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Vollbehr NK, Stant AD, Hoenders HJR, Bartels-Velthuis AA, Nauta MH, Castelein S, Schroevers MJ, de Jong PJ, Ostafin BD. Cost-effectiveness of a mindful yoga intervention added to treatment as usual for young women with major depressive disorder versus treatment as usual only: Cost-effectiveness of yoga for young women with depression. Psychiatry Res 2024; 333:115692. [PMID: 38309011 DOI: 10.1016/j.psychres.2023.115692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 02/05/2024]
Abstract
In a randomized controlled trial in the Netherlands, we studied the (cost)effectiveness of adding a mindful yoga intervention (MYI+TAU) to treatment as usual (TAU) for young women with major depressive disorder (MDD). In this paper, we present the results of the economic analyses. Societal costs and health outcomes were prospectively assessed during 15 months for all randomized participants (n = 171). Symptoms of depression (Depression Anxiety and Stress Scales; DASS) and quality adjusted life years (QALYs) were used as health outcomes in the economic analyses. Mean total societal costs during the 15 months of the study were €11.966 for the MYI+TAU group and €13.818 for the TAU group, differences in mean total societal costs were not statistically significant. Health outcomes (DASS and QALY) were slightly in favour of MYI+TAU, but differences between groups were not statistically significant. Combining costs and health outcomes in cost-effectiveness analyses indicated that MYI+TAU is likely to be cost-effective compared to TAU which was confirmed by sensitivity analyses. Although there were limitations in the cost-effectiveness analysis, findings from this study suggest that MYI+TAU warrants future attention for the potential to be cost-effective compared to TAU for young women with MDD.
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Affiliation(s)
- Nina K Vollbehr
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Hereweg 80, 9725 AG, Groningen, the Netherlands; University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands.
| | | | - H J Rogier Hoenders
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Hereweg 80, 9725 AG, Groningen, the Netherlands; University of Groningen, Faculty of Religion, Culture and Society, Groningen, the Netherlands
| | - Agna A Bartels-Velthuis
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research center, Groningen, the Netherlands
| | - Maaike H Nauta
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
| | - Stynke Castelein
- Lentis Psychiatric Institute, Center for Integrative Psychiatry, Hereweg 80, 9725 AG, Groningen, the Netherlands; University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands; Lentis Psychiatric Institute, Lentis Research, Groningen, the Netherlands
| | - Maya J Schroevers
- University of Groningen, University Medical Center Groningen, Faculty of Medical Sciences, Groningen, the Netherlands
| | - Peter J de Jong
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
| | - Brian D Ostafin
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, the Netherlands
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Borentain S, Desai P, Fu DJ, Nancy Chen L, Lane R, Mathews M, Canuso CM. Commentary on Cochrane review: "Ketamine and other glutamate receptor modulators for depression in adults with unipolar major depressive disorder". J Psychopharmacol 2023; 37:836-844. [PMID: 36218274 PMCID: PMC10399093 DOI: 10.1177/02698811221123046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cochrane recently published a review of esketamine and other glutamate receptor modulators in depression. AIM To address the limitations of the review, analyses of esketamine data were conducted to provide additional perspective to the reviewers' interpretation of their findings. METHODS Response rate, remission rate, and change from baseline in Montgomery-Åsberg Depression Rating Scale (MADRS) total score were determined using data from all esketamine phase 2/3 registration studies of treatment-resistant depression (TRD) and, separately, all esketamine phase 2/3 registration studies of major depressive disorder (MDD) and active suicidal ideation with intent. Outcomes were assessed at all timepoints (i.e., 24 h, 72 h (MDD with active suicidal intent only), and 1, 2, and 4 weeks). Enrollment criteria of the TRD studies were different than those of the studies of MDD and active suicidal ideation with intent, resulting in differences in patients' clinical characteristics and depression severity between the cohorts. Thus, we did not compare results between these cohorts (as was done in the Cochrane review). RESULTS/OUTCOMES In the combined TRD studies, a statistically significant between-group difference favored esketamine plus antidepressant over antidepressant plus placebo at 24 h (based on response, remission, and change in MADRS score), 1 week (change in MADRS score), 2 weeks (response and change in MADRS score), and 4 weeks (response, remission, and change in MADRS score). In the combined studies of MDD and active suicidal ideation with intent, the between-group difference was statistically different, favoring esketamine plus standard-of-care over placebo plus standard-of-care, at 24 h (response, remission, and change in MADRS score), 72 h and 1 week (change in MADRS score), 2 weeks (response), and 4 weeks (response, remission, and change in MADRS score). For both study types, the between-group difference in outcomes was not statistically significant at the other timepoints. CONCLUSIONS/INTERPRETATION Esketamine improves response, remission, and depressive symptoms as early as 24 h post-first dose among patients with TRD and among patients with MDD and active suicidal ideation with intent.
