine, England
| | - Enric Aragones
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Cecilia Björkelund
- Primary Health Care School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Marta Buszewicz
- Institute of Epidemiology and Health, Faculty of Population and Health Sciences, University College London, London, England
| | - Robert M Carney
- Department of Psychiatry, Washington University in St. Louis (WUSTL), St. Louis, Missouri, USA
| | - Martin G Cole
- Department of Psychiatry, St. Mary's Hospital Center, McGill University, Montreal, Quebec, Canada
| | - Karina W Davidson
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Jochen Gensichen
- Institute of General Practice and Family Medicine, LMU Klinikum, Ludwig-Maximilians, University Munich Pettenkoferstr. 10, 80336 Munich, Germany
| | - Nancy K Grote
- School of Social Work, University of Washington, Seattle, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Klaas Huijbregts
- Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jeff C Huffman
- Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Vikram Patel
- The Pershing Square Professor of Global Health, Harvard Medical School, Boston, MA, USA
| | - David A Richards
- Institute of Health Research, University of Exeter College of Medicine and Health, Exeter, England; Western University of Norway, Bergen, Norway
| | - Bruce Rollman
- Center for Behavioral Health, Media and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Annet Smit
- HAN University of Applied Sciences, Nijmegen, Netherlands
| | | | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA; Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
| | - Thomas Zimmermann
- Department of General Practice / Primary Care, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jurgen Unutzer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Maria Panagioti
- National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
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Stein B, Müller MM, Meyer LK, Söllner W. Psychiatric and Psychosomatic Consultation-Liaison Services in General Hospitals: A Systematic Review and Meta-Analysis of Effects on Symptoms of Depression and Anxiety. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 89:6-16. [PMID: 31639791 DOI: 10.1159/000503177] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/04/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Psychiatric and psychosomatic consultation-liaison services (CL) are important providers of diagnosis and treatment for hospital patients with mental comorbidities and psychological burdens. OBJECTIVE To perform a systematic review and meta-analysis investigating the effects of CL on depression and anxiety. METHODS Following PRISMA guidelines, a systematic literature search was conducted until 2017. Included were published randomized controlled trials using CL interventions with adults in general hospitals, treatment as usual as control groups, and depression and/or anxiety as outcomes. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Level of integration was assessed using the Standard Framework for Levels of Integrated Healthcare. Meta-analyses were performed using random effects models and meta-regression for moderator effects. RESULTS We included 38 studies (9,994 patients). Risk of bias was high in 17, unclear in 15, and low in 6 studies. Studies were grouped by type of intervention: brief interventions tailored to the patients (8), interventions based on specific treatment manuals (19), and integrated, collaborative care (11). Studies showed small to medium effects on depression and anxiety. Meta-analyses for depression yielded a small effect (d = -0.19, 95% CI: -0.30 to -0.09) in manual studies and a small effect (d = -0.33, 95% CI: -0.53 to -0.13) in integrated, collaborative care studies, the latter using mostly active control groups with the possibility of traditional consultation. CONCLUSIONS CL can provide a helpful first treatment for symptoms of depression and anxiety. Given that especially depressive symptoms in medically ill patients are long-lasting, the results underline the benefit of integrative approaches that respect the complexity of the illness.
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Affiliation(s)
- Barbara Stein
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany,
| | - Markus M Müller
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
| | - Lisa K Meyer
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
| | - Wolfgang Söllner
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, General Hospital Nuremberg, Nuremberg, Germany
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Moriarty AS, Coventry PA, Hudson JL, Cook N, Fenton OJ, Bower P, Lovell K, Archer J, Clarke R, Richards DA, Dickens C, Gask L, Waheed W, Huijbregts KM, van der Feltz-Cornelis C, Ali S, Gilbody S, McMillan D. The role of relapse prevention for depression in collaborative care: A systematic review. J Affect Disord 2020; 265:618-644. [PMID: 31791677 DOI: 10.1016/j.jad.2019.11.105] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/01/2019] [Accepted: 11/21/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Relapse (the re-emergence of depression symptoms before full recovery) is common in depression and relapse prevention strategies are not well researched in primary care settings. Collaborative care is effective for treating acute phase depression but little is known about the use of relapse prevention strategies in collaborative care. We undertook a systematic review to identify and characterise relapse prevention strategies in the context of collaborative care. METHODS We searched for Randomised Controlled Trials (RCTs) of collaborative care for depression. In addition to published material, we obtained provider and patient manuals from authors to provide more detail on intervention content. We reported the extent to which collaborative care interventions addressed four relapse prevention components. RESULTS 93 RCTs were identified. 31 included a formal relapse prevention plan; 42 had proactive monitoring and follow-up after the acute phase; 39 reported strategies for optimising sustained medication adherence; and 20 of the trials reported psychological or psycho-educational treatments persisting beyond the acute phase or focussing on long-term health/relapse prevention. 30 (32.3%) did not report relapse prevention approaches. LIMITATIONS We did not receive trial materials for approximately half of the trials, which limited our ability to identify relevant features of intervention content. CONCLUSION Relapse is a significant risk amongst people treated for depression and interventions are needed that specifically address and minimise this risk. Given the advantages of collaborative care as a delivery system for depression care, there is scope for more consistency and increased effort to implement and evaluate relapse prevention strategies.
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Affiliation(s)
- Andrew S Moriarty
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Peter A Coventry
- Department of Health Sciences and Centre for Reviews and Dissemination, University of York, Heslington, York, YO10 5DD, UK.
| | - Joanna L Hudson
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - Natalie Cook
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Oliver J Fenton
- Tees, Esk and Wear Valleys NHS Foundation Trust, South and West Community Mental Health Team, Acomb Garth, 2 Oak Rise, York, YO24 4LJ, UK.
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Karina Lovell
- Division of Nursing, Midwifery & Social Work, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Janine Archer
- School of Health and Society, University of Salford, Mary Seacole Building, Broad St, Frederick Road Campus, Salford, M6 6PU, UK.
| | - Rose Clarke
- Sheffield IAPT, St George's Community Health Centre, Winter Street, Sheffield, South Yorkshire, S3 7ND, UK.
| | - David A Richards
- Institute of Health Research, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Chris Dickens
- Institute of Health Research, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Linda Gask
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Waquas Waheed
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK.
| | - Klaas M Huijbregts
- GGNet, Mental Health, RGC SKB Winterswijk, Beatrixpark 1, 7101 BN Winterswijk, The Netherlands.
| | | | - Shehzad Ali
- Epidemiology and Biostatistics Department, Schulich School of Medicine & Dentistry, Western University, Kresge Building, Room K201, London, Ontario, N6A 5C1, Canada; Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK.
| | - Simon Gilbody
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
| | - Dean McMillan
- Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK.
