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Chirico A, Palombi T, Alivernini F, Lucidi F, Merluzzi TV. Emotional Distress Symptoms, Coping Efficacy, and Social Support: A Network Analysis of Distress and Resources in Persons With Cancer. Ann Behav Med 2024:kaae025. [PMID: 38865355 DOI: 10.1093/abm/kaae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND The study's main aim was to analyze the structure and configuration of distress symptoms and resource factors. PURPOSE Common methods of assessing distress symptoms in cancer patients (i) do not capture the configuration of individual distress symptoms and (ii) do not take into account resource factors (e.g., social support, coping, caring health professionals). Network analysis focuses on the configuration and relationships among symptoms that can result in tailored interventions for distress. Network analysis was used to derive a symptom-level view of distress and resource factors. METHODS Nine hundred and ninety-two cancer patients (mixed diagnoses) completed an abridged Distress Screening Schedule that included 24 items describing symptoms related to distress (depression, anxiety) and resource factors (social support, coping, caring health professionals). RESULTS In network analysis, the centrality strength index (CSI) is the degree to which an item is connected to all other items, thus constituting an important focal point in the network. A depression symptom had the highest CSI value: felt lonely/isolated (CSI = 1.30). In addition, resource factors related to coping efficacy (CSI = 1.20), actively seeking support (CSI = 1.10), perceiving one's doctor as caring (CSI = 1.10), and receiving social support (CSI = 1.10) also all had very high CSI scores. CONCLUSIONS AND IMPLICATIONS These results emphasize the integral importance of the social symptoms of loneliness/isolation in distress. Thus, distress symptoms (loneliness) and resource factors (coping efficacy, seeking social support, and perceiving medical professionals as caring) should be integral aspects of distress management and incorporated into assessment tools and interventions to reduce distress.
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Affiliation(s)
- Andrea Chirico
- Department of Developmental and Social Psychology, Sapienza, University of Rome, Rome, Italy
| | - Tommaso Palombi
- Department of Developmental and Social Psychology, Sapienza, University of Rome, Rome, Italy
| | - Fabio Alivernini
- Department of Developmental and Social Psychology, Sapienza, University of Rome, Rome, Italy
| | - Fabio Lucidi
- Department of Developmental and Social Psychology, Sapienza, University of Rome, Rome, Italy
| | - Thomas V Merluzzi
- Department of Psychology, University of Notre Dame, South Bend, Indiana, USA
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Leung MTY, Turner JP, Marquina C, Ilomaki J, Tran T, Bell JS. Trajectories of oral bisphosphonate use after hip fractures: a population-based cohort study. Osteoporos Int 2024; 35:669-678. [PMID: 38195713 PMCID: PMC10957648 DOI: 10.1007/s00198-023-06974-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/07/2023] [Indexed: 01/11/2024]
Abstract
Bisphosphonates prevent future hip fractures. However, we found that one in six patients with hip fractures had a delay in bisphosphonate initiation and another one-sixth discontinued treatment within 12 months after discharge. Our results highlight the need to address hesitancy in treatment initiation and continuous monitoring. PURPOSE Suboptimal antiresorptive use is not well understood. This study investigated trajectories of oral bisphosphonate use following first hip fractures and factors associated with different adherence and persistence trajectories. METHODS We conducted a retrospective study of all patients aged ≥ 50 years dispensed two or more bisphosphonate prescriptions following first hip fracture in Victoria, Australia, from 2012 to 2017. Twelve-month trajectories of bisphosphonate use were categorized using group-based trajectory modeling. Factors associated with different trajectories compared to the persistent adherence trajectory were assessed using multivariate multinomial logistic regression. RESULTS We identified four patterns of oral bisphosphonate use in 1811 patients: persistent adherence (66%); delayed dispensing (17%); early discontinuation (9%); and late discontinuation (9%). Pre-admission bisphosphonate use was associated with a lower risk of delayed dispensing in both sexes (relative risk [RR] 0.28, 95% confidence interval [CI] 0.21-0.39). Older patients ( ≥ 85 years old versus 50-64 years old, RR 0.38, 95% CI 0.22-0.64) had a lower risk of delayed dispensing. Males with anxiety (RR 9.80, 95% CI 2.24-42.9) and females with previous falls had increased risk of early discontinuation (RR 1.80, 95% CI 1.16-2.78). CONCLUSION Two-thirds of patients demonstrated good adherence to oral bisphosphonates over 12 months following hip fracture. Efforts to further increase post-discharge antiresorptive use should be sex-specific and address possible persistent uncertainty around delaying treatment initiation.
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Affiliation(s)
- Miriam T Y Leung
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University (Parkville Campus), 381 Royal Parade, Parkville, Melbourne, VIC, 3052, Australia.
| | - Justin P Turner
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University (Parkville Campus), 381 Royal Parade, Parkville, Melbourne, VIC, 3052, Australia
- Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montreal, QC, Canada
- Faculty of Pharmacy, Laval University, Quebec, Canada
| | - Clara Marquina
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University (Parkville Campus), 381 Royal Parade, Parkville, Melbourne, VIC, 3052, Australia
| | - Jenni Ilomaki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University (Parkville Campus), 381 Royal Parade, Parkville, Melbourne, VIC, 3052, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tim Tran
- Pharmacy Department, Austin Health, Melbourne, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University (Parkville Campus), 381 Royal Parade, Parkville, Melbourne, VIC, 3052, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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Ramesh PV, Morya AK, Azad A, Pannerselvam P, Devadas AK, Gopalakrishnan ST, Ramesh SV, Aradhya AK. Navigating the intersection of psychiatry and ophthalmology: A comprehensive review of depression and anxiety management in glaucoma patients. World J Psychiatry 2024; 14:362-369. [PMID: 38617979 PMCID: PMC11008383 DOI: 10.5498/wjp.v14.i3.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/28/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024] Open
Abstract
Glaucoma, a prevalent and debilitating eye disease, has long been associated with vision impairment and blindness. However, recent research has shed light on the often-underestimated psychological dimensions of this condition. Anxiety and depression, two pervasive psychiatric comorbidities, have been increasingly recognized among glaucoma patients. This comprehensive review aims to explore the intricate relationship between psychiatry and ophthalmology, in the context of managing depression and anxiety in glaucoma patients. By meticulously examining peer-reviewed literature, we synthesize current knowledge on the prevalence, risk factors, and underlying mechanisms of anxiety and depression in glaucoma. The evidence reveals that glaucoma patients face an elevated risk of experiencing these mood disorders. Factors such as progressive vision loss, complex medication regimens, and the fear of further visual deterioration contribute to their vulnerability. Moreover, we delve into the bidirectional relationship between glaucoma and mood disorders, shedding light on the complex interplay between ocular and emotional health. Our review investigates the implications of anxiety and depression on glaucoma management, including their potential impact on treatment adherence, disease progression, and overall quality of life. We also explore the neurobiological pathways linking glaucoma and mood disorders, providing a foundation for future research and potential therapeutic interventions. In conclusion, recognizing the psychological burden carried by glaucoma patients is essential for holistic and patient-centered care. This review underscores the pressing need for integrated approaches that bring together ophthalmological and psychiatric expertise to optimize the well-being of individuals facing the challenges of glaucoma. By addressing anxiety and depression in glaucoma care, healthcare providers can enhance the overall quality of life for these patients, ultimately leading to improved outcomes and a brighter future for those affected by this condition. This review offers valuable insight for healthcare practitioners and researchers, providing a concise overview of key topics and research in the field of managing depression and anxiety in glaucoma patients.
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Affiliation(s)
- Prasanna Venkatesh Ramesh
- Department of Glaucoma and Research, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
| | - Arvind Kumar Morya
- Department of Ophthalmology, All India Institute of Medical Sciences, Hyderabad 508126, Telangana, India
| | - Ashik Azad
- Department of Optometry and Visual Science, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
| | - Pavithra Pannerselvam
- Junior Resident, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
| | - Aji Kunnath Devadas
- Department of Optometry and Visual Science, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
| | | | - Shruthy Vaishali Ramesh
- Department of Cataract and Refractive Surgery, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
| | - Ajanya K Aradhya
- Department of Optometry and Visual Science, Mahathma Eye Hospital Private Limited, Trichy 620017, Tamil Nadu, India
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Bala A, Olejnik A, Dziedzic T, Piwowarska J, Podgórska A, Marchel A. What helps patients to prepare for and cope during awake craniotomy? A prospective qualitative study. J Neuropsychol 2024; 18:30-46. [PMID: 37036087 DOI: 10.1111/jnp.12311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 03/09/2023] [Indexed: 04/11/2023]
Abstract
There is growing interest in awake craniotomies, but some clinicians are concerned that such procedures are poorly tolerated by patients. Therefore, we conducted a study to assess this phenomenon. In this prospective qualitative study, 68 patients who qualified for awake craniotomy were asked to complete the Hospital Anxiety and Depression Scale (HADS)-two days before the surgery and visual analogue scales (VAS) for pain and stress, two days before the surgery and again about two days after. In addition, after their surgery, they took part in a structured interview about what helped them prepare for and cope with the surgery. Most patients tolerated the awake surgery well, scoring low on stress and pain scales. They reported a lower level of stress during the surgery (when questioned afterwards) than before it. Intensity of stress before the surgery correlated negatively with age, positively with HADS anxiety score and positively with stress subsequently experienced during surgery. The level of stress during surgery was associated with stress experienced before the surgery, pain and HADS anxiety and depression scores. Severity of pain during the surgery was positively correlated with stress during surgery and HADS depression and anxiety scores before the surgery. There was no correlation between stress, pain, anxiety and depression and the location of the lesion. Patients have a high tolerance for awake craniotomy. Various factors have an impact on how well patients cope with the operation. Extensive preoperative preparation should be considered a key part of the procedure.
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Affiliation(s)
| | | | - Tomasz Dziedzic
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Jolanta Piwowarska
- Department of Anaesthesiology and Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Anna Podgórska
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
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Clark HL, Dixon LJ, Ramachandran S, Leukel PJ, Lee AA. Psychometric Properties of the Short Scale Anxiety Sensitivity Index Among Adults with Chronic Respiratory Disease. J Clin Psychol Med Settings 2024; 31:186-196. [PMID: 37770802 DOI: 10.1007/s10880-023-09976-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 09/30/2023]
Abstract
Approximately one-third of adults with chronic respiratory disease (CRD) have comorbid depressive and anxiety disorders; yet these disorders are often unrecognized in this patient population. Transdiagnostic processes such as anxiety sensitivity (AS) are useful for identifying mechanisms underlying psychological and heath conditions. The Short-Scale AS Index (SSASI) is a brief self-report measure of AS which has potential clinical utility among CRD populations to evaluate psychological distress and inform comprehensive care. The present study investigated the psychometric properties of the SSASI among adults with CRDs. Participants were recruited from a web-based panel of adults with CRDs (n = 768; 49.3% female; 57.8% White) including adults with asthma only (n = 230), COPD only (n = 321), or co-occurring asthma and COPD (n = 217). Participants completed a battery of self-report questionnaires assessing psychological and medical symptoms. Analyses were conducted to examine the factor structure and measurement invariance across CRD groups. Convergent validity and criterion validity of the SSASI were assessed within each group. Results supported partial measurement invariance across CRD groups. The SSASI demonstrated high reliability, convergent validity, and criterion validity with each CRD group. Findings from this study and existing work indicate that the SSASI is an effective and economical assessment tool for identifying patients CRD who may benefit from psychological interventions to reduce AS.
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Affiliation(s)
- Heather L Clark
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS, 38677, USA
| | - Laura J Dixon
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS, 38677, USA
| | - Sujith Ramachandran
- Department of Pharmacy Administration, University of Mississippi, University, MS, USA
| | - Patric J Leukel
- Department of Pharmacy Administration, University of Mississippi, University, MS, USA
| | - Aaron A Lee
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS, 38677, USA.