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Affiliation(s)
| | - Pooja Desai
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Dong-Jing Fu
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Li Nancy Chen
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Rosanne Lane
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Maju Mathews
- Janssen Research & Development, LLC, Titusville, NJ, USA
- Perception Neuroscience, New York, NY, USA (current employment)
| | - Carla M Canuso
- Janssen Research & Development, LLC, Titusville, NJ, USA
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Petre LM, Gheorghe DA, Watson D, Mitrofan L. Romanian Inventory of Depression and Anxiety Symptoms (IDAS-II). Front Psychol 2023; 14:1159380. [PMID: 37484097 PMCID: PMC10359186 DOI: 10.3389/fpsyg.2023.1159380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 06/05/2023] [Indexed: 07/25/2023] Open
Abstract
Background The Inventory of Depression and Anxiety Symptoms (IDAS-II) is a self-report measure comprising 99 items divided into 18 non-overlapping scales that allows for a dimensional assessment of depression, anxiety, and bipolar symptoms. The IDAS-II is currently available in English, Turkish, Spanish, German, and Swedish. This study's major goal was to adapt and validate the IDAS-II to the Romanian population. Method Participants from a community sample (N = 1,072) completed the IDAS-II (Romanian version) and additional measures assessing depression and anxiety disorders. Results Item-level factor analyses validated the unidimensionality of the scales, and internal consistency results indicated that most symptom scales had satisfactory alpha coefficient values. Based on previous structural analyses, a confirmatory factor analysis (CFA) on the IDAS-II scales confirmed a three-component model of "Distress," "Obsessions/Fear," and "Positive Mood." Convergent and discriminant validity were established by correlational analyses with other symptom measures. Limitations This study was conducted using a sample from the general population and several of the employed measures have limitations. Specifically, the current study was unable to employ Romanian versions of the gold-standard instruments that assess well-being, obsessive-compulsive disorder, and claustrophobia. Conclusion The IDAS-II (Romanian version) is the first clinical measure to assess internalizing dimensions of the Hierarchical Taxonomy of Psychopathology (HiTOP) model that is available for the Romanian population.
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Affiliation(s)
- Ligiana Mihaela Petre
- Department of Applied Psychology and Psychotherapy, Faculty of Psychology and Educational Sciences, University of Bucharest, Bucharest, Romania
| | - Delia Alexandra Gheorghe
- Department of Experimental and Theoretical Neuroscience, Transylvanian Institute of Neuroscience, Cluj-Napoca, Romania
| | - David Watson
- Department of Psychology, University of Notre Dame, Notre Dame, IN, United States
| | - Laurentiu Mitrofan
- Department of Applied Psychology and Psychotherapy, Faculty of Psychology and Educational Sciences, University of Bucharest, Bucharest, Romania
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Effect of low-carbohydrate diet on depression and anxiety: A systematic review and meta-analysis of controlled trials. J Affect Disord 2023; 325:206-214. [PMID: 36584702 DOI: 10.1016/j.jad.2022.12.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 10/12/2022] [Accepted: 12/10/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Despite considerable advances in pharmacological and non-pharmacological treatments, mental health illnesses carry many economic and social burdens. Depression and anxiety are known as mental disorders which are highly prevalent worldwide. Previous studies have shown different results. This diet has attracted enormous interest. OBJECTIVE This is the first meta-analysis conducted to review systematically all trials to evaluating the effect of a low carbohydrate diet (LCD) on depression, and anxiety. METHODS PubMed, Web of Science, and Scopus have been searched until 9 September 2021. In total, 8 RCTs (n = 590) were carried out for evaluation the effects of