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Poulsen R, Hoff A, Fisker J, Hjorthøj C, Eplov LF. Integrated mental health care and vocational rehabilitation to improve return to work rates for people on sick leave because of depression and anxiety (the Danish IBBIS trial): study protocol for a randomized controlled trial. Trials 2017; 18:578. [PMID: 29197414 PMCID: PMC5712198 DOI: 10.1186/s13063-017-2272-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/06/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Depression and anxiety are among the largest contributors to the global burden of disease and have negative effects on both the individual and society. Depression and anxiety are very likely to influence the individual's work ability, and up to 40% of the people on sick leave in Denmark have depression and/or anxiety. There is no clear evidence that treatment alone will provide sufficient support for vocational recovery in this group. Integrated vocational and health care services have shown good effects on return to work in other, similar welfare contexts. The purpose of the IBBIS (Integrated Mental Health Care and Vocational Rehabilitation to Individuals on Sick Leave Due to Anxiety and Depression) interventions is to improve and hasten the process of return to employment for people in Denmark on sick leave because of depression and anxiety. METHODS/DESIGN This three-arm, parallel-group, randomized superiority trial has been set up to investigate the effectiveness of the IBBIS mental health care intervention and the integrated IBBIS mental health care and IBBIS vocational rehabilitation intervention for people on sick leave because of depression and/or anxiety in Denmark. The trial has an investigator-initiated multicenter design. A total of 603 patients will be recruited from Danish job centers in 4 municipalities and randomly assigned to one of 3 groups: (1) IBBIS mental health care integrated with IBBIS vocational rehabilitation, (2) IBBIS mental health care and standard vocational rehabilitation, and (3) standard mental health care and standard vocational rehabilitation. The primary outcome is register-based return to work at 12 months. The secondary outcome measures are self-assessed level of depression (Beck Depression Inventory II), anxiety (Beck Anxiety Inventory), stress symptoms (Four-Dimensional Symptom Questionnaire), work and social functioning (Work and Social Adjustment Scale), and register-based recurrent sickness absence. DISCUSSION This study will provide new knowledge on vocational recovery, integrated vocational and health care interventions, and prevention of recurrent sickness absence among people with depression and anxiety. If the effect on return to work is different in the intervention groups, this study can contribute to current knowledge on shared care models for health care and vocational rehabilitation services. TRIAL REGISTRATION ClinicalTrials.gov, NCT02872051 . Retrospectively registered on 15 August 2016.
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Affiliation(s)
- Rie Poulsen
- Mental Health Center Copenhagen, Mental Health Services Capital Region of Denmark, University of Copenhagen, Kildegårdsvej 28, Opgang 15.4, DK-2900, Hellerup, Copenhagen, Denmark.
| | - Andreas Hoff
- Mental Health Center Copenhagen, Mental Health Services Capital Region of Denmark, University of Copenhagen, Kildegårdsvej 28, Opgang 15.4, DK-2900, Hellerup, Copenhagen, Denmark
| | - Jonas Fisker
- Mental Health Center Copenhagen, Mental Health Services Capital Region of Denmark, University of Copenhagen, Kildegårdsvej 28, Opgang 15.4, DK-2900, Hellerup, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Mental Health Center Copenhagen, Mental Health Services Capital Region of Denmark, University of Copenhagen, Kildegårdsvej 28, Opgang 15.4, DK-2900, Hellerup, Copenhagen, Denmark
| | - Lene Falgaard Eplov
- Mental Health Center Copenhagen, Mental Health Services Capital Region of Denmark, University of Copenhagen, Kildegårdsvej 28, Opgang 15.4, DK-2900, Hellerup, Copenhagen, Denmark
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7
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Poulsen R, Fisker J, Hoff A, Hjorthøj C, Eplov LF. Integrated mental health care and vocational rehabilitation to improve return to work rates for people on sick leave because of exhaustion disorder, adjustment disorder, and distress (the Danish IBBIS trial): study protocol for a randomized controlled trial. Trials 2017; 18:579. [PMID: 29197404 PMCID: PMC5712165 DOI: 10.1186/s13063-017-2273-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/11/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Common mental disorders are important contributors to the global burden of disease and cause negative effects on both the individual and society. Stress-related disorders influence the individual's workability and cause early retirement pensions in Denmark. There is no clear evidence that mental health care alone will provide sufficient support for vocational recovery for this group. Integrated vocational and health care services have shown good effects on return to work in other similar welfare contexts. The purpose of the Danish IBBIS (Integreret Behandlings- og BeskæftigelsesIndsats til Sygemeldte) study is to examine the efficacy of (1) a stepped mental health care intervention with individual stress coaching and/or group-based MBSR and (2) an integrated stepped mental health care with individual stress coaching and/or group-based MBSR and vocational rehabilitation intervention for people on sick leave because of exhaustion disorder, adjustment disorder or distress in Denmark. METHOD/DESIGN This three-armed, parallel-group, randomized superiority trial is set up to investigate the effectiveness of a stepped mental health care intervention and an integrated mental health care and vocational rehabilitation intervention for people on sick leave because of exhaustion disorder, adjustment disorder or distress in Denmark. The trial has an investigator-initiated multicenter design. Six hundred and three patients will be recruited from Danish vocational rehabilitation centers in four municipalities and randomly assigned into three groups: (1) IBBIS mental health care integrated with IBBIS vocational rehabilitation, (2) IBBIS mental health care and standard vocational rehabilitation, and (3) standard mental health care and standard vocational rehabilitation. The primary outcome is register-based return to work at 12 months. The secondary outcome measures are self-assessed level of depression (BDI), anxiety (BAI), distress symptoms (4DSQ), work- and social functioning (WSAS), and register-based recurrent sickness absence. DISCUSSION This study will contribute with knowledge on the consequence of the current organizational separation of health care interventions and vocational rehabilitation regarding the individual's process of returning to work after sick leave because of exhaustion disorder, adjustment disorder or distress. If the effect on return to work, symptom level, and recurrent sick leave is different in the intervention groups, this study can contribute with new knowledge on shared care models and the potential for preventing deterioration in stress symptoms, prolonged sick leave, and recurrent sick leave. TRIAL REGISTRATION ClinicalTrials.gov, registration number: NCT02885519 . Retrospectively registered on 15 August 2016). Participants have been included in the IBBIS trial for distress, adjustment disorder and exhaustion disorder since April 2016.
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Affiliation(s)
- Rie Poulsen
- Mental Health Center Copenhagen, Mental Health Services Capital Region of Denmark, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Copenhagen, Denmark.
| | - Jonas Fisker
- Mental Health Center Copenhagen, Mental Health Services Capital Region of Denmark, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Copenhagen, Denmark
| | - Andreas Hoff
- Mental Health Center Copenhagen, Mental Health Services Capital Region of Denmark, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Copenhagen, Denmark
| | - Carsten Hjorthøj
- Mental Health Center Copenhagen, Mental Health Services Capital Region of Denmark, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Copenhagen, Denmark
| | - Lene Falgaard Eplov
- Mental Health Center Copenhagen, Mental Health Services Capital Region of Denmark, University of Copenhagen, Kildegårdsvej 28, 2900, Hellerup, Copenhagen, Denmark
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8
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Dham P, Colman S, Saperson K, McAiney C, Lourenco L, Kates N, Rajji TK. Collaborative Care for Psychiatric Disorders in Older Adults: A Systematic Review. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:761-771. [PMID: 28718325 PMCID: PMC5697628 DOI: 10.1177/0706743717720869] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the mode of implementation, clinical outcomes, cost-effectiveness, and the factors influencing uptake and sustainability of collaborative care for psychiatric disorders in older adults. DESIGN Systematic review. SETTING Primary care, home health care, seniors' residence, medical inpatient and outpatient. PARTICIPANTS Studies with a mean sample age of 60 years and older. INTERVENTION Collaborative care for psychiatric disorders. METHODS PubMed, MEDLINE, Embase, and Cochrane databases were searched up until October 2016. Individual randomized controlled trials and cohort, case-control, and health service evaluation studies were selected, and relevant data were extracted for qualitative synthesis. RESULTS Of the 552 records identified, 53 records (from 29 studies) were included. Very few studies evaluated psychiatric disorders other than depression. The mode of implementation differed based on the setting, with beneficial use of telemedicine. Clinical outcomes for depression were significantly better compared with usual care across settings. In depression, there is some evidence for cost-effectiveness. There is limited evidence for improved dementia care and outcomes using collaborative care. There is a lack of evidence for benefit in disorders other than depression or in settings such as home health care and general acute inpatients. Attitudes and skill of primary care staff, availability of resources, and organizational support are some of the factors influencing uptake and implementation. CONCLUSIONS Collaborative care for depressive disorders is feasible and beneficial among older adults in diverse settings. There is a paucity of studies on collaborative care in conditions other than depression or in settings other than primary care, indicating the need for further evaluation.