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Al-Maskari A, Al-Zaabi G, AL-Mamari HA, Al-mawali M, Nadar SK. Psychological impact of first admission with cardiovascular disease in a tertiary hospital in Oman. J Taibah Univ Med Sci 2024; 19:28-34. [PMID: 37868102 PMCID: PMC10585295 DOI: 10.1016/j.jtumed.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 08/05/2023] [Accepted: 08/30/2023] [Indexed: 10/24/2023] Open
Abstract
Background and objectives Cardiovascular diseases (CVD) are associated with substantial psychological effects that can adversely influence long term prognosis. The aim of this study was to determine the psychological effect of the first hospital admission for acute coronary syndrome (ACS) or congestive heart failure (CHF) in an adult Omani population. Methods This cross-sectional questionnaire based study used the Hospital Anxiety and Depression Scale. Patients were recruited from the in-patient cardiology and medical wards of our institution. Patients with a prior hospital admission for CHF and ACS were excluded. The questionnaire was administered between days 3 and 7 after admission once patients were clinically stable. Results The study included 116 patients (mean age 60.3 + 13.8 years; 78 (67.8%) men), comprising 52 patients with ACS and 64 patients with CHF. Based on the scores, a total of 45 (38.8%) patients had moderate to severe anxiety, and 32 (27.6%) had moderate to severe depression. Patients with severe anxiety tended to be younger, and no other factors predicted anxiety or depression. The proportion of patients with severe depression was higher among patients with CHF (31.4%), and no other differences were observed between patients with ACS or CHF. Conclusion A substantial proportion of patients admitted to our institution in Oman with CVD had severe anxiety and depression. Treating physicians and caregivers should be more open to identifying these patients, and steps should be taken to address their psychological wellbeing along with the medical management of their illness.
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Affiliation(s)
- Ahmed Al-Maskari
- Department of Nursing, Directorate of Nursing, Sultan Qaboos University Hospital, Muscat, Oman
| | - Ghanima Al-Zaabi
- Department of Nursing, Directorate of Nursing, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hafsa A. AL-Mamari
- Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University, Muscat, Oman
| | - Manar Al-mawali
- Department of Medicine, College of Medicine and Health Science, Sultan Qaboos University, Muscat, Oman
| | - Sunil K. Nadar
- Department of Cardiology, Sultan Qaboos University Hospital, Muscat Oman
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Sisay T, Mulate M, Hailu T, Belete TM. The prevalence of depression and anxiety among cardiovascular patients at University of Gondar specialized hospital using beck's depression inventory II and beck anxiety inventory: A cross-sectional study. Heliyon 2024; 10:e24079. [PMID: 38293464 PMCID: PMC10827446 DOI: 10.1016/j.heliyon.2024.e24079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 02/01/2024] Open
Abstract
Psychosocial issues are leading factor as well as consequences of cardiovascular disease. Identifying factors associated with depression facilitate service quality improvement for inpatients. This study assessed the prevalence and identified associated factors with depression and anxiety among patients with cardio vascular disease. Method An institution-based cross-sectional study was conducted with a convenience sample of 370 stable adult patients from June 1 to July 30, 2020 among cardiovascular disease patients at the University of Gondar Specialized Hospital Ethiopia. Data were collected by using structured questionnaires. Data analyses were conducted using SPSS version 21. The statistical significance declared at p-value <0.05. Result In this study, among 370 Cardiovascular diseases patients, 228 (61.6 %) suffer from anxiety, and 53.51 % (198) suffer with depression. There was a significant mean difference in the level of depression and anxiety between male and female Cardiovascular diseases patients. The females' scores of depression (mean = 28, p < 0.01) and anxiety (mean = 25.3, p < 0.01) were more than that of males 'scores of depression (mean = 15.1, p < 0.01) and anxiety (mean = 12.3, p < 0.01). Cardiovascular diseases patients aged greater than 60 years have the highest rate of prevalence of depression in all age group. Being in the age category of greater than 60 years was 1.16 (0.57-2.32) times more likely to have depression than the age category of 18-24 years. Depression and anxiety were significantly associated with being woman, widowed, being single, unable to read and write, and possess mental disorders history.
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Affiliation(s)
- Tihitina Sisay
- Department of Psychology, College of Social Science and Humanities, University of Gondar, Gondar, Ethiopia
| | - Missaye Mulate
- Department of Psychology, College of Social Science and Humanities, University of Gondar, Gondar, Ethiopia
| | - Tewodrose Hailu
- Department of Psychology, College of Social Science and Humanities, University of Gondar, Gondar, Ethiopia
| | - Tafere Mulaw Belete
- Department of Pharmacology, College of Medicine and Health Sciences, University of Gondar, P.o.box 196, Gondar, Ethiopia
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McCall T, Foster M, Schwartz TA. Attitudes Toward Seeking Mental Health Services and Mobile Technology to Support the Management of Depression Among Black American Women: Cross-Sectional Survey Study. J Med Internet Res 2023; 25:e45766. [PMID: 37467027 PMCID: PMC10398364 DOI: 10.2196/45766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/18/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Depression is a common mental health condition among Black American women. Many factors may contribute to the development of depressive symptoms, such as gender and racial discrimination, financial strain, chronic health conditions, and caregiving responsibilities. Barriers such as the stigmatization of mental illness, less access to treatment, the lack of or inadequate health insurance, mistrust of providers, and limited health literacy prevent marginalized populations from seeking care. Previous literature has shown that mobile health interventions are effective and can increase access to mental health services and resources. OBJECTIVE We aimed to understand the attitudes and perceptions of Black women toward using mental health services and determine the acceptability and concerns of using mobile technology (ie, voice call, video call, SMS text messaging, and mobile app) to support the management of depression. METHODS We launched a self-administered web-based questionnaire in October 2019 and closed it in January 2020. Women (aged ≥18 years) who identify as Black or African American or multiracial (defined as Black or African American and another race) were eligible to participate. The survey consisted of approximately 70 questions and included topics such as attitudes toward seeking professional psychological help, the acceptability of using a mobile phone to receive mental health care, and screening for depression. RESULTS The findings (n=395) showed that younger Black women were more likely to have greater severity of depression than their older counterparts. The results also revealed that Black women have favorable views toward seeking mental health services. Respondents were the most comfortable with the use of voice calls or video calls to communicate with a professional to receive support for managing depression in comparison with SMS text messaging or mobile apps. The results revealed that higher help-seeking propensity increased the odds of indicating agreement with the use of voice calls and video calls to communicate with a professional to receive support for managing depression by 27% and 38%, respectively. However, no statistically significant odds ratios (all P>.05) were found between help-seeking propensity and respondents' agreement to use mobile apps or SMS text messaging. Moderate to severe depression severity increased the odds of using mobile apps to communicate with a professional to receive support for managing depression by 43%; however, no statistically significant odds ratios existed for the other modalities. Privacy and confidentiality, communication issues (eg, misinterpreting text), and the impersonal feeling of communicating by mobile phone (eg, SMS text messaging) were the primary concerns. CONCLUSIONS Black American women, in general, have favorable views toward seeking mental health services and are comfortable with the use of mobile technology to receive support for managing depression. Future work should address the issues of access and consider the preferences and cultural appropriateness of the resources provided.
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Affiliation(s)
- Terika McCall
- Division of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States
- Section of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, United States
- Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Public Health, New Haven, CT, United States
| | - Meagan Foster
- Division of Health Informatics, Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States
| | - Todd A Schwartz
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Gosmann NP, Costa MDA, Jaeger MDB, Frozi J, Spanemberg L, Manfro GG, Cortese S, Cuijpers P, Pine DS, Salum GA. Incidence of adverse events and comparative tolerability of selective serotonin reuptake inhibitors, and serotonin and norepinephrine reuptake inhibitors for the treatment of anxiety, obsessive-compulsive, and stress disorders: a systematic review and network meta-analysis. Psychol Med 2023; 53:3783-3792. [PMID: 37278215 DOI: 10.1017/s0033291723001630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) show similar efficacy as treatments for anxiety, obsessive-compulsive, and stress-related disorders. Hence, comparisons of adverse event rates across medications are an essential component of clinical decision-making. We aimed to compare patterns of adverse events associated with SSRIs and SNRIs in the treatment of children and adults diagnosed with these disorders through a network meta-analysis. We searched MEDLINE, PsycINFO, Embase, Cochrane, websites of regulatory agencies, and international registers from inception to 09 September 2022, for randomized controlled trials assessing the efficacy of SSRIs or SNRIs. We analyzed the proportion of participants experiencing at least one adverse event and incidence rates of 17 specific adverse events. We estimated incidence rates and odds ratios through network meta-analysis with random effects and three-level models. We analyzed 799 outcome measures from 80 studies (n = 21 338). Participants in medication groups presented higher rates of adverse events (80.22%, 95% CI 76.13-83.76) when compared to placebo groups (71.21%, 67.00-75.09). Nausea was the most common adverse event (25.71%, CI 23.96-27.54), while weight change was the least common (3.56%, 1.68-7.37). We found higher rates of adverse events of medications over placebo for most medications, except sertraline and fluoxetine. We found significant differences between medications for overall tolerability and for autonomic, gastrointestinal, and sleep-related symptoms. Adverse events are a common reason that patients discontinue SSRIs and SNRIs. Results presented here guide clinical decision-making when clinicians weigh one medication over another. This might improve treatment acceptability and compliance.
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Affiliation(s)
- Natan Pereira Gosmann
- Section of Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Anxiety Disorders Outpatient Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Postgraduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marianna de Abreu Costa
- Anxiety Disorders Outpatient Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marianna de Barros Jaeger
- Anxiety Disorders Outpatient Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Júlia Frozi
- Section of Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas Spanemberg
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Gisele Gus Manfro
- Anxiety Disorders Outpatient Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Postgraduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Samuele Cortese
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Daniel Samuel Pine
- Emotion and Development Branch, Section on Development and Affective Neuroscience, National Institute of Mental Health, Bethesda, USA
| | - Giovanni Abrahão Salum
- Section of Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Postgraduate Program in Psychiatry and Behavioral Sciences, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Child Mind Institute, New York, New York, USA
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Benatti B, Girone N, Conti D, Cocchi M, Achilli F, Leo S, Putti G, Bosi M, Dell’Osso B. The Role of Lifestyle on Adherence to Treatment in a Sample of Patients with Unipolar and Bipolar Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20031994. [PMID: 36767361 PMCID: PMC9915922 DOI: 10.3390/ijerph20031994] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 06/01/2023]
Abstract
Introduction: Poor adherence to treatment is currently stated to be one of the causes of depression relapse and recurrence. The aim of the present study is to assess potential differences in terms of clinical and lifestyle features related to adherence to treatment in a sample of patients with unipolar and bipolar depression. Methods: One hundred and eight patients with a diagnosis of unipolar or bipolar depressive episode were recruited from January 2021 to October 2022. Adherence to psychopharmacological treatment was assessed using the clinician rating scale. Descriptive and association analyses were performed to compare subgroups based on adherence to treatment. Results: Lower levels of adherence to treatment were associated with fewer years of education, work impairment, manic prevalent polarity lifetime, and greater comorbidity with alcohol and drug abuse. The majority of patients with positive adherence did not report any hospitalization and involuntary commitment lifetime. Conclusions: Patients with a positive treatment adherence showed significant differences in terms of lifestyle and clinical features compared to non-adherent patients. Our results may help to identify patients more likely to have poor medication adherence, which seem to lead to a worse disease course and quality of life.