LCDs on depression and anxiety were included. All the trials included in the analyses evaluated patients without a mood disorder. Random model effects meta-analysis was conducted. To evaluate the heterogeneity among the included studies. The egger test was used. Subgroup analyses performed based on regions, assessment methods, carbohydrate intake and duration of studies. RESULTS This study did not show any significant association between a low carbohydrate diet and the of anxiety (SMD = 0.19, 95 % CI -0.10, 0.47; P = 0.20) and also depression (SMD = 0.06, 95 % CI -0.11, 0.24; P = 0.49). If one of the studies is excluded, this diet significantly increases anxiety (SMD = 0.33, 95 % CI 0.12, 0.54; P ≤ 0.001). This study showed that this diet increases anxiety in studies with <26 % carbohydrate intake (SMD = 0.31; 95%CI 0.10, 0.52; P ≤ 0.001; I2 = 0.00, P = 0.52), in the Australia (SMD = 0.29; 95%CI 0.08, 0.49; P = 0.01; I2 = 0.00, P = 0.42), and in studies that used the Spielberger State Anxiety Inventory (SAI) to assess anxiety (SMD = 0.33; 95%CI 0.11, 0.54; P ≤ 0.001; I2 = 0.00, P = 0.54). LIMITATIONS One of the limitations of intervention studies examining the effect of diet is that it is difficult to blind people under intervention. CONCLUSION The present study did not demonstrate significant association between a low carbohydrate diet and improvement of depression and anxiety. More accurate studies are needed to reach definitive conclusions.
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Dong Y, Weir NM. Antidepressants: A content analysis of healthcare providers' tweets. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 9:100232. [PMID: 36876146 PMCID: PMC9976573 DOI: 10.1016/j.rcsop.2023.100232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/25/2023] [Accepted: 01/28/2023] [Indexed: 02/12/2023] Open
Abstract
Background Antidepressants are the primary treatment for depression, and social support from social media may offer another support route. Whilst Twitter has become an interactive platform for healthcare providers and their patients, previous studies found low engagement of healthcare providers when discussing antidepressants on Twitter. This study aims to analyse the Twitter posts of healthcare providers related to antidepressants and to explore the healthcare providers' engagement and their areas of interest. Method Tweets within a 10-day period were collected through multiple searches with a list of keywords within Twitter. The results were filtered against several inclusion criteria, including a manual screening to identify healthcare providers. A content analysis was conducted on eligible tweets where correlative themes and subthemes were identified. Key findings Healthcare providers contributed 5.9% of the antidepressant-related tweets (n = 770/13,005). The major clinical topics referred to in the tweets were side effects, antidepressants for the treatment of COVID-19, and antidepressant studies of psychedelics. Nurses posted more tweets sharing personal experiences with commonly negative attitudes, in contrast to physicians. Links to external webpages were commonly used among healthcare providers, especially users representing healthcare organisations. Conclusions A relatively low proportion of healthcare providers' engagement on Twitter regarding antidepressants (5.9%) was identified, with a minimal increase throughout the COVID-19 pandemic when compared to previous studies. The major clinical topics referred to in the tweets were side effects, antidepressants for the treatment of COVID-19 and antidepressant studies of psychedelics, which have been made publicly available. In general, the findings confirmed that social media platforms are a mechanism by which healthcare providers, organisations and students support patients, share information about adverse drug effects, communicate personal experiences, and share research. It is plausible that this could impact the belief and behaviours of people with lived experience of depression who may see these tweets.
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Affiliation(s)
| | - Natalie M. Weir
- Corresponding author at: 161 Cathedral Street, Glasgow G4 0NR, United Kingdom.