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Affiliation(s)
- Pallavi Dham
- 1 Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,2 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Colman
- 1 Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,2 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Karen Saperson
- 3 Department of Psychiatry & Behavioral Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Carrie McAiney
- 3 Department of Psychiatry & Behavioral Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lillian Lourenco
- 1 Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Nick Kates
- 3 Department of Psychiatry & Behavioral Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Tarek K Rajji
- 1 Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,2 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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McCusker J, Yaffe M, Sussman T, Cole M, Sewitch M, Strumpf E, Freeman E, Lambert S, de Raad M. La gestion de la dépression chez les aînés et leurs aidants naturels : résultats d’un programme de recherche au Québec. SANTE MENTALE AU QUEBEC 2017. [DOI: 10.7202/1040254ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
La dépression est un problème répandu, sérieux, et souvent chronique chez les aînés, qui sont souvent atteints de maladies physiques chroniques, et affecte de façon négative leurs traitements et leurs soins. Malheureusement, le taux de détection et de suivi adéquat de la dépression est faible dans cette population. Au cours des deux dernières décennies, notre équipe a mené une série d’études pour mieux comprendre et améliorer la gestion de la dépression chez les aînés. Nous présentons une revue narrative et synthèse de 25 articles qui incluent : 4 revues systématiques, 10 études observationnelles, 9 essais d’interventions, et 2 conférences de consensus. Nous proposons en conclusion nos recommandations pour 1) la détection de la dépression dans les soins de santé primaires ; 2) les soins collaboratifs de la dépression ; 3) des interventions d’autogestion de la dépression ; 4) le rôle des aidants naturels dans les interventions d’autogestion de la dépression.
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Affiliation(s)
- Jane McCusker
- Centre de recherche de St. Mary, Montréal, Canada
- Département d’épidémiologie, biostatistique et santé au travail, Université McGill, Montréal, Canada
| | - Mark Yaffe
- Département de médecine familiale, Centre hospitalier de St. Mary, Montréal, Canada
- Département de médecine de famille, Université McGill, Montréal, Canada
| | - Tamara Sussman
- École de travail social, Université McGill, Montréal, Canada
| | - Martin Cole
- Centre de recherche de St. Mary, Montréal, Canada
- Département de psychiatrie, Centre hospitalier de St. Mary, Montréal, Canada
- Département de psychiatrie, Université McGill, Montréal, Canada
| | - Maida Sewitch
- Département d’épidémiologie, biostatistique et santé au travail, Université McGill, Montréal, Canada
- Institut de recherche du Centre universitaire de santé McGill, Montréal, Canada
- Centre universitaire de santé McGill, Divisions de gastroentérologie et d’épidémiologie clinique, Montréal, Canada
| | - Erin Strumpf
- Département d’économie, Université McGill, Montréal, Canada
| | - Ellen Freeman
- Centre de recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Canada
| | - Sylvie Lambert
- Centre de recherche de St. Mary, Montréal, Canada
- École des sciences infirmières Ingram, Université McGill, Montréal, Canada
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Anderson D. Depression: to screen or not to screen? Age Ageing 2015; 44:728-9. [PMID: 26259949 DOI: 10.1093/ageing/afv097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Esiwe C, Baillon S, Rajkonwar A, Lindesay J, Lo N, Dennis M. Screening for depression in older adults on an acute medical ward: the validity of NICE guidance in using two questions. Age Ageing 2015; 44:771-5. [PMID: 25736417 DOI: 10.1093/ageing/afv018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 12/10/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND depression is common in older people in general hospital settings and associated with poor outcomes. This study aimed to evaluate the validity of two screening questions recommended by the UK National Institute for Health and Clinical Excellence (NICE). METHODS one hundred and eighteen patients aged over 65 years, admitted to acute medical wards at a teaching hospital, were interviewed in a standardised manner using relevant sections of the Present State Examination-Schedules for Clinical Assessment in Neuropsychiatry to identify depression according to ICD-10 criteria. Subsequently, participants completed the two depression screening questions and the 15-item version of the Geriatric Depression Scale (GDS-15). RESULTS a threshold of one or more positive responses to the two NICE depression screening questions gave a sensitivity of 100%, specificity of 71%, positive predictive value (PPV) of 49% and negative predictive value (NPV) of 100%. The GDS-15 optimal cut-off was 6/7 with a sensitivity of 80%, specificity of 86%, PPV of 62% and NPV of 94%. A two-stage screening process utilising the NICE two questions followed by the GDS-15 with these cut-offs gave a sensitivity of 80%, specificity of 91%, PPV of 71% and NPV of 94%. CONCLUSION the two depression questions perform well as an initial screening process for non-cognitively impaired older people in the acute medical setting. A positive response to either question would indicate that further assessment is required by a clinician competent in diagnosing depression in this population, or the possible use of a more detailed instrument such as the GDS-15 to reduce the number of false-positive cases.
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Affiliation(s)
- Collins Esiwe
- Lincolnshire Partnership NHS Foundation Trust, Sleaford, Lincolnshire, UK
| | - Sarah Baillon
- Department of Health Sciences, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
| | | | - James Lindesay
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Nelson Lo
- Department of Geriatric Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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Esteghamat SS, Moghaddami S, Esteghamat SS, Kazemi H, Kolivand PH, Gorji A. The course of anxiety and depression in surgical and non-surgical patients. Int J Psychiatry Clin Pract 2014; 18:16-20. [PMID: 24370120 DOI: 10.3109/13651501.2013.878365] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of this study was to compare the level of anxiety and depression in patients admitted to surgery or internal departments. METHODS The study was carried out on 359 hospitalized patients over the age of 18 years and designed as a cross sectional survey. Participants were recruited from internal medicine and surgery departments of Khatam Ol Anbia hospital, Tehran, Iran. Information was collected using the Hospital Anxiety and Depression Scale. RESULTS Ninety-four (26.18%) patients had no anxiety and depression, 96 (26.7%) were borderline cases of anxiety, 140 (39%) were very anxious, 89 (24.8%) were borderline cases of depression, and 106 (29.5%) had depressed mood. There was a significant correlation between anxious mood and sex and duration of background disease as well as between the level of depressive mood and age. Patients with anxiety are significantly more prone to depression. However there were no significant differences between the level of anxiety or depression between surgical or non-surgical patients. CONCLUSIONS The prevalence of anxious and depressive moods was high in both surgical and non-surgical patients. However, non-surgical treatments were as stressful as surgical procedures for patients admitted to hospital in the first 24 h.