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Affiliation(s)
- Beatrice Benatti
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20122 Milan, Italy
- “Aldo Ravelli” Center for Neurotechnology and Brain Therapeutic, University of Milan, 20122 Milan, Italy
| | - Nicolaja Girone
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20122 Milan, Italy
| | - Dario Conti
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20122 Milan, Italy
| | - Maddalena Cocchi
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20122 Milan, Italy
| | - Francesco Achilli
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20122 Milan, Italy
| | - Silvia Leo
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20122 Milan, Italy
| | - Gianmarco Putti
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20122 Milan, Italy
| | - Monica Bosi
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20122 Milan, Italy
| | - Bernardo Dell’Osso
- Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, 20122 Milan, Italy
- “Aldo Ravelli” Center for Neurotechnology and Brain Therapeutic, University of Milan, 20122 Milan, Italy
- Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, Stanford, CA 94305, USA
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11
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Donahue S, Quinn DK, Cukor D, Kimmel PL. Anxiety Presentations and Treatments in Populations With Kidney Disease. Semin Nephrol 2022; 41:516-525. [PMID: 34973696 DOI: 10.1016/j.semnephrol.2021.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Anxiety is common in patients with chronic kidney disease, but in its extreme expressions, anxiety can also be a complicating comorbid psychiatric illness. There is only a small literature base on anxiety disorders in patients with renal disease, and many of the studies are not sufficiently specific about which anxiety disorders are being studied. Larger epidemiological studies are required to delineate the incidence, prevalence, and outcomes associated with the varied anxiety disorders. In addition, the impact of the co-occurrence of anxiety with other chronic psychiatric or medical problems, needs further study. Anxiety is a clinical condition that warrants treatment, primarily due to its association with mortality in end-stage renal disease patients, and its negative impact on perceived quality of life. Therapeutic options for patients with anxiety and kidney disease include both pharmacologic and nonpharmacologic approaches. Current treatment strategies for anxiety specific to patients with renal disease are provided.
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Affiliation(s)
| | - Davin K Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM
| | | | - Paul L Kimmel
- Department of Medicine, George Washington University, Washington, DC
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12
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Yang M, Chao J, Fillbrunn M, Mallya UG, Wang MJ, Franke L, Cohn L, Kamat S. Patient Preferences for Attributes of Biologic Treatments in Moderate to Severe Asthma: A Discrete Choice Experiment Study. Patient Prefer Adherence 2022; 16:2649-2661. [PMID: 36176349 PMCID: PMC9514297 DOI: 10.2147/ppa.s365117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Multiple biologics are available for moderate to severe asthma. Given the important relationship between patient engagement in healthcare decision-making and health outcomes, patient preference is an increasingly important consideration. This study elicited patients' preferences for attributes of biologic therapies for moderate to severe asthma. PATIENT AND METHODS A discrete choice experiment (DCE) questionnaire was designed to collect data from an existing survey panel of adults with moderate to severe asthma in the United States. Patients were asked to select their preferred hypothetical treatment from profiles with varying attributes related to efficacy, safety, and administration convenience. Conditional logit regression models were used to quantify patient preferences. RESULTS Of 301 eligible patients who completed the survey, the mean age was 46.7±15.1 years and 71.8% were female. Patients had asthma for 22.5±16.3 years on average, and most (97.3%) had experienced ≥1 asthma attack in the past 12 months. Among treatment attributes examined, patients most valued the absence of a black box warning for the risk of a life-threatening allergic reaction, effectiveness of reducing severe asthma exacerbations, and improvement in lung function (all p < 0.001). Home administration setting for subcutaneous injections (vs doctor's office/clinic) (p = 0.009) and ability of a biologic to treat additional chronic condition(s) (p < 0.05) were also considered important. Dosing frequency and type of injection device were not significant factors. CONCLUSION Patients with moderate to severe asthma valued efficacy and safety over convenience attributes when selecting biologic treatments. Awareness of these preferences can facilitate patient-physician shared decision-making when managing moderate to severe asthma in clinical practice.
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Affiliation(s)
- Min Yang
- Analysis Group, Inc, Boston, MA, USA
- Correspondence: Min Yang, Analysis Group, Inc, 111 Huntington Avenue, Fourteenth Floor, Boston, MA, 02199, USA, Tel +1-617-425-8487, Fax +1-617-425-8001, Email
| | | | | | | | | | | | - Lauren Cohn
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
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13
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Kumar-M P, Mohindra R, Bhalla A, Shafiq N, Suri V, Kumari D, Pandey AK, Gupta A, Gupta PC, Patil A, Kakkar AK, Malhotra S. System for administering and monitoring hydroxychloroquine prophylaxis for COVID-19 in accordance with a national advisory: preliminary experience of a tertiary care institute in India. Expert Rev Anti Infect Ther 2021; 19:1331-1339. [PMID: 33781166 PMCID: PMC8054489 DOI: 10.1080/14787210.2021.1909476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/24/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hydroxychloroquine (HCQ) was one of the earliest drugs to be recommended for tackling the COVID-19 threat leading to its widespread usage. We provide preliminary findings of the system, established in a tertiary care academic center for the administration of HCQ prophylaxis to healthcare workers (HCW) based on Indian Council of Medical Research (ICMR) advisory. METHODS A dedicated clinical pharmacology and internal medicine team screened for contraindications, administered informed consent, maintained compliance and monitored for adverse events. RESULTS Among the 194 HCWs screened for ruling out contraindications for prophylaxis, 9 were excluded and 185 were initiated on HCQ. A total of 55 adverse events were seen in 38 (20.5%) HCWs out of which 70.9%, 29.1% were mild and moderate & none were severe. Before the completion of therapy, a total of 23 participants discontinued. Change in QTc interval on day 2 was 5 (IQR: -3.75, 11) ms and the end of week 1 was 15 ms (IQR: 2, 18). Out of the 5 HCW who turned positive for COVID-19, 2 were on HCQ. CONCLUSION HCQ prophylaxis was found to be safe and well tolerated in HCW when administered after appropriate screening and with monitoring for adverse events.
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Affiliation(s)
- Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritin Mohindra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashish Bhalla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nusrat Shafiq
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vikas Suri
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepa Kumari
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Avaneesh Kumar Pandey
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ankur Gupta
- Department of Cardiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Parul Chawla Gupta
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Amol Patil
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashish Kumar Kakkar
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Samir Malhotra
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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14
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Eshtehardi SS, Taylor AA, Chen TA, de Dios MA, Correa-Fernández V, Kendzor DE, Businelle MS, Reitzel LR. Sociodemographic Determinants of Nonadherence to Depression and Anxiety Medication among Individuals Experiencing Homelessness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157958. [PMID: 34360251 PMCID: PMC8345659 DOI: 10.3390/ijerph18157958] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/11/2021] [Accepted: 07/27/2021] [Indexed: 12/03/2022]
Abstract
Psychiatric medication nonadherence continues to be a leading cause of poor health outcomes for individuals experiencing homelessness. Identifying the sociodemographic factors that contribute to medication nonadherence may help guide strategies to care for and support this group. This study examined 200 adults with depression diagnoses and active anti-depressant prescriptions (Mage = 43.98 ± 12.08, 59.4% Caucasian, 58.5% male, 70% uninsured, 89.5% unemployed) and 181 adults with anxiety diagnoses and active anti-anxiety prescriptions (Mage = 43.45 ± 11.02, 54.4% Caucasian, 57.5% male, 66.3% uninsured, 88.9% unemployed) recruited from six homeless-serving agencies in Oklahoma City. Self-reported sociodemographic variables included: age, sex, race/ethnicity, education, monthly income, employment status, and health insurance status. Adjusted logistic regression analyses revealed that employed (OR = 4.022, CI0.95: 1.244–13.004) and insured (OR = 2.923, CI0.95: 1.225–6.973) participants had greater odds of depression medication nonadherence. For anxiety, being employed (OR = 3.573, CI0.95: 1.160–11.010) was associated with greater odds of anxiety medication nonadherence, whereas having depression and anxiety diagnostic comorbidity (OR = 0.333, CI0.95: 0.137–0.810) was associated with lower odds of anxiety medication nonadherence. Interventions aimed at facilitating accessible prescription acquisition or otherwise reducing barriers to prescription medications for employed adults, including those with health insurance, may benefit adherence, but more research is needed. Future studies would benefit from using a qualitative approach to better delineate nuanced barriers to psychiatric medication adherence.
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Affiliation(s)
- Sahar S. Eshtehardi
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
| | - Ashley A. Taylor
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
| | - Tzuan A. Chen
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Marcel A. de Dios
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Virmarie Correa-Fernández
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
| | - Darla E. Kendzor
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma, OK 73104, USA; (D.E.K.); (M.S.B.)
| | - Michael S. Businelle
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma, OK 73104, USA; (D.E.K.); (M.S.B.)
| | - Lorraine R. Reitzel
- Department of Psychological, Health, & Learning Sciences, The University of Houston, 3657 Cullen Blvd Stephen Power Farish Hall, Houston, TX 77204, USA; (S.S.E.); (A.A.T.); (T.A.C.); (M.A.d.D.); (V.C.-F.)
- HEALTH Research Institute, The University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
- Correspondence: ; Tel.: +1-713-743-6679
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15
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Wawruch M, Murin J, Tesar T, Paduchova M, Petrova M, Celovska D, Havelkova B, Trnka M, Aarnio E. Non-Persistence With Antiplatelet Medications Among Older Patients With Peripheral Arterial Disease. Front Pharmacol 2021; 12:687549. [PMID: 34093210 PMCID: PMC8170080 DOI: 10.3389/fphar.2021.687549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/04/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction: Antiplatelet therapy needs to be administered life-long in patients with peripheral arterial disease (PAD). Our study was aimed at 1) the analysis of non-persistence with antiplatelet medication in older PAD patients and 2) identification of patient- and medication-related characteristics associated with non-persistence. Methods: The study data was retrieved from the database of the General Health Insurance Company. The study cohort of 9,178 patients aged ≥ 65 years and treated with antiplatelet medications was selected from 21,433 patients in whom PAD was newly diagnosed between 01/2012 and 12/2012. Patients with a 6 months treatment gap without antiplatelet medication prescription were classified as non-persistent. Characteristics associated with non-persistence were identified using the Cox regression. Results: At the end of the 5 years follow-up, 3,032 (33.0%) patients were non-persistent. Age, history of ischemic stroke or myocardial infarction, clopidogrel or combination of aspirin with clopidogrel used at the index date, higher co-payment, general practitioner as index prescriber and higher overall number of medications were associated with persistence, whereas female sex, atrial fibrillation, anxiety disorders, bronchial asthma/chronic obstructive pulmonary disease, being a new antiplatelet medication user (therapy initiated in association with PAD diagnosis), and use of anticoagulants or antiarrhythmic agents were associated with non-persistence. Conclusion: In patients with an increased probability of non-persistence, an increased attention should be paid to improvement of persistence.