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Huntsman JL, Bulaj G. Health education via "empowerment" digital marketing of consumer products and services: Promoting therapeutic benefits of self-care for depression and chronic pain. Front Public Health 2023; 10:949518. [PMID: 36703812 PMCID: PMC9871258 DOI: 10.3389/fpubh.2022.949518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023] Open
Abstract
Increasing health care costs and high economic burden exemplify the impact of chronic diseases on public health. Multifaceted approaches to treating chronic diseases include pharmaceutical drugs, digital therapeutics, and lifestyle medicine. Chronic diseases are largely preventable, and health promotion yields positive outcomes. However, despite positive return on investment (ROI) and cost-to-benefit ratio (CBR) for health promotion (median ROI 2.2, median CBR 14.4), commercial marketing of healthy lifestyles and self-care is limited. The objective of this perspective article is to discuss how digital marketing of consumer goods and services that support therapeutic self-care can also bridge public health and for-profit interests. We describe how "empowerment" marketing campaigns can provide evidence-based associations between products/services and self-care benefits for people living with chronic pain and depression. Such a "health education as marketing" strategy is illustrated by educational ads describing how contact with nature, music, and yoga can improve chronic pain and reduce depressive symptoms. Creating associations between health-related benefits of these activities with products (outdoor and yoga apparel, audio equipment) and services (music streaming services, music mobile apps, eco-tourism, yoga studios) that support them expand their value proposition, thus incentivizing profit-driven companies to engage in public health campaigns. Long-term success of companies that incorporate evidence-based health education as marketing and branding strategies will depend on following ethical considerations and advertising guidelines defined by consumer protection regulatory agencies, such as the Federal Trade Commission (FTC). In conclusion, integration of health education about self-care and commercial marketing can support health care outcomes and disease prevention.
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Affiliation(s)
| | - Grzegorz Bulaj
- OMNI Self-care, LLC, Salt Lake City, UT, United States,L. S. Skaggs College of Pharmacy, University of Utah, Salt Lake City, UT, United States,*Correspondence: Grzegorz Bulaj ✉
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Zhou YH, Leung D, Lin JK, Hu LC, Lin XY, Zhang X, Mak YW. Experiences of seeking and accessing medical care among persons with major depression: A qualitative descriptive study of persons with depression in China. Front Psychiatry 2023; 14:1092711. [PMID: 36846228 PMCID: PMC9950104 DOI: 10.3389/fpsyt.2023.1092711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/24/2023] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION A large number of people in China are affected by depression, yet tend to delay seeking treatment. This study aims to explore persons living with depression and their journey of diagnoses and seeking professional medical help in China. METHODS Semi-structured interviews were conducted with 20 persons who visiting physicians to be diagnosed and receive professional help from a large mental health center in Guangzhou, Guangdong province, China. Individual interviews were conducted and data were analyzed using content analysis. RESULTS Three themes were identified from the findings: (1) "noticed something was wrong"; (2) negotiated decisions with their own narratives and the personal suggestions of others; and (3) gave new meaning to their experiences of depression, whereby they sought medical treatment. DISCUSSION The findings of the study indicated that the impact of progressive depressive symptoms on the participants' daily lives was a strong motivation for them to seek professional help. The obligation to care for and support their family prevented them from initially disclosing their depressive symptoms to family members, but eventually prompted them to seek professional help and persist in follow-up treatment. Some participants experienced unexpected benefits (e.g., relief at no longer feeling "alone") during their first visit to the hospital for depression or when they were diagnosed with depression. The results suggest a need to continue to actively screen for depression and provide more public education to prevent negative assumptions and reduce public and personal stigmatization of those with mental health problems.