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Stoppe C, Fahlenkamp A, Rex S, Veeck N, Gozdowsky S, Schälte G, Autschbach R, Rossaint R, Coburn M. Feasibility and safety of xenon compared with sevoflurane anaesthesia in coronary surgical patients: a randomized controlled pilot study † †Presented, in part, at the annual congress ‘25. Herbsttreffen des wissenschaftlichen Arbeitskreises Kardioanästhesie’ in Fulda, Germany, 2011: ‘Feasibility and hemodynamic effects of xenon anaesthesia compared to sevoflurane anaesthesia in cardiac surgical patients'a randomized controlled pilot study’. Br J Anaesth 2013; 111:406-16. [DOI: 10.1093/bja/aet072] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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14
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Sachs-Ericsson N, Corsentino E, Moxley J, Hames JL, Collins N, Sawyer K, Selby EA, Joiner T, Zarit S, Gotlib IH, Steffens DC. A longitudinal study of differences in late- and early-onset geriatric depression: depressive symptoms and psychosocial, cognitive, and neurological functioning. Aging Ment Health 2013; 17:1-11. [PMID: 22934752 PMCID: PMC3535510 DOI: 10.1080/13607863.2012.717253] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Studies suggest early-onset depression (EOD) is associated with a more severe course of the depressive disorder, while late-onset depression (LOD) is associated with more cognitive and neuroimaging changes. This study examined if older adults with EOD, compared with those with LOD, would exhibit more severe symptoms of depression and, consistent with the glucocorticoid cascade hypothesis, have more hippocampal volume loss. A second goal was to determine if LOD, compared with EOD, would demonstrate more cognitive and neuroimaging changes. METHOD At regular intervals over a four-year period non-demented, older, depressed adults were assessed on the Mini-Mental Status Examination and the Montgomery-Asberg Depression Rating Scale. They were also assessed on magnetic resonance imaging. RESULTS Compared with LOD, EOD had more depressive symptoms, more suicidal thoughts, and less social support. Growth curve analyses indicated that EOD demonstrated higher levels of residual depressive symptoms over time. The LOD group exhibited a greater decrement in cognitive scores. Contrary to the glucocorticoid cascade hypothesis, participants with EOD lost right hippocampal volume at a slower rate than did participants with LOD. Right cerebrum gray matter was initially smaller among participants with LOD. CONCLUSIONS EOD is associated with greater severity of depressive illness. LOD is associated with more severe cognitive and neurological changes. These differences are relevant to understanding cognitive impairment in geriatric depression.
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Pierluissi E, Mehta KM, Kirby KA, Boscardin WJ, Fortinsky RH, Palmer RM, Landefeld CS. Depressive symptoms after hospitalization in older adults: function and mortality outcomes. J Am Geriatr Soc 2012. [PMID: 23176725 DOI: 10.1111/jgs.12008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To determine the relationship between depressive symptoms after hospitalization and survival and functional outcomes. DESIGN Secondary analysis of a prospective cohort study. SETTING General medical service of two urban, teaching hospitals in Ohio. PARTICIPANTS Hospitalized individuals aged 70 and older. MEASUREMENTS Ten depressive symptoms, instrumental activities of daily living (IADLs), and basic activities of daily living (ADLs) were measured at hospital discharge and 1, 3, 6, and 12 months later. Participant-specific changes in depressive symptoms (slopes) were determined using all data points. Four groups were also defined according to number of depressive symptoms (≤3 symptoms, low; 4-10 symptoms, high) at discharge and follow-up: low-low, low-high, high-low, and high-high. Mortality was measured 3, 6, and 12 months after hospital discharge. RESULTS Participant-specific discharge depressive symptoms and change in depressive symptoms over time (slopes) were associated (P < .05) with functional and mortality outcomes. At 1 year, more participants in the low-low depressive symptom group (49%) were alive and independent in IADLs and ADLs than in the low-high group (37%, P = .02), and more participants in the high-low group (39%) were alive and independent in IADLs and ADLs than in the high-high group (19%, P < .001). CONCLUSION Number of depressive symptoms and change in number of depressive symptoms during the year after discharge were associated with functional and mortality outcomes in hospitalized older adults. Fewer participants with persistently high or increasing depressive symptoms after hospitalization were alive and functionally independent 1 year later than participants with decreasing or persistently low symptoms, respectively.
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Affiliation(s)
- Edgar Pierluissi
- Division of Geriatrics, University of California at San Francisco, San Francisco, California 94110, USA.
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Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev 2012; 10:CD006525. [PMID: 23076925 DOI: 10.1002/14651858.cd006525.pub2] [Citation(s) in RCA: 456] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Common mental health problems, such as depression and anxiety, are estimated to affect up to 15% of the UK population at any one time, and health care systems worldwide need to implement interventions to reduce the impact and burden of these conditions. Collaborative care is a complex intervention based on chronic disease management models that may be effective in the management of these common mental health problems. OBJECTIVES To assess the effectiveness of collaborative care for patients with depression or anxiety. SEARCH METHODS We searched the following databases to February 2012: The Cochrane Collaboration Depression, Anxiety and Neurosis Group (CCDAN) trials registers (CCDANCTR-References and CCDANCTR-Studies) which include relevant randomised controlled trials (RCTs) from MEDLINE (1950 to present), EMBASE (1974 to present), PsycINFO (1967 to present) and the Cochrane Central Register of Controlled Trials (CENTRAL, all years); the World Health Organization (WHO) trials portal (ICTRP); ClinicalTrials.gov; and CINAHL (to November 2010 only). We screened the reference lists of reports of all included studies and published systematic reviews for reports of additional studies. SELECTION CRITERIA Randomised controlled trials (RCTs) of collaborative care for participants of all ages with depression or anxiety. DATA COLLECTION AND ANALYSIS Two independent researchers extracted data using a standardised data extraction sheet. Two independent researchers made 'Risk of bias' assessments using criteria from The Cochrane Collaboration. We combined continuous measures of outcome using standardised mean differences (SMDs) with 95% confidence intervals (CIs). We combined dichotomous measures using risk ratios (RRs) with 95% CIs. Sensitivity analyses tested the robustness of the results. MAIN RESULTS We included seventy-nine RCTs (including 90 relevant comparisons) involving 24,308 participants in the review. Studies varied in terms of risk of bias.The results of primary analyses demonstrated significantly greater improvement in depression outcomes for adults with depression treated with the collaborative care model in the short-term (SMD -0.34, 95% CI -0.41 to -0.27; RR 1.32, 95% CI 1.22 to 1.43), medium-term (SMD -0.28, 95% CI -0.41 to -0.15; RR 1.31, 95% CI 1.17 to 1.48), and long-term (SMD -0.35, 95% CI -0.46 to -0.24; RR 1.29, 95% CI 1.18 to 1.41). However, these significant benefits were not demonstrated into the very long-term (RR 1.12, 95% CI 0.98 to 1.27).The results also demonstrated significantly greater improvement in anxiety outcomes for adults with anxiety treated with the collaborative care model in the short-term (SMD -0.30, 95% CI -0.44 to -0.17; RR 1.50, 95% CI 1.21 to 1.87), medium-term (SMD -0.33, 95% CI -0.47 to -0.19; RR 1.41, 95% CI 1.18 to 1.69), and long-term (SMD -0.20, 95% CI -0.34 to -0.06; RR 1.26, 95% CI 1.11 to 1.42). No comparisons examined the effects of the intervention on anxiety outcomes in the very long-term.There was evidence of benefit in secondary outcomes including medication use, mental health quality of life, and patient satisfaction, although there was less evidence of benefit in physical quality of life. AUTHORS' CONCLUSIONS Collaborative care is associated with significant improvement in depression and anxiety outcomes compared with usual care, and represents a useful addition to clinical pathways for adult patients with depression and anxiety.
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Affiliation(s)
- Janine Archer
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK.