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Affiliation(s)
- Martin Wawruch
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Jan Murin
- 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Tomas Tesar
- Department of Organization and Management of Pharmacy, Faculty of Pharmacy, Comenius University, Bratislava, Slovakia
| | | | - Miriam Petrova
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Denisa Celovska
- 1st Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | | | - Michal Trnka
- Institute of Medical Physics, Biophysics, Informatics and Telemedicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Emma Aarnio
- Institute of Biomedicine, University of Turku, Turku, Finland.,School of Pharmacy, University of Eastern Finland, Kuopio, Finland
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16
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Witcraft SM, Dixon LJ, Leukel P, Lee AA. Anxiety sensitivity and respiratory disease outcomes among individuals with chronic obstructive pulmonary disease. Gen Hosp Psychiatry 2021; 69:1-6. [PMID: 33444938 DOI: 10.1016/j.genhosppsych.2020.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Depression and anxiety worsen COPD and lead to greater respiratory symptom severity and health care utilization. Fear of physical sensations of anxiety (AS-P) is known to exacerbate respiratory symptoms. The current study investigated the unique contribution of AS-P in respiratory symptom exacerbations, emergency department visits, hospitalizations, and COPD-related functional health status, controlling for medical characteristics, depression, and anxiety. METHOD The sample included 535 adults with COPD (Mage = 56.57; 58.1% male). Participants were recruited from a web-based panel of adults with chronic respiratory disease and completed an online battery of self-report measures. RESULTS Consistent with hypotheses, AS-P significantly increased the likelihood of acute symptom exacerbations by 12% and respiratory-related emergency department visits and hospitalizations by 7% during the prior 12 month period. Additionally, AS-P demonstrated a unique, large effect (f2 = 0.37) on COPD-related functional health status. CONCLUSION Fear of physical sensations contributed to worse respiratory outcomes and health care utilization among adults with COPD. Screening for AS-P may effectively identify at-risk COPD patients, while reducing AS-P through targeted interventions may result in decreased symptom severity, functional limitations, and burden on the health care system.
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Affiliation(s)
- Sara M Witcraft
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS, 38677, USA.
| | - Laura J Dixon
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS, 38677, USA.
| | - Patric Leukel
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS, 38677, USA.
| | - Aaron A Lee
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS, 38677, USA.
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17
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Mendorf S, Witte OW, Zipprich H, Prell T. Association Between Nonmotor Symptoms and Nonadherence to Medication in Parkinson's Disease. Front Neurol 2020; 11:551696. [PMID: 33192983 PMCID: PMC7604271 DOI: 10.3389/fneur.2020.551696] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/14/2020] [Indexed: 01/09/2023] Open
Abstract
Background: Nonadherence to medication is a common and serious issue in the treatment of patients with Parkinson's disease (PD). Among others, distinct nonmotor symptoms (NMS) were found to be associated with nonadherence in PD. Here, we aimed to confirm the association between NMS and adherence. Methods: In this observational study, the following data were collected: sociodemographic data, the German versions of the Movement Disorder Society-sponsored revision of the unified Parkinson's disease rating scale for motor function (MDS-UPDRS III), Hoehn and Yahr (H&Y) stage, levodopa equivalent daily dose (LEDD), Becks depression inventory II (BDI-II), nonmotor symptoms questionnaire (NMSQ), and the Stendal adherence to medication score (SAMS). Results: The final sample included 137 people with PD [54 (39.4%) females] with a mean age of 71.3 ± 8.2 years. According to SAMS, 10.9% of the patients were fully adherent, 73% were moderately nonadherent, and 16.1% showed clinically significant nonadherence. Nonadherence was associated with LEDD, BDI-II, education level, MDS-UPDRS III, and the NMSQ. The number of NMS was higher in nonadherent patients than in adherent patients. In the multiple stepwise regression analysis, the items 5 (constipation), 17 (anxiety), and 21 (falls) predicted nonadherence to medication. These NMSQ items also remained significant predictors for SAMS after correction for LEDD, MDS-UPDRS III, BDI-II, age, education level, gender, and disease duration. Conclusion: Our study, in principle, confirms the association between NMS burden and nonadherence in PD. However, in contrast to other clinical factors, the relevance of NMSQ in terms of nonadherence is low. More studies with larger sample sizes are necessary to explore the impact of distinct NMS on adherence.
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Affiliation(s)
- Sarah Mendorf
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Otto W Witte
- Department of Neurology, Jena University Hospital, Jena, Germany.,Centre for Healthy Ageing, Jena University Hospital, Jena, Germany
| | - Hannah Zipprich
- Department of Neurology, Jena University Hospital, Jena, Germany.,Centre for Healthy Ageing, Jena University Hospital, Jena, Germany
| | - Tino Prell
- Department of Neurology, Jena University Hospital, Jena, Germany.,Centre for Healthy Ageing, Jena University Hospital, Jena, Germany
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18
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Toelle BG, Marks GB, Dunn SM. Psychological and Medical Characteristics Associated with Non-Adherence to Prescribed Daily Inhaled Corticosteroid. J Pers Med 2020; 10:jpm10030126. [PMID: 32937794 PMCID: PMC7565720 DOI: 10.3390/jpm10030126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/31/2020] [Accepted: 09/10/2020] [Indexed: 12/28/2022] Open
Abstract
Medication non-adherence is associated with sub-optimal asthma control. Identification of medical and psychological characteristics associated with non-adherence is important to enable a targeted and personalized approach when working with patients and for the development of interventions to improve patient outcomes by improving medication adherence. We enrolled adults who had diagnosed asthma and who were prescribed daily inhaled corticosteroid medication. We used published and validated instruments to measure medical characteristics including asthma features, practical asthma knowledge and perceived involvement in care and psychological characteristics including anxiety, depression, optimism, and personality traits, to assess the relationship with medication non-adherence. A total of 126 participants provided data, with 64 (50.8%) of the participants identified as non-adherent. Multivariate analyses showed that younger age, high neuroticism scores and a previous asthma hospital admission were associated with non-adherence. Interestingly, depression was associated with a lower risk of non-adherence. This study showed that a personalized medicine approach would include interventions targeting those who are younger, who have been in hospital for asthma and who rate high on the neuroticism personality trait. Given the availability of effective medications for asthma, better understanding of the characteristics associated with non-adherence is important to enhance optimal self-management.
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Affiliation(s)
- Brett G. Toelle
- Woolcock Institute of Medical Research, The University of Sydney, Sydney 2006, Australia;
- Sydney Local Health District, Sydney 2050, Australia
- Correspondence: ; Tel.: +61-2-9114-0462; Fax: +61-2-9114-0011
| | - Guy B. Marks
- Woolcock Institute of Medical Research, The University of Sydney, Sydney 2006, Australia;
- South Western Sydney Clinical School, University of New South Wales, Sydney 2170, Australia
- Ingham Institute of Applied Medical Research, Sydney 2170, Australia
| | - Stewart M. Dunn
- Department of Psychological Medicine, The University of Sydney, Sydney 2006, Australia;
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19
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Park TW, Larochelle MR, Saitz R, Wang N, Bernson D, Walley AY. Associations between prescribed benzodiazepines, overdose death and buprenorphine discontinuation among people receiving buprenorphine. Addiction 2020; 115:924-932. [PMID: 31916306 PMCID: PMC7156323 DOI: 10.1111/add.14886] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/23/2019] [Accepted: 10/29/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Benzodiazepines are commonly prescribed to patients with opioid use disorder receiving buprenorphine treatment, yet may increase overdose risk. However, prescribed benzodiazepines may improve retention in care by reducing buprenorphine discontinuation and thus may prevent relapse to illicit opioid use. We aimed to test the association between benzodiazepine prescription and fatal opioid overdose, non-fatal opioid overdose, all-cause mortality and buprenorphine discontinuation. DESIGN AND SETTING This was a retrospective cohort study using five individually linked data sets from Massachusetts, United States government agencies. PARTICIPANTS We studied 63 389 Massachusetts residents aged 18 years or older who received buprenorphine treatment between January 2012 and December 2015. MEASUREMENTS Filled benzodiazepine prescription during buprenorphine treatment was the main independent variable. The primary outcome was time to fatal opioid overdose. Secondary outcomes were time to non-fatal opioid overdose, all-cause mortality and buprenorphine discontinuation. We defined buprenorphine discontinuation as having a 30-day gap without another prescription following the end date of the previous prescription. We used Cox proportional hazards models to calculate hazards ratios that tested the association between receipt of benzodiazepines and all outcomes, restricted to periods during buprenorphine treatment. FINDINGS Of the 63 345 individuals who received buprenorphine, 24% filled at least one benzodiazepine prescription during buprenorphine treatment. Thirty-one per cent of the 183 deaths from opioid overdose occurred when individuals received benzodiazepines during buprenorphine treatment. Benzodiazepine receipt during buprenorphine treatment was associated with an increased risk of fatal opioid overdose adjusted hazard ratio (HR) = 2.92, 95% confidence interval (CI) = 2.10-4.06, non-fatal opioid overdose, adjusted HR = 2.05, 95% CI, 1.68-2.50, all-cause mortality, adjusted HR = 1.90, 95% CI, 1.48-2.44 and a decreased risk of buprenorphine discontinuation, adjusted HR = 0.87, 95% CI, 0.85-0.89. CONCLUSIONS Benzodiazepine receipt appears to be associated with both increased risk of opioid overdose and all-cause mortality and decreased risk of buprenorphine discontinuation among people receiving buprenorphine.
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Affiliation(s)
- Tae Woo Park
- Department of Psychiatry, Boston University School of Medicine and Boston Medical Center,Grayken Center for Addiction, Boston Medical Center
| | - Marc R. Larochelle
- Grayken Center for Addiction, Boston Medical Center,Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center
| | - Richard Saitz
- Grayken Center for Addiction, Boston Medical Center,Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center,Department of Community Health Sciences, Boston University School of Public Health
| | - Na Wang
- Biostatistics, Epidemiology, and Data Analytics Center, Boston University School of Public Health
| | - Dana Bernson
- Office of Population Health, Massachusetts Department of Public Health
| | - Alexander Y. Walley
- Grayken Center for Addiction, Boston Medical Center,Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine and Boston Medical Center
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20
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Shoair OA, Cook EA, Shipman D, Dunn RL. Antidepressant Target Dose Optimization and Control of Severe Asthma Exacerbations in Uninsured and Underinsured Patients with Anxiety and/or Depression. Pharmacotherapy 2020; 40:320-330. [PMID: 32060937 DOI: 10.1002/phar.2374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Generalized anxiety disorder (GAD) and major depressive disorder (MDD) are prevalent in patients with asthma. These disorders may increase asthma severity and decrease asthma control. No studies have evaluated the impact of achieving antidepressant target dose optimization compared with not achieving antidepressant target doses on asthma control in uninsured and underinsured patients. OBJECTIVE To evaluate the impact of achieving antidepressant target dose optimization in uninsured and underinsured adult asthma patients with GAD and/or MDD on the risk of severe asthma exacerbations and number of asthma-related outcomes. METHODS We conducted a retrospective cohort study of uninsured and underinsured adult asthma patients with GAD and/or MDD who have been initiated on a single antidepressant and maintained on a stable dose for 8 weeks (index date). Eligible patients were followed for 12-24 months after the index date and separated into those who achieved a target dose (target group) and those who did not (control group). Poisson regression was used to compare the risk of severe exacerbations, and analysis of covariance was used to compare the number of severe exacerbations and other asthma-related outcomes between the target and control groups during the 1- and 2-year post-index periods. RESULTS A total of 61 patients (24 in the target group and 37 in the control group) met inclusion criteria. The target group had a reduced risk of severe asthma exacerbations compared with the control group during the 1-year post-index (adjusted risk reduction [RR] 0.46, 95% confidence interval [CI] 0.26-0.82) and 2-year post-index (adjusted RR 0.5, 95% CI 0.3-0.82) periods. The target group also experienced a lower number of severe asthma exacerbations and other asthma-related outcomes during the 1- and 2-year post-index periods compared with the control group after adjusting for confounders. CONCLUSIONS Among uninsured and underinsured asthma patients with GAD and/or MDD who were initiated on a single antidepressant, those who were titrated to achieve target doses had a reduced risk of severe asthma exacerbations and a lower number of asthma-related outcomes than those who were not optimized to achieve target doses.