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Affiliation(s)
- Yan Hua Zhou
- School of Nursing, Guangzhou Health Science College, Guangzhou, China
| | - Doris Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Jian Kui Lin
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Li Chan Hu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiao Yang Lin
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuelin Zhang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Yim Wah Mak
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
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Healthcare use and costs among individuals receiving mental health services for depression within primary care in Nepal. BMC Health Serv Res 2022; 22:1596. [PMID: 36585707 PMCID: PMC9804956 DOI: 10.1186/s12913-022-08969-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 12/14/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Integrating mental health services into primary care is a key strategy for reducing the mental healthcare treatment gap in low- and middle-income countries. We examined healthcare use and costs over time among individuals with depression and subclinical depressive symptoms in Chitwan, Nepal to understand the impact of integrated care on individual and health system resources. METHODS Individuals diagnosed with depression at ten primary care facilities were randomized to receive a package of integrated care based on the Mental Health Gap Action Programme (treatment group; TG) or this package plus individual psychotherapy (TG + P); individuals with subclinical depressive symptoms received primary care as usual (UC). Primary outcomes were changes in use and health system costs of outpatient healthcare at 3- and 12-month follow up. Secondary outcomes examined use and costs by type. We used Poisson and log-linear models for use and costs, respectively, with an interaction term between time point and study group, and with TG as reference. RESULTS The study included 192 primary care service users (TG = 60, TG + P = 60, UC = 72; 86% female, 24% formally employed, mean age 41.1). At baseline, outpatient visits were similar (- 11%, p = 0.51) among TG + P and lower (- 35%, p = 0.01) among UC compared to TG. Visits increased 2.30 times (p < 0.001) at 3 months among TG, with a 50% greater increase (p = 0.03) among TG + P, before returning to baseline levels among all groups at 12 months. Comparing TG + P to TG, costs were similar at baseline (- 1%, p = 0.97) and cost changes did not significantly differ at three (- 16%, p = 0.67) or 12 months (- 45%, p = 0.13). Costs among UC were 54% lower than TG at baseline (p = 0.005), with no significant differences in cost changes over follow up. Post hoc analysis indicated individuals not receiving psychotherapy used less frequent, more costly healthcare. CONCLUSION Delivering psychotherapy within integrated services for depression resulted in greater healthcare use without significantly greater costs to the health system or individual. Previous research in Chitwan demonstrated psychotherapy determined treatment effectiveness for people with depression. While additional research is needed into service implementation costs, our findings provide further evidence supporting the inclusion of psychotherapy within mental healthcare integration in Nepal and similar contexts.
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van Eeden WA, van Hemert AM, Giltay EJ, Spinhoven P, de Beurs E, Carlier IV. Prognostic Value of Pathological Personality Traits for Treatment Outcome in Anxiety and Depressive Disorders: The Leiden Routine Outcome Monitoring Study. J Nerv Ment Dis 2022; 210:767-776. [PMID: 35471975 PMCID: PMC9555756 DOI: 10.1097/nmd.0000000000001535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Previous studies have failed to take baseline severity into account when assessing the effects of pathological personality traits (PPT) on treatment outcome. This study assessed the prognostic value of PPT (Dimensional Assessment of Personality Pathology-Short Form) on treatment outcome (Brief Symptom Inventory [BSI-posttreatment]) among patients with depressive and/or anxiety disorders ( N = 5689). Baseline symptom level (BSI-pretreatment) was taken into account as a mediator or moderator variable. Results showed significant effects of PPT on outcome, of which Emotional Dysregulation demonstrated the largest association ( β = 0.43, p < 0.001). When including baseline BSI score as a mediator variable, a direct effect ( β = 0.11, p < 0.001) remained approximately one-third of the total effect. The effects of Emotional Dysregulation (interaction effect β = 0.061, p < 0.001) and Inhibition (interaction effect β = 0.062, p < 0.001), but not Compulsivity or Dissocial Behavior, were moderated by the baseline symptom level. PPT predicts higher symptom levels, both before and after treatment, but yields relatively small direct effects on symptom decline when the effect of pretreatment severity is taken into account.