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Sachs-Ericsson N, Selby E, Corsentino E, Collins N, Sawyer K, Hames J, Arce D, Joiner T, Steffens DC. Depressed older patients with the atypical features of interpersonal rejection sensitivity and reversed-vegetative symptoms are similar to younger atypical patients. Am J Geriatr Psychiatry 2012; 20:622-34. [PMID: 21997599 PMCID: PMC3374907 DOI: 10.1097/jgp.0b013e31822cccff] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The atypical depression (AD) subtype has rarely been examined in older patients. However, younger AD patients have been characterized as having more severe and chronic symptoms of depression compared with non-AD patients. DESIGN Secondary data analysis by using analyses of variance and Growth Curve Modeling. SETTING Clinical Research Center for the study of depression in later life. PARTICIPANTS Depressed older patients (N = 248) followed over 2 years. METHOD In a longitudinal study, we examined depression severity and chronicity in patients with major depression with some features of AD, specifically rejection sensitivity and reversed-vegetative symptoms (e.g., hyperphagia and hypersomnia), or leaden paralysis, and compared them to non-AD patients. The Diagnostic Interview Schedule (DIS) was used to assess depressive symptoms and history. Depression severity and chronicity were assessed every 3 months by using the Montgomery Asberg Depression Rating Scale. RESULTS The AD symptom group reported more DIS depressive symptoms, more thoughts about wanting to die, earlier age of onset, poorer social support, and double the number of lifetime episodes than non-AD patients. Growth curve analyses revealed that, compared with non-AD patients, the AD symptom group had more residual symptoms of depression during the first year of follow-up but not during the second year. CONCLUSION Characteristics of older patients with features of AD are similar to younger patients. Assessment of atypical symptoms, in particular, rejection sensitivity and reversed-vegetative symptoms, is essential and should be considered in treatment plans.
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Thota AB, Sipe TA, Byard GJ, Zometa CS, Hahn RA, McKnight-Eily LR, Chapman DP, Abraido-Lanza AF, Pearson JL, Anderson CW, Gelenberg AJ, Hennessy KD, Duffy FF, Vernon-Smiley ME, Nease DE, Williams SP. Collaborative care to improve the management of depressive disorders: a community guide systematic review and meta-analysis. Am J Prev Med 2012; 42:525-38. [PMID: 22516495 DOI: 10.1016/j.amepre.2012.01.019] [Citation(s) in RCA: 304] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 01/27/2012] [Accepted: 01/27/2012] [Indexed: 12/21/2022]
Abstract
CONTEXT To improve the quality of depression management, collaborative care models have been developed from the Chronic Care Model over the past 20 years. Collaborative care is a multicomponent, healthcare system-level intervention that uses case managers to link primary care providers, patients, and mental health specialists. In addition to case management support, primary care providers receive consultation and decision support from mental health specialists (i.e., psychiatrists and psychologists). This collaboration is designed to (1) improve routine screening and diagnosis of depressive disorders; (2) increase provider use of evidence-based protocols for the proactive management of diagnosed depressive disorders; and (3) improve clinical and community support for active client/patient engagement in treatment goal-setting and self-management. EVIDENCE ACQUISITION A team of subject matter experts in mental health, representing various agencies and institutions, conceptualized and conducted a systematic review and meta-analysis on collaborative care for improving the management of depressive disorders. This team worked under the guidance of the Community Preventive Services Task Force, a nonfederal, independent, volunteer body of public health and prevention experts. Community Guide systematic review methods were used to identify, evaluate, and analyze available evidence. EVIDENCE SYNTHESIS An earlier systematic review with 37 RCTs of collaborative care studies published through 2004 found evidence of effectiveness of these models in improving depression outcomes. An additional 32 studies of collaborative care models conducted between 2004 and 2009 were found for this current review and analyzed. The results from the meta-analyses suggest robust evidence of effectiveness of collaborative care in improving depression symptoms (standardized mean difference [SMD]=0.34); adherence to treatment (OR=2.22); response to treatment (OR=1.78); remission of symptoms (OR=1.74); recovery from symptoms (OR=1.75); quality of life/functional status (SMD=0.12); and satisfaction with care (SMD=0.39) for patients diagnosed with depression (all effect estimates were significant). CONCLUSIONS Collaborative care models are effective in achieving clinically meaningful improvements in depression outcomes and public health benefits in a wide range of populations, settings, and organizations. Collaborative care interventions provide a supportive network of professionals and peers for patients with depression, especially at the primary care level.
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Affiliation(s)
- Anilkrishna B Thota
- Community Guide Branch, Epidemiology and Analysis Program Office, Office of Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia 30333, USA.
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Antidepressant use and cognitive functioning in older medical patients with major or minor depression: a prospective cohort study with database linkage. J Clin Psychopharmacol 2011; 31:429-35. [PMID: 21694621 PMCID: PMC3558972 DOI: 10.1097/jcp.0b013e318221b2f8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The long-term cognitive effect of antidepressant medications in older persons is not well understood, especially in those with minor depression and complex medical conditions. The objective of this study is to examine this relationship in older medical patients with different depression diagnoses. METHODS 281 medical inpatients aged 65 years and older from 2 acute care hospitals in Montreal, Canada, were diagnosed as with major or minor depression or without depression according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. They were followed up with the Mini-Mental State Examination for cognitive function and the Hamilton Depression Rating Scale for depressive symptoms at baseline and 3, 6, and 12 months after discharge. Antidepressant medication was ascertained from a provincial prescription database and quantified as cumulative exposures over each follow-up interval. RESULTS During the 12-month follow-up period, 1027 antidepressant prescriptions were filled. The most frequently prescribed antidepressant agents were citalopram (0.81 prescriptions per person), sertraline (0.76), and paroxetine (0.66). Antidepressant use was not associated with cognitive changes among patients with major depression or without depression but was associated with an increased Mini-Mental State Examination score in patients with minor depression (1.4 points; 95% confidence interval, 0.1-2.6), independent of change in the severity of depression symptoms, concomitant benzodiazepine or psychotropic drug use, and other potentially important confounders. CONCLUSIONS In this cohort of older medical patients, antidepressant use for 12 months did not lead to significant cognitive impairment. The small cognitive improvement among minor depression associated with antidepressant use deserves further investigation.
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Richter AW, Dawson JF, West MA. The effectiveness of teams in organizations: a meta-analysis. INTERNATIONAL JOURNAL OF HUMAN RESOURCE MANAGEMENT 2011. [DOI: 10.1080/09585192.2011.573971] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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The moderating effect of the APOE [small element of] 4 allele on the relationship between hippocampal volume and cognitive decline in older depressed patients. Am J Geriatr Psychiatry 2011; 19:23-32. [PMID: 21218563 PMCID: PMC3057467 DOI: 10.1097/jgp.0b013e3181f61ae8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE the apolipoprotein E epsilon-4 (APOE [small element of] 4) allele and depression are independently associated with increased risk for cognitive decline (CD). The authors have reported that depressed elders with an APOE [small element of]4 allele had greater CD compared with depressed elders without the allele. Depression affects the hippocampus, and reduced hippocampal volume has been associated with CD. This study sought to examine in depressed patients the relationships between hippocampal volume, the APOE [small element of] 4 allele, and their interaction on CD. Analyses were performed to examine the influence of baseline hippocampal volume, the APOE [small element of] 4 allele, and their interactions on change in cognitive functioning overtime. DESIGN secondary data analysis using linear regression analyses. SETTING clinical Research Center for the Study of Depression in Later Life conducted at Duke University. PARTICIPANTS depressed older patients (N = 61) followed up for 4 years. MEASURES At baseline, cognitive functioning (assessed by the Mini-Mental State Examination), left and right hippocampal volume (assessed by magnetic resonance imaging), and APOE genotype were obtained. At 4-year follow-up, cognitive functioning was reassessed. RESULTS the APOE [small element of] 4 allele and left hippocampal volume, but not right hippocampal volume, were independently associated with CD. Importantly, the authors found the APOE [small element of]4 allele to moderate the effects of left hippocampal volume on CD. The APOE [small element of]4 allele seemed to have little effect among those with larger left hippocampal volumes, whereas the allele influenced CD among those with smaller hippocampal volumes. CONCLUSION future studies of cognitive impairment and decline should examine both individual and conjoint effects of putative risk factors.