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Affiliation(s)
- Osama A Shoair
- Department of Pharmaceutical Sciences, Fisch College of Pharmacy, The University of Texas at Tyler, Tyler, Texas
| | - Elizabeth A Cook
- Department of Clinical Sciences, Fisch College of Pharmacy, The University of Texas at Tyler, Tyler, Texas.,Department of Pharmacy, Clinical Services at The Robert J. Dole Veteran Affairs Medical Center, Wichita, Kansas
| | - Denver Shipman
- Department of Clinical Sciences, Fisch College of Pharmacy, The University of Texas at Tyler, Tyler, Texas.,Department of Pharmacy, Clinical Services at The Robert J. Dole Veteran Affairs Medical Center, Wichita, Kansas
| | - Rebecca L Dunn
- Department of Clinical Sciences, Fisch College of Pharmacy, The University of Texas at Tyler, Tyler, Texas
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21
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Kaneko Y, Mouri T, Seto Y, Nishioka N, Yoshimura A, Yamamoto C, Harita S, Chihara Y, Tamiya N, Yamada T, Uchino J, Takayama K. The Quality of Life of Patients with Suspected Lung Cancer before and after Bronchoscopy and the Effect of Mirtazapine on the Depressive Status. Intern Med 2020; 59:1605-1610. [PMID: 32612064 PMCID: PMC7402957 DOI: 10.2169/internalmedicine.4341-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective Patients with suspected lung cancer often experience adverse side effects such as anxiety, depression, and a decreased appetite. These side effects influence the patients' quality of life and their ability to make decisions concerning appropriate treatment. This study examined the psychological status and quality of life of patients with suspected lung cancer before and after bronchoscopy treatment and evaluated the effect of mirtazapine prescribed to patients with depression. Methods To assess patient characteristics (e.g. age, gender, and medical history), a questionnaire including the Hospital Anxiety and Depression Scale - Japanese version and the Functional Assessment of Cancer Therapy-L was administered. Patients Forty-three patients admitted for bronchoscopy treatment between May 2017 and April 2018 were included. Results The results showed that patients with depression reported a worse quality of life than those without depression. Compared with no medication, the administration of mirtazapine alleviated depressive symptoms. Furthermore, the patients' depressive status was affected by their physical symptoms, including coughing, tightness of chest, and dyspnea. Conclusion Our results emphasize the importance of detecting depression in the early stages of a cancer diagnosis and have significant implications concerning pharmacological intervention in patients with cancer displaying signs of depression.
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Affiliation(s)
- Yoshiko Kaneko
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Takako Mouri
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Yurie Seto
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Naoya Nishioka
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Akihiro Yoshimura
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Chie Yamamoto
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Sachi Harita
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Yusuke Chihara
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Nobuyo Tamiya
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Tadaaki Yamada
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Junji Uchino
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Koichi Takayama
- Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Japan
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22
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Welsh J, Paige E, Banks E, Joshy G, Brieger D, Korda RJ. Psychological distress and medication use for secondary prevention of cardiovascular events: Evidence from a large-scale population-based cohort study. J Psychosom Res 2019; 124:109748. [PMID: 31443818 DOI: 10.1016/j.jpsychores.2019.109748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/14/2019] [Accepted: 06/19/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Cardiac patients with psychological distress have a poorer prognosis than patients without distress, potentially reflecting differences in preventive care. We aimed to examine distress-related variation in guideline-recommended medication use for secondary prevention of cardiovascular disease (CVD). METHODS Baseline questionnaire data from the 45 and Up Study (collected 2006-2009) were linked to hospitalisation, pharmaceutical dispensing and death records (to exclude those who died). Among participants hospitalised with myocardial infarction, angina, stroke/transient ischaemic attack in the six years before the questionnaire, Modified Poisson regression was used to estimate relative risks (RR) for distress (Kessler 10 scores: low[10- < 12], mild[12- < 16], moderate[16- < 22] and high[22-50]) and use of both blood pressure- and lipid-lowering medications, and use of neither medication in the three months following the questionnaire, adjusting for sociodemographic and health characteristics. RESULTS Among 7598 participants, 34.0% had low, 35.4% mild, 18.3% moderate and 12.3% high psychological distress. Around two-thirds (63.4%) were using both medications and the proportion declined with increasing levels of distress: RRs were 1.01(95%CI:0.97-1.05), 0.95(0.90-1.00) and 0.91(0.86-0.97) for mild, moderate and high compared to low distress, respectively (p(trend) = 0.001). The proportion using neither medication was 9.1% and increased with increasing distress: RRs for mild, moderate and high compared to low distress were 0.99(0.82-1.19), 1.30(1.06-1.59) and 1.60(1.28-1.98), respectively (p(trend) < 0.001). CONCLUSION Patients with psychological distress may need more support to optimise their use of secondary CVD prevention medications. Increasing the use of these medications for distressed patients may improve prognosis for patients with distress and improve population-level secondary prevention of CVD more broadly.
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Affiliation(s)
- Jennifer Welsh
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia.
| | - Ellie Paige
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia.
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia; Sax Institute, Sydney, Australia.
| | - Grace Joshy
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia.
| | - David Brieger
- Concord Clinical School, The University of Sydney, Sydney, Australia.
| | - Rosemary J Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australia.
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Mendes R, Martins S, Fernandes L. Adherence to Medication, Physical Activity and Diet in Older Adults With Diabetes: Its Association With Cognition, Anxiety and Depression. J Clin Med Res 2019; 11:583-592. [PMID: 31413770 PMCID: PMC6681861 DOI: 10.14740/jocmr3894] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/20/2019] [Indexed: 01/13/2023] Open
Abstract
Background Adherence to medication, physical activity (PA) and diet in diabetes mellitus (DM) patients is crucial for its good management, avoiding acute and chronic complications. There are several risk factors associated with non-adherence, including cognitive impairment, depression and anxiety. Nevertheless, studies on therapeutic adherence in older patients with DM are scarce. In this context, the present study aimed to analyze whether adherence to medication, PA and diet are associated with cognitive impairment, anxiety and depression. It also aimed to identity predictors of medication non-adherence. Methods A cross-sectional study of older patients (≥ 65 years old) with DM was carried out in the Outpatient Department of Internal Medicine Service of CHUSJ-Porto, Portugal. Those unable to communicate were excluded. Cognition (mini-mental state examination), anxiety and depression (hospital anxiety and depression scale) were assessed. Adherence to medication, PA and diet was measured, based on self-reporting patient/family, questionnaires, physician clinical opinion, hemoglobin test and pharmacy records. Patient groups were compared, using the Mann-Whitney or the Kruskal-Wallis test for continuous variables and the Chi-square test for paired categorical variables (significance level of 0.05). The odds ratio (OR) was calculated to identify independent predictors of non-adherence to medication. Results The final sample (n = 94) had a mean age of 75.2 years (standard deviation: 6.7) and mostly were female (53.2%), married (63.8%) and with a low education level (61.7%). Also, 22.3% with cognitive impairment, 16% with depression and 23.4% with anxiety were found. Patients non-adherent to medication had higher depression (P = 0.048) and anxiety (P = 0.010), compared to adherents/partial adherents. Patients non-adherent to PA showed higher anxiety (P = 0.035) and depression (P = 0.004), compared to adherents. Non-adherents to PA had more cognitive impairment than adherents (26.3% vs. 0%; P = 0.034). Patients who had insulin prescribed presented a higher risk of non-adherence to medication (OR: 4.041, 95% confidence interval (CI): 1.404 - 11.628; P = 0.010). Also, the risk of non-adherence to medication is higher by an increase of one unit in anxiety (OR: 1.252, 95% CI: 1.046 - 1.499; P = 0.014). Conclusions Higher anxiety and depression were associated with non-adherence to medication and to PA. Insulin prescribed and high anxiety scores were predictors of medication non-adherence. This study appears to contribute to the knowledge about the influence of cognitive and psychological factors in therapeutic adherence in these older diabetic patients.
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Affiliation(s)
- Rosa Mendes
- Department of Internal Medicine, Centro Hospitalar Universitario S. Joao (CHUSJ), Porto, Portugal.,Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Portugal
| | - Sonia Martins
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Portugal.,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto (FMUP), Portugal
| | - Lia Fernandes
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Portugal.,Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto (FMUP), Portugal.,Clinic of Psychiatry and Mental Health, Centro Hospitalar Universitario S. Joao (CHUSJ), Porto, Portugal
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24
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Parker K, Bull-Engelstad I, Aasebø W, von der Lippe N, Reier-Nilsen M, Os I, Stavem K. Medication regimen complexity and medication adherence in elderly patients with chronic kidney disease. Hemodial Int 2019; 23:333-342. [PMID: 30779285 DOI: 10.1111/hdi.12739] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/17/2019] [Accepted: 01/23/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Elderly patients with chronic kidney disease (CKD) stage 5 with or without dialysis treatment usually have concomitant comorbidities, which often result in multiple pharmacological therapies. This study aimed to identify factors associated with medication complexity and medication adherence, as well as the association between medication complexity and medication adherence, in elderly patients with CKD. METHODS This prospective study involved elderly patients with CKD stage 5 (estimated glomerular filtration rate < 15 ml/min/1.73m2 ) recruited from three Norwegian hospitals. Most of the patients were receiving either hemodialysis or peritoneal dialysis. We used the Medication Regimen Complexity Index (MRCI) to assess the complexity of medication regimens, and the eight-item Morisky Medication Adherence Scale (MMAS-8) to assess medication adherence. Factors associated with the MRCI and MMAS-8 score were determined using either multivariable linear or ordinal logistic regression analysis. FINDINGS In total, 157 patients aged 76 ± 7.2 years (mean ± SD) were included in the analysis. Their overall MRCI score was 22.8 ± 7.7. In multivariable linear regression analyses, female sex (P = 0.044), Charlson Comorbidity Index of 4 or 5 (P = 0.029) and using several categories of phosphate binders (P < 0.001 to 0.04) were associated with the MRCI. Moderate or high adherence (MMAS-8 score ≥ 6) was demonstrated by 83% of the patients. The multivariable logistic regression analyses found no association of medication complexity, age or other variables with medication adherence as assessed using the MMAS-8. DISCUSSION Female sex, comorbidity and use of phosphate binders were associated with more-complex medication regimens in this population. No association was found between medication regimen complexity, phosphate binders or age and medication adherence. These findings are based on a homogeneous elderly group, and so future studies should test if they can be generalized to patients of all ages with CKD.