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Affiliation(s)
| | | | - Erik J. Giltay
- Department of Psychiatry, Leiden University Medical Centre (LUMC)
| | - Philip Spinhoven
- Department of Psychiatry, Leiden University Medical Centre (LUMC)
- Clinical Psychology Unit, Institute of Psychology, Leiden University, Leiden, Zuid Holland, the Netherlands
| | - Edwin de Beurs
- Clinical Psychology Unit, Institute of Psychology, Leiden University, Leiden, Zuid Holland, the Netherlands
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Handajani YS, Schröder-Butterfill E, Hogervorst E, Turana Y, Hengky A. Depression among Older Adults in Indonesia: Prevalence, Role of Chronic Conditions and Other Associated Factors. Clin Pract Epidemiol Ment Health 2022; 18:e174501792207010. [PMID: 37274861 PMCID: PMC10156049 DOI: 10.2174/17450179-v18-e2207010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/16/2022] [Accepted: 04/01/2022] [Indexed: 06/07/2023]
Abstract
Background Depression is one of the most common illnesses worldwide, with a prevalence of 5.7% among older adults aged over 60. Depression is a severe health condition that can significantly affect the quality of life. Objective The objective of this study is to investigate the determinant factors of depression among older adults in Indonesia. Methods Data of 4236 adults of 60 years old and over were taken from the fifth wave of the Indonesian Family Life Survey (IFLS-5). Sociodemographic and multiple health-related variables collected through interviews and measurements were analyzed. Multivariate logistic regression was used to evaluate depression and its associated factors. Results The prevalence of depression assessed using ten questions from the Center for Epidemiologic Studies Depression Scale (CES-D 10) was 16.3%. Significant associated factors for depression were moderate and low subjective economic status, living in Java or other regions outside Sumatra and Java, no life satisfaction, self-perceived as having poor health, having dependency (IADL scores), and experienced falls and insomnia. Among chronic conditions, stroke, arthritis, and hearing impairment were also more common in depressed older adults. Conclusion Predictors of depression identified in this study may be used to help prevent and improve depression in Indonesian older adults, especially those who live on Java. Improvement in healthcare, especially in the prevention and rehabilitation of stroke, arthritis, possible frailty (falls and dependency), hearing impairment, and insomnia, concurrent with early detection of depression in these chronic conditions, may help create a better quality of life among Indonesian older adults.
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Affiliation(s)
- Yvonne Suzy Handajani
- School of Medicine and Health Science, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | | | - Eef Hogervorst
- School of Sport, Exercise & Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Yuda Turana
- School of Medicine and Health Science, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Antoninus Hengky
- Center of Health Research, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
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Irvin KM, Bell DJ, Steinley D, Bartholow BD. The thrill of victory: Savoring positive affect, psychophysiological reward processing, and symptoms of depression. Emotion 2022; 22:1281-1293. [PMID: 33252936 PMCID: PMC8343962 DOI: 10.1037/emo0000914] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Depression is characterized by a pattern of maladaptive emotion regulation. Recently, researchers have begun to focus on associations between depression and two positive affect regulation strategies: savoring and dampening. Savoring, or upregulation of positive affect, is positively associated with well-being and negatively associated with depression, whereas dampening, or downregulation of positive affect, is positively associated with depression, anhedonia, and negative affect. To date, no research has examined whether savoring or dampening can affect neurophysiological reactivity to reward, which previous research has shown is associated with symptoms of depression. Here, we examined associations between psychophysiological reward processing-primarily captured by the Reward Positivity (RewP), an event-related potential (ERP) deflection elicited by feedback indicating reward (vs. nonreward)-positive affect regulation strategies, and symptoms of depression. One hundred undergraduates completed questionnaires assessing affect, emotion regulation, and depressive symptoms and completed a computerized guessing task, once before and again after being randomly assigned to emotion-regulation strategy conditions. Results indicate that (a) the relationship between RewP amplitude and depressive symptoms may, in part, depend upon positive affect regulation strategies and (b) the RewP elicited by reward appears sensitive to a savoring intervention. These findings suggest that mitigating depressive symptoms in emerging adults may depend on both top-down (i.e., savoring) and bottom-up (i.e., RewP) forms of positive affect regulation and have important implications for clinical prevention and intervention efforts for depressive symptoms and disorder. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Cost-utility of a web-based intervention to promote maternal mental health among postpartum women presenting low risk for postpartum depression. Int J Technol Assess Health Care 2022; 38:e62. [PMID: 35861012 DOI: 10.1017/s0266462322000447] [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: 11/06/2022]