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Which version of the geriatric depression scale is most useful in medical settings and nursing homes? Diagnostic validity meta-analysis. Am J Geriatr Psychiatry 2010; 18:1066-77. [PMID: 21155144 DOI: 10.1097/jgp.0b013e3181f60f81] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The Geriatric Depression Scale (GDS) has been evaluated in individual studies, but its validity and added value in medical settings and nursing homes is uncertain. Therefore, the authors conducted a meta-analysis, analyzing the diagnostic accuracy of long, short, and ultrashort versions of the GDS and stratified this into those with and without cognitive impairment. METHODS A comprehensive search identified 69 studies that measured the diagnostic validity of the GDS against a semistructured psychiatric interview, and of these, 43 analyses (in 36 publications) took place inmedical settings. Twenty-one studies examined the GDS₃₀, 12 studies examined the GDS₁₅, and 3 examined the GDS₄(/)₅. For comparison, the authors also summarized studies examining unassisted clinical judgment. Heterogeneity was moderate to high; therefore, random effects meta-analysis was used. RESULTS Across all studies, the prevalence of late-life depression was 29.2% (95% confidence interval [CI] = 24.7%–33.9%), with no difference between inpatients, outpatients, and nursing homes. Diagnostic accuracy of the GDS₃₀ aftermeta-analytic weighting was given by a sensitivity of 81.9% (95% CI = 76.4%–86.9%) and a specificity of 77.7% (95% CI = 73.0%–82.1%). For the GDS₁₅, sensitivity was 84.3% (95% CI = 79.7%–88.4%) and specificity was 73.8% (95% CI = 68.0%–79.2%). For the GDS₄(/)₅, the sensitivity and specificity were 92.5% (95% CI = 85.5%–97.4%) and 77.2% (95% CI = 66.6%–86.3%), respectively. Results were not significantly influenced by the presence of dementia. Concerning added value, when identification using the GDS was compared with routine clinicians’ ability to diagnose late-life depressions, at a prevalence of 30%, of every 100 attendees, the GDS₃₀ would help correctly identify an additional 22 people as depressed but at a cost of 13 additional false positives. The GDS₁₅ performed the same as GDS₃₀ but with 15 false positives. The ultrashort form would help identify an additional 25 true positives with only 10 false positives. Thus, the best option when choosing between versions of the GDS seems to be the GDS₄(/)₅. CONCLUSION All versions of the GDS yield potential added value in medical settings, but the GDS₄(/)₅ is the most efficient. In nursing homes, given an absence of data on the GDS₄(/)₅, the GDS₁₅ may be preferred until more studies are reported.
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A Hope Intervention Compared to Friendly Visitors as a Technique to Reduce Depression among Older Nursing Home Residents. Nurs Res Pract 2010; 2010:676351. [PMID: 21994812 PMCID: PMC3168928 DOI: 10.1155/2010/676351] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 03/25/2010] [Accepted: 05/10/2010] [Indexed: 11/17/2022] Open
Abstract
Depression is common among older persons. An experimental study was undertaken to test the impact of a four-week hope program on depressed nursing home residents. Residents aged 65 or older, who met the criteria for this pilot study and agreed to participate, were randomly assigned to (a) an intervention group, and provided with weekday hope interventions mainly involving positive messages and pictures or (b) a modified control group, and provided with a friendly weekday greeting. The structured hope intervention was not proven effective for reducing depression or raising hope. Instead, a significant reduction in depression among the control subjects was found, as well as a nonsignificant increase in their level of hope. Although these findings suggest friendly visitors may be a more efficacious nonpharmacological approach for reducing depression, further investigations are needed to confirm this and to explore the impact of other hope interventions.
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Helvik AS, Skancke RH, Selbaek G. Screening for depression in elderly medical inpatients from rural area of Norway: prevalence and associated factors. Int J Geriatr Psychiatry 2010; 25:150-9. [PMID: 19551706 DOI: 10.1002/gps.2312] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIM The present investigation screened for depression in order to assess the prevalence of depression and to study the associated factors with depression in elderly medically hospitalised patients from a rural area in Norway. METHODS A cross-sectional study evaluated 484 (243 women) elderly medical inpatients with age range 65-101 (mean 80.7) years between September 2006 and August 2008 and used the Hospital Anxiety and Depression scale (HAD), Montgomery and Asberg Depression Rating Scale, the Mini-Mental State Examination, Lawton and Brody's scale for self-maintaining and instrumental activities of daily living. RESULTS The prevalence of current depression, depression score > or =8 at HAD, was for the total sample 10% of whom 78% was previously not diagnosed as having depression. The odds for depression were decreased for women aged 80 years or more while for men at the same age strata it was increased threefold. Age adjusted logistic regression analyses demonstrated an increased odds for depression for those who were in need of nursing assistance before hospitalisation, had lower level of physical functioning, had clinical anxiety symptoms and had higher number of medicaments at inclusion time. CONCLUSION The prevalence of depression in medical hospitalised elderly from rural areas was lower than in most other hospital studies. However, most patients with depression were not previously recognised as being depressed.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Depression and health status in elderly hospitalized patients with chronic illness. Arch Gerontol Geriatr 2010; 50:6-10. [DOI: 10.1016/j.archger.2008.12.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 12/14/2008] [Accepted: 12/17/2008] [Indexed: 11/21/2022]
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Kim H, Capezuti E, Boltz M, Fairchild S. The Nursing Practice Environment and Nurse-Perceived Quality of Geriatric Care in Hospitals. West J Nurs Res 2009; 31:480-95. [DOI: 10.1177/0193945909331429] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The relationships between general and geriatric-specific nursing practice environments (NPEs) and nurse-perceived quality of geriatric care in hospitals were examined using the Nurses Improving Care for Healthsystems Elders benchmarking database. The overall general NPE was negatively related, but the overall geriatric-specific NPE was positively related to quality of geriatric care. Among five subdomains of the general NPE measured by the Practice Environment Scale of the Nursing Work Index, Nurse Participation in Hospital Affairs was positively related to quality of geriatric care, whereas two subdomains were not significant, and another two were negatively related to quality of geriatric care. All three subdomains of the geriatric-specific NPE measured by the Geriatric Nursing Practice Environment scale were positively related to quality of geriatric care when adjusting for general NPE. These findings suggest geriatric-specific organizational support combined with nurse involvement in hospital decision making is critical for delivering quality geriatric care.
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McCusker J, Latimer E, Cole M, Ciampi A, Sewitch M. The nature of informal caregiving for medically ill older people with and without depression. Int J Geriatr Psychiatry 2009; 24:239-46. [PMID: 18618842 DOI: 10.1002/gps.2096] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To describe patient and caregiver perceptions of the nature of informal caregiving in a sample of older medical inpatients with and without depression. METHODS One hundred and fifty-four patient-caregiver pairs were recruited from a larger prospective observational study of three groups of medical inpatients aged 65 and over, with major, minor, and no depression, respectively, and with at most mild cognitive impairment. Interviews were conducted at the time of hospital admission to assess characteristics of patients (disability, comorbidity, perceptions of support) and caregivers (relationship, residence, types of assistance and time spent caregiving). Time spent on the physical tasks of caregiving (assistance with activities of daily living, physical care, transport) was estimated by all caregivers. Time spent on emotional or other support was estimated only for non-coresident caregivers RESULTS In multivariable analyses, neither major nor minor depression was associated with time spent on physical support; major depression was associated with significantly increased time spent by non-coresident caregivers on emotional or other support; minor depression was associated with perceived inadequacy of support. CONCLUSIONS Major depression is independently associated with greater time spent by non-coresident caregivers on emotional or other support; minor depression is associated with perceived inadequacy of support.