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Affiliation(s)
- Krystina Parker
- Department of Nephrology, Medical Division, Akershus University Hospital, Lørenskog, Norway.,Faculty of Medicine, University of Oslo, Institute of Clinical Medicine, Oslo, Norway
| | - Ingrid Bull-Engelstad
- Department of Nephrology, Medical Division, Vestre Viken HF, Drammen Hospital, Drammen, Norway
| | - Willy Aasebø
- Department of Nephrology, Medical Division, Akershus University Hospital, Lørenskog, Norway
| | - Nanna von der Lippe
- Faculty of Medicine, University of Oslo, Institute of Clinical Medicine, Oslo, Norway.,Department of Nephrology, Medical Division, Oslo University Hospital Ullevål, Oslo, Norway
| | - Morten Reier-Nilsen
- Department of Nephrology, Medical Division, Vestre Viken HF, Drammen Hospital, Drammen, Norway
| | - Ingrid Os
- Faculty of Medicine, University of Oslo, Institute of Clinical Medicine, Oslo, Norway.,Department of Nephrology, Medical Division, Oslo University Hospital Ullevål, Oslo, Norway
| | - Knut Stavem
- Faculty of Medicine, University of Oslo, Institute of Clinical Medicine, Oslo, Norway.,Department of Pulmonary Medicine, Medical Division, Akershus University Hospital, Lørenskog, Norway.,HØKH, Department of Health Services Research, Akershus University Hospital, Lørenskog, Norway
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25
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Thunander Sundbom L, Hedborg K. Association between prescribed antidepressants and other prescribed drugs differ by gender: a nationwide register-based study in Sweden. Nord J Psychiatry 2019; 73:73-79. [PMID: 30661437 DOI: 10.1080/08039488.2018.1536766] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND People with depression are prescribed more drugs than people in general, partly due to comorbidity with other conditions. However, little research has been done on depression-related drug use from a gender perspective. AIM Examine the association between antidepressants, other types of prescribed drugs, and polypharmacy, by gender. METHODS Data on drugs dispensed October to December 2016 to all Swedish citizens aged 18-84 years were collected from the Swedish prescribed drug register. Logistic regression analyses were performed to examine the associations between antidepressants and other drugs, by gender. RESULTS For both men and women, associations were found between antidepressants and drugs for alimentary tract problems, respiratory problems, blood, nervous system, analgesics, and polypharmacy. However, for women, but not men, associations were also found for drugs for diabetes, musculoskeletal problems, dermatological problems, and systemic hormones. CONCLUSIONS Associations were found between antidepressants and many other types of drugs for both men and women; indicating comorbidity between depression and other conditions. Further, some of the associations between antidepressants and other drugs were found to be specific among women. Whether this indicates that men and women differ in comorbidity between depression and other conditions cannot be concluded based on this cross-sectional study. However, comorbidity impairs the possibility of recovery; in the somatic condition as well as the depression. Thus, physicians need to be aware that the association between antidepressants and other types of drugs are more common among women than men.
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Affiliation(s)
- Lena Thunander Sundbom
- a Faculty of Health and Occupational Studies, Department of Health and Caring Sciences , University of Gävle , Gävle , Sweden.,b Pharmacoepidemiology and Pharmacoeconomics, Department of Pharmacy , Uppsala University , Uppsala , Sweden
| | - Kerstin Hedborg
- a Faculty of Health and Occupational Studies, Department of Health and Caring Sciences , University of Gävle , Gävle , Sweden
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Ofori‐Asenso R, Ilomäki J, Tacey M, Si S, Curtis AJ, Zomer E, Bell JS, Zoungas S, Liew D. Predictors of first-year nonadherence and discontinuation of statins among older adults: a retrospective cohort study. Br J Clin Pharmacol 2019; 85:227-235. [PMID: 30402916 PMCID: PMC6303220 DOI: 10.1111/bcp.13797] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/26/2018] [Accepted: 10/13/2018] [Indexed: 12/21/2022] Open
Abstract
AIMS The aim of this study was to examine the level of and predictors of statin nonadherence and discontinuation among older adults. METHODS Among 22 340 Australians aged ≥65 years who initiated statin therapy from January 2014 to December 2015, we estimated the first-year nonadherence (proportion of days covered [PDC] <0.80) and discontinuation (≥90 days without statin coverage) rates. Predictors of nonadherence and discontinuation were examined via multivariable logistic regression. Analyses were performed separately for general beneficiaries (with a higher co-payment; n = 4841) and concessional beneficiaries (with a lower co-payment; n = 17 499). RESULTS During the one-year follow-up, 55.1% were nonadherent (concessional 52.6%; general beneficiaries 64.2%) and 44.7% discontinued statins (concessional 43.1%; general beneficiaries 50.4%). Among concessional beneficiaries, those aged 75-84 years and ≥85 years were more likely to discontinue than people aged 65-74 years (odds ratio 1.11, 95% confidence interval 1.04-1.19 and 1.38, 1.23-1.54, respectively). Diabetes was associated with an increased likelihood of nonadherence and discontinuation, while hypertension, angina and congestive heart failure were associated with a lower likelihood of nonadherence and discontinuation. Anxiety was associated with an increased likelihood of discontinuation, but polypharmacy (concurrent use of five or more drugs) was associated with a lower likelihood of nonadherence and discontinuation. Statin initiation by a general medical practitioner was associated with both increased likelihood of nonadherence and discontinuation. Similar predictors of nonadherence and discontinuation were identified for the general beneficiaries. CONCLUSIONS Among older adults prescribed statins, first-year nonadherence and discontinuation are high. Specific population subgroups such as people aged ≥85 years, those with diabetes or anxiety may require additional attention to improve statin adherence.
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Affiliation(s)
- Richard Ofori‐Asenso
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
- Epidemiological Modelling Unit, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
- Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Mark Tacey
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Si Si
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Andrea J. Curtis
- Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Ella Zomer
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
- School of Pharmacy and Medical SciencesUniversity of South AustraliaAdelaideAustralia
| | - Sophia Zoungas
- Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Danny Liew
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
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27
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Guo L, Huang Y, Xu Y, Huang G, Gao X, Lei Y, Luo M, Xi C, Lu C. The mediating effects of depressive symptoms on the association of childhood maltreatment with non-medical use of prescription drugs. J Affect Disord 2018; 229:14-21. [PMID: 29294372 DOI: 10.1016/j.jad.2017.12.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/16/2017] [Accepted: 12/24/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Childhood maltreatment might increase the risk of subsequent drug use behavior, and depressive symptoms have been reported to be associated both childhood maltreatment and non-medical use of prescription drugs (NMUPD). This large-scale study aimed to test the mediating effects of depressive symptoms on the association of childhood maltreatment with NMUPD among Chinese adolescents. METHODS A secondary analysis of the cross-sectional data collected from 7th to 12th graders who were sampled using a multistage, stratified cluster, random sampling method in the 2015 School-based Chinese Adolescents Health Survey. There were 24,457 students who were invited to participate and 23,039 students' questionnaires were completed and qualified for our survey (response rate: 94.2%). RESULTS In the adjusted models without mediation, the results showed that students who reported that they had experienced emotional abuse were at a higher risk of past year use and past month use of opioids (past year: Adjusted OR [AOR] = 1.07, 95% CI = 1.05-1.10; past month: AOR = 1.08, 95% CI = 1.06-1.10) and sedatives (past year: AOR = 1.06, 95% CI = 1.03-1.08; past month: AOR = 1.15, 95% CI = 1.13-1.16). The results of mediation analyses demonstrated that there were significant standardized indirect effects of emotional abuse on opioids use and sedatives use through depressive symptoms, respectively (P < 0.001). LIMITATIONS Our study sample only included school students, and causal inference could not be examined due to the cross-sectional design. CONCLUSIONS Depressive symptoms play a significant mediator role on the association of childhood maltreatment with NMUPD. Interventions targeted at adolescents who are involved in NMUPD should pay attention to their histories of childhood maltreatment.
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Affiliation(s)
- Lan Guo
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Yeen Huang
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Yan Xu
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China; Center for ADR monitoring of Guangdong, Guangzhou 510080, People's Republic of China
| | - Guoliang Huang
- Center for ADR monitoring of Guangdong, Guangzhou 510080, People's Republic of China
| | - Xue Gao
- Center for ADR monitoring of Guangdong, Guangzhou 510080, People's Republic of China
| | - Yiling Lei
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Min Luo
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Chuhao Xi
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China
| | - Ciyong Lu
- Department of Medical statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510080, People's Republic of China.
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28
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A weekend/weekday comparison of adherence to daily treatment regimens in adults with cystic fibrosis. HEALTH PSYCHOLOGY REPORT 2018. [DOI: 10.5114/hpr.2018.72331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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29
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Luk S, Stroman L, Kang S, Natkunarajah M, Duguid G. Patient Perception and Emotional Disturbance in Out-of-Hour Ophthalmic Emergency Care. Semin Ophthalmol 2017; 32:559-563. [DOI: 10.3109/08820538.2015.1131834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sheila Luk
- Accident and Emergency Department, Western Eye Hospital, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Luke Stroman
- Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Swan Kang
- Accident and Emergency Department, Western Eye Hospital, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Mythili Natkunarajah
- Accident and Emergency Department, Western Eye Hospital, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Graham Duguid
- Accident and Emergency Department, Western Eye Hospital, Imperial College Healthcare NHS Foundation Trust, London, UK
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30
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Jensen ML, Jørgensen ME, Hansen EH, Aagaard L, Carstensen B. Long-term patterns of adherence to medication therapy among patients with type 2 diabetes mellitus in Denmark: The importance of initiation. PLoS One 2017; 12:e0179546. [PMID: 28665996 PMCID: PMC5493299 DOI: 10.1371/journal.pone.0179546] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 05/31/2017] [Indexed: 12/01/2022] Open
Abstract
AIMS Poor adherence to medication therapy among type 2 diabetes patients is a clinical challenge. We aimed to determine which factors are associated with the three phases of long-term adherence to medication: initiation, implementation and discontinuation in a register-based study. METHODS Adherence to six medicine groups (metformin, sulfonylureas, acetylsalicylic acid, thiazide diuretics, renin angiotensin system inhibitors, and statins) were analysed among 5,232 patients with type 2 diabetes at a tertiary referral hospital during 1998-2009. Rate-ratios of initiation of treatment, recurrent gaps in supply of medication, and discontinuation of treatment were analysed using Poisson regression. RESULTS Poor initiation rather than poor implementation or discontinuation was the main contributor to medication nonadherence. Polypharmacy was a risk factor for slower initiation of treatment for all six medicine groups (rate ratio ranging 0.79 95%CI [0.72-0.87] to 0.89 95%CI [0.82-0.96] per already prescribed medicine), but once patients were in treatment, polypharmacy was not associated with recurrence of gaps in supply of medication, and polypharmacy was associated with lower risk of discontinuation (rate ratio ranging 0.93 95%CI [0.86-1.00] to 0.96 95%CI [0.93-0.99] per prescribed medicine). Other identified risk factors for slow initiation, poor implementation, and discontinuation were diabetes duration, younger age, and Turkish/Pakistani origin. DISCUSSION This study showed that a risk factor does not necessarily have the same association with all three elements of adherence (initiation, implementation and discontinuation), and that efforts supporting patients introduced to more complex drug combinations should be prioritized.
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Affiliation(s)
- Majken Linnemann Jensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Faculty of Health and Medical Sciences, Department of Pharmacy, Section for Social and Clinical Pharmacy, Universitetsparken 2, University of Copenhagen, Denmark
| | | | - Ebba Holme Hansen
- Faculty of Health and Medical Sciences, Department of Pharmacy, Section for Social and Clinical Pharmacy, Universitetsparken 2, University of Copenhagen, Denmark
| | - Lise Aagaard
- Faculty of Health, University of Southern Denmark, Odense, Denmark
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Thunander Sundbom L, Bingefors K, Hedborg K, Isacson D. Are men under-treated and women over-treated with antidepressants? Findings from a cross-sectional survey in Sweden. BJPsych Bull 2017; 41:145-150. [PMID: 28584650 PMCID: PMC5451647 DOI: 10.1192/pb.bp.116.054270] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aims and method To examine gender differences in self-reported depression and prescribed antidepressants (ADs). The Hospital Anxiety and Depression Scale was used to assess depression, and information on prescribed ADs was obtained from the Swedish Prescribed Drug Register. Results Depression was reported by 11.7% of the participants (12.3% men and 11.2% women). ADs were prescribed for 7.6% of the participants (5.3% men, 9.8% women). Among men, 1.8% reported depression and used ADs, 10.5% reported depression but did not use ADs, and 3.6% used ADs but did not report depression. The corresponding figures for women were 2.6%, 8.6% and 7.2%. Clinical implications Men report depression to a greater extent than women but are prescribed ADs to a lesser extent, possibly a sign of under-treatment. Women are prescribed ADs without reporting depression more often than men, possibly a sign of over-treatment. Although the causes remain unclear, diagnostic and treatment guidelines should benefit from considering gender differences in these respects.
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Wawruch M, Zatko D, Wimmer G, Luha J, Hricak V, Murin J, Kukumberg P, Tesar T, Hloska A, Shah R. Patient-related characteristics associated with non-persistence with statin therapy in elderly patients following an ischemic stroke. Pharmacoepidemiol Drug Saf 2016; 26:201-207. [PMID: 27935151 DOI: 10.1002/pds.4148] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/10/2016] [Accepted: 11/15/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE This study was aimed at evaluating the extent of non-persistence with statin therapy in elderly patients after an ischemic stroke and identifying patient-related characteristics that are risk factors for non-persistence. METHODS The evaluable study cohort (n = 2748) was derived from the database of the largest health insurance provider in the Slovak Republic. Patients aged ≥65 years who were initiated on statin therapy following the diagnosis of an ischemic stroke during one full year (1 January 2010 to 31 December 2010) constituted this cohort. Each patient was followed for a period of 3 years from the date of the first statin prescription. Patients with a continuous treatment gap of 6 months without statin prescription were designated as non-persistent. The Cox proportional hazard model was applied to determine patient-associated characteristics that influenced the likelihood of non-persistence. RESULTS During the 3-year follow-up period, 39.7% of patients in the study cohort became non-persistent. Factors associated with decreased probability of a patient becoming non-persistent were age ≥75 years (hazard ratio (HR) 0.75), polypharmacy (concurrent use of ≥6 drugs) (HR 0.79), diabetes mellitus (HR 0.80), dementia (HR 0.81) and hypercholesterolemia (HR 0.50). On the other hand, the presence of anxiety disorders (HR 1.33) predicted an increased likelihood of a patient being non-persistent. CONCLUSIONS Our findings suggest that patients aged ≥75 years or those with the presence of diabetes mellitus, dementia, hypercholesterolemia or polypharmacy were likely to be persistent with statin therapy, whereas those with anxiety disorders may need greater assistance with persistence of statin therapy. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Martin Wawruch
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Dusan Zatko
- General Health Insurance Company, Bratislava, Slovakia
| | - Gejza Wimmer
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Jan Luha
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Vasil Hricak
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Jan Murin
- First Department of Internal Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Peter Kukumberg
- Second Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Tomas Tesar
- Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University, Bratislava, Slovakia
| | - Adam Hloska
- Ministry of Health of the Slovak Republic, Bratislava, Slovakia.,Department of Pharmacology, Jessenius Faculty of Medicine in Martin, Comenius University, Bratislava, Slovakia
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Choi SM, Lee J, Park YS, Lee CH, Lee SM, Yim JJ. Effect of Verbal Empathy and Touch on Anxiety Relief in Patients Undergoing Flexible Bronchoscopy: Can Empathy Reduce Patients' Anxiety? Respiration 2016; 92:380-388. [PMID: 27764835 DOI: 10.1159/000450960] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 09/19/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Patients undergoing flexible bronchoscopy usually experience anxiety before and during the procedure. OBJECTIVES We performed this study to investigate whether verbal empathy and intentional touch from a bronchoscopist could reduce anxiety in patients undergoing flexible bronchoscopy. METHODS We conducted a prospective randomized trial in a university-affiliated hospital. Participants were randomly assigned to one of the following groups: a control group, a verbal empathy group, or a verbal empathy and touch group. The staff pulmonologist performing bronchoscopy expressed verbal empathy and used touch by speaking to the patient (using predefined short statements) and making eye contact, and by laying his/her left hand on the patient's right shoulder. We assessed the level of patient anxiety with a visual analog scale before and after the intervention. RESULTS Participants were 267 patients with a median age of 65 years; 62.2% were men. Although there were no differences in changes in anxiety between the three groups, subgroup analysis of the visual analog scale including participants with higher baseline anxiety (empathy and touch group participants with anxiety ≥60 mm; empathy group and empathy and touch group participants with anxiety ≥70 mm) showed a larger reduction in anxiety than the control group. CONCLUSIONS Verbal empathy and touch given by a bronchoscopist before bronchoscopy reduced anxiety in patients with high baseline anxiety levels.
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Affiliation(s)
- Sun Mi Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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Panigrahi M, Swain TR, Mohanty S. Nonadherence to anti-HIV medication is associated with higher level of anxiety: Experience from a tertiary care hospital of Odisha. Indian J Pharmacol 2016; 47:672-5. [PMID: 26729962 PMCID: PMC4689024 DOI: 10.4103/0253-7613.169578] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim: To correlate the level of anxiety with nonadherence to antiretroviral medication. Materials and Methods: This observational, cross-sectional, hospital-based study was conducted in 78 patients attending antiretroviral therapy (ART) center of a tertiary care hospital of Odisha. The study duration was 6 months. Patients were designated as nonadherent by referring to the white card. Utilization of ART drugs and adverse drug reactions were included in a predesigned format. The anxiety level of all included patients was scored as per Hamilton Anxiety Rating Scale. Mean anxiety score of the adherent group was compared with that of the nonadherent group. Possible causes of nonadherence leading to high anxiety level were evaluated. Results: 46% of patients in the nonadherent group had very severe, 17% had moderate to severe, 28% had mild to moderate and 9% had a mild level of anxiety. In the adherent group, however, mild to moderate level of anxiety was observed only in 10% patients. Conclusions: Anxiety is associated with sub-optimal medication adherence in HIV infected patients.
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Affiliation(s)
| | | | - Srikanta Mohanty
- Department of Pharmacology, SCB Medical College, Cuttack, Odisha, India
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Lebeau G, Consoli SM, Le Bouc R, Sola-Gazagnes A, Hartemann A, Simon D, Reach G, Altman JJ, Pessiglione M, Limosin F, Lemogne C. Delay discounting of gains and losses, glycemic control and therapeutic adherence in type 2 diabetes. Behav Processes 2016; 132:42-48. [PMID: 27663668 DOI: 10.1016/j.beproc.2016.09.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 09/18/2016] [Accepted: 09/19/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Delay discounting is the tendency to prefer smaller, sooner rewards to larger, later ones. Poor adherence in type 2 diabetes could be partially explained by a discounted value of health, as a function of delay. Delay discounting can be described with a hyperbolic model characterized by a coefficient, k. The higher k, the less future consequences are taken into account when making decisions. This study aimed to determine whether k would be correlated with glycated hemoglobin and adherence in type 2 diabetes. METHODS Ninety-three patients were recruited in two diabetology departments. Delay discounting coefficients were measured with a computerized task. HbA1c was recorded and adherence was assessed by questionnaires. Potential socio-demographic and clinical confounding factors were collected. RESULTS There was a positive correlation between delay discounting of gains and HbA1c (r=0.242, P=0.023). This association remained significant after adjusting for potential confounding factors (F=4.807, P=0.031, η2=0.058). This association was partially mediated by adherence to medication (β=0.048, 95% CI [0.004-0.131]). CONCLUSIONS Glycemic control is associated with delay discounting in patients suffering from type 2 diabetes. Should these findings be replicated with a prospective design, they could lead to new strategies to improve glycemic control among these patients.
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Affiliation(s)
- Gaële Lebeau
- Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France; Inserm U894, Center for Psychiatry and Neuroscience, Paris, France; AP-HP, West Paris University Hospitals, Department of Psychiatry, Paris, France.
| | - Silla M Consoli
- Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France; AP-HP, West Paris University Hospitals, Department of Psychiatry, Paris, France
| | - Raphael Le Bouc
- Inserm U1127, CNRS U7225, Brain and Spine Institute, "Motivation, Brain and Behavior" Team, Pitié-Salpêtrière Hospital, Paris, France; Pierre and Marie Curie University, Paris, France; AP-HP, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Agnès Hartemann
- Pierre and Marie Curie University, Paris, France; AP-HP, Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Dominique Simon
- Pierre and Marie Curie University, Paris, France; AP-HP, Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), Pitié Salpêtrière Hospital, Paris, France
| | - Gerard Reach
- AP-HP, Endocrinology, Diabetology and Metabolic Diseases Department, Avicenne Hospital, Bobigny, France; Paris 13 University, Sorbonne Paris Cité, Bobigny, France
| | - Jean-Jacques Altman
- Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France; AP-HP, West Paris University Hospitals, Diabetology Department, Paris, France
| | - Mathias Pessiglione
- Inserm U1127, CNRS U7225, Brain and Spine Institute, "Motivation, Brain and Behavior" Team, Pitié-Salpêtrière Hospital, Paris, France; Pierre and Marie Curie University, Paris, France
| | - Frédéric Limosin
- Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France; Inserm U894, Center for Psychiatry and Neuroscience, Paris, France; AP-HP, West Paris University Hospitals, Department of Psychiatry, Paris, France
| | - Cédric Lemogne
- Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France; Inserm U894, Center for Psychiatry and Neuroscience, Paris, France; AP-HP, West Paris University Hospitals, Department of Psychiatry, Paris, France
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Bertolotti G, Moroni L, Burro R, Spanevello A, Pedretti RF, Giorgetti G. Shortened questionnaires to assess anxiety and depression during in-hospital rehabilitation: clinical validation and cutoff scores. Neuropsychiatr Dis Treat 2016; 12:2627-2633. [PMID: 27789951 PMCID: PMC5068471 DOI: 10.2147/ndt.s111797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A postacute phase needs reliable routine screening instruments in order to identify the patients to be referred for a clinical interview with a psychologist. The aim of this study was to estimate the clinical cutoff scores of the anxiety and depression questionnaires and their clinical validity using a gold standard. METHODS The study involved 177 patients with pulmonary, cardiac, or neurological disease undergoing in-hospital rehabilitation. Receiver operating characteristic curves were used to determine the best concordance between questionnaire's scores and the gold standards. RESULTS There was a significant difference (P<0.001) between clinically anxious and depressed patients and nonclinical subjects. The receiver operating characteristic curve for anxiety indicated that the best area under the curve for State Anxiety Inventory is obtained with a cutoff point of 21 for males and 25 for females; for depression scores, the highest area under the curve for Depression Questionnaire-Reduced Form is obtained with a cutoff point of six for males and eight for females. CONCLUSION Using appropriate cutoff values, the State Anxiety Inventory and Depression Questionnaire-Reduced Form allow psychologists to optimize early clinical intervention strategies selecting patients with significant needs.
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Affiliation(s)
- Giorgio Bertolotti
- Psychology Unit, Salvatore Maugeri Foundation, IRCCS, Scientific Institute, Tradate
| | - Loretta Moroni
- Psychology Unit, Salvatore Maugeri Foundation, IRCCS, Scientific Institute, Tradate
| | - Roberto Burro
- Department of Human Sciences - University of Verona, Verona
| | | | | | - Giandomenico Giorgetti
- Department of Neuromotor Rehabilitation, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Tradate, Italy
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Jacobson NC, Newman MG. PERCEPTIONS OF CLOSE AND GROUP RELATIONSHIPS MEDIATE THE RELATIONSHIP BETWEEN ANXIETY AND DEPRESSION OVER A DECADE LATER. Depress Anxiety 2016; 33:66-74. [PMID: 26290461 PMCID: PMC4959466 DOI: 10.1002/da.22402] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 06/24/2015] [Accepted: 07/02/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Previous research has demonstrated that anxiety reliably predicts later depression, but little has been uncovered about the mechanism underlying this connection. Interpersonal relationships appear to be a viable mechanism of the association as anxiety has been shown to predict later deficits in both close (e.g., "best friendships") and group relationships (e.g., classroom peer groups), and deficits in both close and group relationships have been linked to later depressive symptoms. The current study examined close and group relationships as potential mediators between anxiety and depression 12-14 years later. METHODS In a nationally representative sample of adolescents (N = 6,504), anxiety was measured at baseline, perceptions of close relationships (i.e., feeling loved) and perceptions of group relationships (i.e., feeling part of a group) were measured 6 months later, and depression levels and diagnosis were measured 12-14 years later. RESULTS Using structural equation models, the results showed that adolescent perceptions of both close and group relationships significantly mediated the relationship between adolescent anxiety and adult levels of depression. Furthermore, perceptions of not being accepted/loved in close relationships significantly mediated the relationship between adolescent anxiety and clinical depression in adulthood. CONCLUSIONS These results suggest that a perception of not being accepted in group relationships may be a mechanism by which heightened anxiety in adolescents leads to heightened nonclinical depression in adulthood. On the other hand, adolescent perceptions of not feeling loved or accepted in close relationships may be a mechanism by which heightened anxiety in adolescence leads to clinical depression--in adulthood.