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Affiliation(s)
- Jane McCusker
- St Mary's Hospital, McGill University, Montreal, Quebec, Canada.
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Cullum S, Metcalfe C, Todd C, Brayne C. Does depression predict adverse outcomes for older medical inpatients? A prospective cohort study of individuals screened for a trial. Age Ageing 2008; 37:690-5. [PMID: 19004962 DOI: 10.1093/ageing/afn193] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE to examine the relationship between depressive symptoms and hospital outcomes in an unselected consecutive sample of older medical inpatients. DESIGN a prospective cohort study of individuals screened for a trial. SETTING medical wards of UK district general hospital in rural East Anglia. PARTICIPANTS six hundred and seventeen medical inpatients aged 65+ were randomly selected from consecutive admissions. Baseline measures: 15-item Geriatric Depression Scale (GDS-15), the Abbreviated Mental Test Score (AMTS) and the Cumulative Illness Rating Scale-Geriatric (CIRS-G). MAIN OUTCOME MEASURES length of hospital stay; discharge to a community hospital (for rehabilitation), institutional care or usual place of residence; dying in hospital. RESULTS depressive symptoms are independently associated with an increased likelihood of inpatient death and transfer to a community hospital for rehabilitation, but are not associated with longer length of stay. CONCLUSIONS research evaluating effectiveness of identification and treatment of depression in older medical inpatients should consider including inpatient death and use of rehabilitation services as potential outcomes.
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Affiliation(s)
- Sarah Cullum
- West Suffolk Hospital and Department of Public Health and Primary Care, University of Cambridge, UK.
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Abstract
OBJECTIVE To examine the temporal relationship between depression diagnoses and cognitive function in older medical patients. DESIGN Prospective cohort study with repeated follow-up assessments at 3, 6, and 12 months after hospitalization. SETTING The medical services of two acute care hospitals in Montreal, Quebec, Canada. PARTICIPANTS Two hundred eighty-one medical inpatients aged 65 and older without apparent cognitive impairment at study entry. MEASUREMENTS Diagnostic Interview Schedule for depression and Mini-Mental State Examination (MMSE) for cognitive function. RESULTS At study entry, 121 (43.1%) and 51 (18.1%) patients, respectively, met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for major or minor depression. Based on a mixed effects regression model, depression diagnoses were associated with poorer cognitive function, independent of age, education, baseline cognitive and physical function, cardiovascular diseases and other comorbidities, previous history of depression and antidepressant treatment, and fluctuation in the severity of depression symptoms over time. On average across three follow-up assessments, patients with major or minor depression, respectively, had a 0.8 (95% confidence interval: 0.1-1.5) and 1.0 (0.3-1.8) point lower performance on the MMSE than those without depression. In contrast, there was no significant association when depression diagnoses and cognitive function were assessed over shorter intervals or cross-sectionally. A general linear regression model yielded consistent results, with adjusted effect estimates of 0.9 (0.03-0.8) for major and 1.5 (0.5-2.5) for minor depression over 12 months. CONCLUSION A diagnosis of major or minor depression at hospital admission is an independent risk factor for poorer cognitive function during the subsequent 12 months in older medical patients.
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McCusker J, Cole M, Latimer E, Sewitch M, Ciampi A, Cepoiu M, Belzile E. Recognition of depression in older medical inpatients discharged to ambulatory care settings: a longitudinal study. Gen Hosp Psychiatry 2008; 30:245-51. [PMID: 18433656 DOI: 10.1016/j.genhosppsych.2008.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Revised: 01/21/2008] [Accepted: 01/23/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to examine the recognition of depression in older medical inpatients by nonpsychiatric physicians over a 2-year period. METHODS A cohort of medical inpatients aged 65 and above was recruited at two university-affiliated hospitals, with oversampling of depressed patients. Participants were assessed with research diagnoses of major or minor depression (DSM-IV) at admission and at 3, 6 and 12 months. Indicators of recognition during the 12 months before and the 12 months after admission, derived from administrative databases, included the following: depression diagnosis, antidepressant prescription and psychiatric referral. Multiple logistic regression analyses were used to identify factors associated with recognition. RESULTS Among 185 patients with at least one research diagnosis of depression during the study, recognition rates ranged up to 56% during the 12 months before admission among patients with major depression lasting at least 6 months and up to 61% during the 12 months after admission among patients with persistent major depression. In both study periods, a greater number of physician visits and prescription of a psychotropic medication (non-antidepressant) were independently associated with recognition. CONCLUSIONS A longitudinal approach to measuring recognition of late-life depression in ambulatory care settings indicates that persistent major depression is more likely to be recognized than previously reported.
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Affiliation(s)
- Jane McCusker
- Department of Clinical Epidemiology and Community Studies, St Mary's Hospital, Montreal, Quebec, Canada.
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Abstract
OBJECTIVE To determine risk factors for major depression in older medical inpatients. METHOD In a prospective cohort study, 86 older medical inpatients without depression or antidepressant medication were assessed 3, 6, and 12 months after enrollment. Incident major depression was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Potential predictive variables included sociodemographic variables, physical state, cognition, depressive symptoms, medication use, prior depressive episode, social network, support, and bereavement. Cox proportional hazards analysis (with backward variable elimination) was used to determine the best set of predictors. RESULTS Twenty-six patients (30.2%) met criteria for incident major depression. Predictors of major depression included the following: prior depressive episode, birth outside Canada, low comorbidity, inadequate emotional support, fewer children seen, depressed mood, and diurnal variation. The risk of depression increased with the number of risk factors present. CONCLUSION The seven identified risk factors may guide efforts to prevent major depression in older medical inpatients.
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McCusker J, Cole M, Ciampi A, Latimer E, Windholz S, Belzile E. Major depression in older medical inpatients predicts poor physical and mental health status over 12 months. Gen Hosp Psychiatry 2007; 29:340-8. [PMID: 17591511 DOI: 10.1016/j.genhosppsych.2007.03.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Revised: 03/21/2007] [Accepted: 03/22/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the 12-month effects upon physical and mental health status of a diagnosis of major or minor depression among older medical inpatients. METHODS Patients 65 years and older, admitted to the medical wards of two university-affiliated hospitals, with at most mild cognitive impairment, were screened for major and minor depression (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria). All depressed patients and a random sample of nondepressed patients were invited to participate. The physical functioning and mental health subscales of the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were measured at baseline and at 3, 6 and 12 months. RESULTS Two hundred ten patients completed the SF-36 at baseline and at one or more follow-ups. In multiple linear regression analysis for longitudinal data, adjusting for baseline level of the SF-36 subscale outcome, severity of physical illness, premorbid disability, age, sex and other covariates, patients with major depression at baseline had lower SF-36 scores at follow-up, in comparison to patients with no depression [physical health, 9.22 (95% CI -15.52 to -2.93); mental health, 6.28 (95% CI -11.76 to -0.79)]. CONCLUSION A diagnosis of major depression in cognitively intact older medical inpatients is associated with sustained poor physical and mental health status over the following 12 months.
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Affiliation(s)
- Jane McCusker
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, Montreal (Quebec), Canada H3T 1M5.