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Affiliation(s)
- Nicholas C. Jacobson
- Correspondence to: Nicholas C. Jacobson, Department of Psychology, 378 Moore Building, The Pennsylvania State University, University Park, PA 16802-3103,
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McAuley JW, Passen N, Prusa C, Dixon J, Cotterman-Hart S, Shneker BF. An evaluation of the impact of memory and mood on antiepileptic drug adherence. Epilepsy Behav 2015; 43:61-5. [PMID: 25561379 DOI: 10.1016/j.yebeh.2014.11.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 11/17/2014] [Indexed: 01/08/2023]
Abstract
RATIONALE Antiepileptic drugs are the mainstay of treatment for patients with epilepsy. Adherence to the prescribed regimen is a major factor in achieving a reduced seizure burden, which can decrease morbidity and mortality. Patients with epilepsy oftentimes complain about difficulty with memory. Because little is known about the relationship between memory and mood and adherence, the purpose of this project was to determine the impact of the confounding factors of memory and mood on antiepileptic drug adherence in patients with epilepsy. METHODS One hundred adult patients with epilepsy were recruited from the outpatient neurology clinic for this cross-sectional study. Patients who met the inclusion criteria completed measures of subjective memory (subset of 6 memory questions from the QOLIE-89) and objective memory (Hopkins Verbal Learning Test - Revised), subjective adherence (Morisky scale) and objective adherence (medication possession ratio), and mood (Neurological Disorders Depression Inventory for Epilepsy). Refill records from each patient's community pharmacy were used to objectively assess adherence. Medication possession ratios were calculated based on the antiepileptic drug refill records over the previous 6months. Patients were considered adherent if their MPR was >80%. RESULTS Women made up the majority of the sample (n=59), and, on average, patients had been living with epilepsy for nearly 20years. Approximately 40% of the sample were on antiepileptic drug monotherapy; most patients (>70%) took their antiepileptic drugs twice daily, and the mean number of total medications was 4.25±2.98. Based on the objective measure of adherence, 35% of the patients were nonadherent. Patients self-reported better adherence than what was objectively measured. Only the retention metric of the objective memory measure differentiated adherent patients from nonadherent patients. Patients in the adherent group had significantly lower depression scores (indicating better mood) compared with those in the nonadherent group (p=0.04). CONCLUSIONS Objective memory measures were not robustly correlated with adherence. However, we observed that patients with higher depressed mood scores were more likely to be nonadherent. By targeting patients with epilepsy and comorbid depression, practitioners may identify patients at greatest risk of nonadherence and subsequent harm.
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Affiliation(s)
- James W McAuley
- Ohio State University College of Pharmacy, Columbus, OH 43210, USA; Ohio State University College of Medicine, Columbus, OH 43210, USA.
| | - Nina Passen
- Ohio State University College of Pharmacy, Columbus, OH 43210, USA
| | - Christine Prusa
- Ohio State University College of Pharmacy, Columbus, OH 43210, USA
| | - Joanne Dixon
- Ohio State University College of Pharmacy, Columbus, OH 43210, USA
| | | | - Bassel F Shneker
- Ohio State University College of Medicine, Columbus, OH 43210, USA; Ohio State University College of Pharmacy, Columbus, OH 43210, USA
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Sandoval L, Pierce A, Davis S, Feldman S. Improved psoriasis with weight loss: the role of behavioural factors. Br J Dermatol 2015; 172:826-7. [DOI: 10.1111/bjd.13345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- L.F. Sandoval
- Department of Dermatology; Center for Dermatology Research; Wake Forest School of Medicine; Medical Center Boulevard; Winston-Salem NC 27157-1071 U.S.A
| | - A. Pierce
- Department of Dermatology; Center for Dermatology Research; Wake Forest School of Medicine; Medical Center Boulevard; Winston-Salem NC 27157-1071 U.S.A
| | - S.A. Davis
- Department of Dermatology; Center for Dermatology Research; Wake Forest School of Medicine; Medical Center Boulevard; Winston-Salem NC 27157-1071 U.S.A
| | - S.R. Feldman
- Department of Dermatology; Center for Dermatology Research; Wake Forest School of Medicine; Medical Center Boulevard; Winston-Salem NC 27157-1071 U.S.A
- Department of Pathology; Center for Dermatology Research; Wake Forest School of Medicine; Medical Center Boulevard; Winston-Salem NC 27157-1071 U.S.A
- Department of Public Health Sciences; Center for Dermatology Research; Wake Forest School of Medicine; Medical Center Boulevard; Winston-Salem NC 27157-1071 U.S.A
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Stefanaki C, Bacopoulou F, Livadas S, Kandaraki A, Karachalios A, Chrousos GP, Diamanti-Kandarakis E. Impact of a mindfulness stress management program on stress, anxiety, depression and quality of life in women with polycystic ovary syndrome: a randomized controlled trial. Stress 2015; 18:57-66. [PMID: 25287137 DOI: 10.3109/10253890.2014.974030] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disorder with a significant psychological burden throughout the life course of affected women. Thus, use of mindful awareness may be beneficial as an adjunct to conventional medical management of women with PCOS. A randomized, controlled trial was conducted at the Evgenideion Hospital of the Athens University Medical School to explore the impact of an 8-week mindfulness stress management program on measures of depression, anxiety and stress as well as on the quality of life in reproductive age women with PCOS. The study was approved by the Research Ethics Committee. Twenty-three and 15 women with PCOS were randomly allocated to the intervention or control group, respectively. All participants were administered DASS21, PSS-14, PCOSQ, Daily Life and General Life Satisfaction Questionnaires and provided three-timed daily samples of salivary cortisol, before and after the intervention. Intervention group participants were provided with the Credibility/Expectancy Questionnaire at the day of enrolment, to check for possible placebo effect on the outcome. Post-intervention, between-group results revealed statistically significant reductions in stress, depressive and anxiety symptoms, as well as in salivary cortisol concentrations, along with an increase in Life Satisfaction and Quality of Life scores in the intervention group only. There was no significant "placebo" effect on the outcome measures. Mindfulness techniques seem promising in ameliorating stress, anxiety, depression and the quality of life in women with PCOS and could be used as an adjunct method to the conventional management of these women.
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Affiliation(s)
- Charikleia Stefanaki
- Division of Endocrinology, Metabolism and Diabetes, Evgenideion Hospital, Athens University Medical School , Athens , Greece
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Sharif R, Parekh TM, Pierson KS, Kuo YF, Sharma G. Predictors of early readmission among patients 40 to 64 years of age hospitalized for chronic obstructive pulmonary disease. Ann Am Thorac Soc 2014; 11:685-94. [PMID: 24784958 PMCID: PMC4225809 DOI: 10.1513/annalsats.201310-358oc] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 04/02/2014] [Indexed: 01/21/2023] Open
Abstract
RATIONALE Various causes can contribute to the high rates of readmission among patients hospitalized with chronic obstructive pulmonary disease (COPD). OBJECTIVES To determine the frequency and predictors of early readmission among patients aged 40-64 years, hospitalized with COPD. METHODS In a retrospective cohort study, using a large national commercial insurance database, we obtained the clinical information within 12 months of the index hospitalization and 30 days after discharge. MEASUREMENTS AND MAIN RESULTS Primary outcome was early readmission, defined as hospitalization within 30 days of discharge. We categorized predictor variables as patient, provider, and system factors, and compared these variables between patients readmitted and those not readmitted. Logistic regression was used for multivariable analysis. Of 8,263 patients who met the inclusion criteria, 741 (8.9%) had early readmission. Multivariable analysis showed patient factors (male, history of heart failure, lung cancer, osteoporosis, and depression), provider factors (no prior prescription of statin within 12 mo of the index hospitalization and no prescription of short-acting bronchodilator, oral steroid and antibiotic on discharge), and system factors (length of stay, <2 or >5 d and lack of follow-up visit after discharge) were associated with early readmission among patients hospitalized with COPD. The C-statistic of the model including patient characteristics was 0.677 (95% confidence interval, 0.656-0.697), which was improved to 0.717 (95% confidence interval, 0.702-0.732) after addition of provider- and system-based factors. CONCLUSIONS One of 11 patients hospitalized with COPD is readmitted within 30 days of discharge. Provider and system factors are important modifiable risk factors of early readmission.
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Affiliation(s)
- Roozbeh Sharif
- Department of Internal Medicine
- Graduate School of Biomedical Sciences
| | | | | | - Yong-Fang Kuo
- Department of Internal Medicine
- Sealy Center on Aging, and
| | - Gulshan Sharma
- Division of Pulmonary and Critical Care,
Department of Internal Medicine, University of Texas Medical Branch, Galveston,
Texas
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Abstract
'The extent to which an individual's medication-taking behaviour and/or execution of lifestyle changes, corresponds with agreed recommendations from a healthcare provider', is a highly complex behaviour, defined as adherence. However, intentional non-adherence is regularly observed and results in negative outcomes for patients along with increased healthcare provision costs. Whilst this is a consistent issue amongst adults of all ages, the burden of chronic disease is greatest amongst older adults. As a result, the absolute prevalence of intentional non-adherence is increased in this population. This non-systematic review of intentional non-adherence to medication highlights the extent of the problem amongst older adults. It notes that age, per se, is not a contributory factor in intentionally non-adherent behaviours. Moreover, it describes the difference in methodology required to identify such behaviours in contrast to reports of non-adherence in general: the use of focus groups, semi-structured, one-to-one interviews and questionnaires as opposed to pill counts, electronic medication monitors and analysis of prescription refill rates. Using Leventhal's Common-Sense Model of Self-Regulation, it emphasizes six key factors that may contribute to intentional non-adherence amongst older adults: illness beliefs, the perceived risks (e.g. dependence, adverse effects), benefits and necessity of potential treatments, the patient-practitioner relationship, inter-current physical and mental illnesses, financial constraints and pharmaceutical/pharmacological issues (poly-pharmacy/regimen complexity). It describes the current evidence for each of these aspects and notes the paucity of data validating Leventhal's model in this regard. It also reports on interventions that may address these issues and explicitly acknowledges the lack of evidence-based interventions available to healthcare practitioners. As a result, it highlights five key areas that require urgent research amongst older adults: (1) the overlap between intentional and unintentional non-adherence, particularly amongst those who may be frail or isolated; (2) the potential correlation between symptomatic benefit and intentional vs. unintentional non-adherence to medication; (3) an evaluation of the source of prescribing (i.e. a long-standing provider vs. an acute episode of care) and the patient-prescriber relationship as determinants of intentional and unintentional non-adherence; (4) the decision-making processes leading to selective intentional non-adherence amongst older adults with multiple medical problems; and (5) the development and evaluation of interventions designed to reduce intentional non-adherence, specifically addressing each of the aspects listed above.
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Affiliation(s)
- Omar Mukhtar
- Clinical Pharmacology and Therapeutics, King's Health Partners, King's College Hospital, Denmark Hill, London, SE5 9RS, UK,
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