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McCusker J, Latimer E, Cole M, Ciampi A, Sewitch M. Major depression among medically ill elders contributes to sustained poor mental health in their informal caregivers. Age Ageing 2007; 36:400-6. [PMID: 17537745 DOI: 10.1093/ageing/afm059] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND No longitudinal studies have addressed the effect of late life depression on the physical and mental health status of their informal caregivers. OBJECTIVE To examine whether a diagnosis of depression in older medical inpatients is associated with the physical and mental health status of their informal caregivers after 6 months, independent of the physical health of the care recipient. DESIGN Longitudinal observational study with 6-month follow-up. SETTING Two Montreal acute-care hospitals. SUBJECTS A sample of 97 cognitively intact medical inpatients aged 65 and over and their informal caregivers, with oversampling of patients with a diagnosis of major or minor depression. METHODS Patient data included depression (current diagnosis, duration of current diagnosis, severity of symptoms, and history of depression), physical health (severity of illness, comorbidity, premorbid disability), and cognitive impairment. Caregiver data included relationship to patient, co-residence, and the physical and mental health status subscales of the SF-36. Multivariate linear regression analyses were conducted to determine the relationship between patient depression and caregiver 6 month SF-36 physical and mental scores, adjusting for baseline values, patient comorbidity, disability, and other patient and caregiver variables. RESULTS Patient characteristics included: mean age 79.3, 62% female, 46% major depression, 18% minor depression, 36% no depression. Caregiver characteristics included: 73% female, 35% co-resident spouse, 15% other co-resident relation, 50% not residing with the patient. Results of the multivariate analyses showed that in comparison with caregivers of patients without a current diagnosis of depression, caregivers of those with major depression had a lower mental health score at follow-up (-9.54, 95% CI -16.66, -2.43), even though their physical health was slightly better (5.42 95% CI 0.04, 10.81). CONCLUSIONS A diagnosis of major depression in older medical inpatients is independently associated with poor mental health in their informal caregivers 6 months later.
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Affiliation(s)
- Jane McCusker
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, Canada.
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Abstract
Several compounds to improve cognition in schizophrenia are being studied in clinical trials, but little is known about how clinicians conceptualize the cognitive deficits of schizophrenia. In a pilot study, the author asked 40 psychiatrists 3 brief questions about the clinical presentation of cognitive deficits. Descriptions of cognitive deficits show high variability. Informants describe phenomenology like follow-through, attention, and emptiness as indicative of cognitive impairment. Informants' concepts of cognitive deficits overlap substantially with positive, negative, and thought disorder symptoms. Clinicians' concepts are complex and contextualized, in contrast to the discrete skills measured by neuropsychological tests. Results suggest that appropriate prescribing of cognition-enhancing medications may be challenging.
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Affiliation(s)
- Elizabeth Bromley
- Semel Institute Health Services Research Center, University of California, Los Angeles, 10920 Wilshire Boulevard, Suite 300, Los Angeles, CA 90024-6505, USA.
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McCusker J, Cole M, Ciampi A, Latimer E, Windholz S, Elie M, Belzile E. Twelve-month course of depressive symptoms in older medical inpatients. Int J Geriatr Psychiatry 2007; 22:411-7. [PMID: 17096457 DOI: 10.1002/gps.1689] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The study aimed: (1) to describe the 12-month course of depressive symptoms among medical inpatients aged 65+, and (2) to investigate predictors of a more severe course that could be identified easily by non-psychiatric staff. METHODS Patients were recruited at two Montreal hospitals. Inclusion criteria were: aged 65+, admitted to medical service, at most mild cognitive impairment. Patients were screened for major and minor depression (DSM-IV criteria). All depressed patients and a random sample of non-depressed patients were invited to participate in the prospective study. The Hamilton Depression Scale (HAMD) was administered at admission, 3, 6, and 12 months. Individual patient trajectories of depressive symptoms over time were grouped using hierarchical clustering into three patient groups with a minimal, mild, and moderate/severe course of symptoms, respectively. The baseline predictors of a more severe clinical course were identified using ordinal logistic regression. RESULTS Two hundred and thirty-two patients completed baseline and one or more follow-up interviews. Baseline patient characteristics that independently predicted a more severe symptom course included higher initial HAMD score, depressive core symptoms lasting 6 months or more, and female sex. CONCLUSION The 12-month course of depression symptoms in this medically ill older sample was generally stable. Patients who will experience a more severe course can be identified by non-psychiatric staff at admission to hospital.
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Affiliation(s)
- Jane McCusker
- Department of Clinical Epidemiology and Community Studies, St Mary's Hospital, and Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada.
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Abstract
BACKGROUND Studies of recognition of depression in older (aged 65 or more) medical inpatients show low rates of recognition of depression by attending physicians. However, few studies have compared different measures of recognition of depression. OBJECTIVES (1) To compare the validity of four indicators of recognition of depression and a global measure of recognition against a diagnosis of depression and (2) to explore the effect of patient characteristics on recognition of depression. METHODS In a cohort of 264 medical inpatients 65 years and older (115 with major or minor depression, 78 with no depression), sensitivities, specificities, and diagnostic odds ratios (DOR) of 4 indicators of recognition (symptoms, diagnosis, treatment, and referral) and a global measure of recognition (any of the 4 indicators) were calculated. The associations between patient characteristics (age, sex, history of depression, antidepressant use before admission, severity of depression, comorbidity, duration of hospitalization, disability, and hospital of admission) and recognition were explored using multiple logistic regression. RESULTS Less than half of the depressed patients were recognized. The indicator with the highest sensitivity was treatment (27.8%, 95% confidence interval [CI] 20.0-37.0), whereas the indicator with the best specificity was diagnosis (96.6%, 95% CI 91.9-98.7). The unadjusted DOR of global recognition was 2.6 (95% CI 1.5, 4.4). Less comorbidity, more severe depression symptoms, a history of depression, longer hospital stay, and antidepressant use before admission were significantly associated with better global recognition. CONCLUSION Recognition of depression in elderly medical inpatients depends upon the indicator of recognition used.
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Affiliation(s)
- Monica Cepoiu
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, Montreal, QC, Canada.
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Amore M, Tagariello P, Laterza C, Savoia E. Beyond nosography of depression in elderly. Arch Gerontol Geriatr 2007; 44 Suppl 1:13-22. [PMID: 17317429 DOI: 10.1016/j.archger.2007.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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McCusker J, Cole M, Ciampi A, Latimer E, Windholz S, Belzile E. Does Depression in Older Medical Inpatients Predict Mortality? J Gerontol A Biol Sci Med Sci 2006; 61:975-81. [PMID: 16960030 DOI: 10.1093/gerona/61.9.975] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous studies of the effect of depression on mortality among older medical inpatients have yielded inconsistent results. We examined the effects on mortality of both a diagnosis of depression at hospital admission and a history of previous depression, taking into account potential sources of bias (sample selection and confounding). METHODS Medical inpatients aged 65+ with at most mild cognitive impairment were recruited at two Montreal hospitals and were screened for depression. All those with a diagnosis of major or minor depression (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV] criteria) and a random sample of nondepressed patients were invited to participate. Baseline data included: history of previous depression, severity of physical illness, comorbidity, and health services utilization. Cox proportional hazards methods were used to analyze survival during the 16- to 52-month follow-up period. RESULTS Five hundred patients were enrolled; 116 (23.2%) had a history of previous depression. After adjustment for demographic factors, physical illness, cognitive impairment, and prior service utilization, the only depression group with significantly different mortality was patients with both current major depression and a history of depression, who had lower mortality than all other patient groups (hazard ratio 0.42; 95% confidence interval: 0.25, 0.70). CONCLUSIONS Among patients with no history of depression, a diagnosis of depression was not associated with mortality after adjustment for confounding by physical illness and other factors. Coincident major depression and history of depression was associated with decreased mortality.
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Affiliation(s)
- Jane McCusker
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, 3830 Lacombe, Montreal (Quebec), Canada.
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