Abstract
OBJECTIVES Web-based interventions for the promotion of maternal mental health could represent a cost-effective strategy to reduce the burden associated with perinatal mental illness. This study aimed to evaluate the cost-utility of Be a Mom, a self-guided web-based cognitive behavioral therapy intervention, compared with a waiting-list control. METHODS The economic evaluation alongside a randomized controlled trial was conducted from a societal perspective over a 14-month time frame. Postpartum women presenting low risk for postpartum depression were randomized to the intervention (n = 191) or control (n = 176) group and assessed at baseline, postintervention and 4 and 12 months after postintervention. Data regarding healthcare use, productive losses and quality-adjusted life years (QALYs) were collected and used to calculate incremental cost-effectiveness ratios (ICERs). Uncertainty was accounted for with nonparametric bootstrapping and sensitivity analyses. RESULTS At 14 months, and after accounting for a 3.5 percent discount rate, the intervention resulted in a yearly cost-saving of EUR 165.47 (-361.77, 28.51) and a QALY gain of 0.0064 (-0.0116, 0.0244). Bootstrapping results revealed a dominant ICER for the intervention group. Although results were statistically nonsignificant, cost-effectiveness acceptability curves showed that at a EUR 0 willingness to pay threshold, there is a 96 percent probability that the intervention is cost-effective when compared with the control group. The sensitivity analyses generally supported the acceptable likelihood of the intervention being more cost-effective than the control group. CONCLUSIONS From a societal perspective, the implementation of Be a Mom among low-risk postpartum women could be a cost-effective way to improve perinatal mental health.
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Research on the Relationship between Chinese Elderly Health Status, Social Security, and Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127496. [PMID: 35742744 PMCID: PMC9223444 DOI: 10.3390/ijerph19127496] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/05/2022] [Accepted: 06/16/2022] [Indexed: 12/01/2022]
Abstract
(1) Background: To explore the relationship between health status, social security status, and the occurrence of depression in older adults and provide a basis for mental health care services for the elderly population; (2) Methods: This study used the 2018 China Health and Senior Care Tracking Survey (CHARLS) data to select 8383 older people aged over 60 years old as the research subjects. The two-category Logistic model was used to analyze the research problem; (3) Results: Older adults with depressive tendencies accounted for 34.1% of the total older adults. The incidence of depression among female older adults reached 41.51%. The risk of depression in the elderly population was 40.3% lower in males than in females (OR = 0.597, 95% CI: 0.539−0.662). Self-rated health status, physical disability, and receipt of pensions affected the incidence of depression in older adults (all p < 0.05); (4) Conclusions: Focus on and intervene in the mental status of elderly females and disabled elderly people. Provide mental and economic support and mental health care services to the elderly at the family and social levels. Promote the healthy development of the mental health of the elderly and promote active aging.
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Guan L, Liu Q, Chen D, Chen C, Wang Z. Hearing loss, depression, and medical service utilization among older adults: evidence from China. Public Health 2022; 205:122-129. [PMID: 35278783 DOI: 10.1016/j.puhe.2022.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/05/2021] [Accepted: 01/21/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To acquire a better understanding of the mechanisms underlying the association between hearing loss and medical service utilization, this study examined the relationship between hearing loss, depression, and medical service utilization. STUDY DESIGN Using the methods of probability proportional to size, a survey conducted in 28 provinces, 150 countries/districts, 450 villages/urban communities, 11,628 households, and 19,816 individuals of China in 2018. METHODS The data for this article were derived from the 2018 China Health and Retirement Longitudinal Study, which enrolled 14,455 people aged 50-80 years. Hearing loss was determined using self-reported hearing status. Self-reported outpatient visits in the last month and hospitalization within the last year were used to determine medical service utilization. Depression was obtained from the CES-D-10 scale. Logistic regression and stepwise regression methods were used. RESULTS Older adults with hearing loss problems used significantly more outpatient care services (odds ratio [OR] = 1.292, 95% confidence interval [CI] 1.152, 1.449; P < 0.001) and inpatient care services (OR = 1.238, 95% CI 1.021, 1.501; P < 0.05) than those without hearing loss problems. Following that, individuals with hearing loss problems were more likely to experience depressive symptoms (OR = 1.467, 95% CI 1.345, 1.599; P < 0.001) than those without. Moreover, respondents with depressive symptoms used outpatient care services at a significantly higher rate (OR = 1.292, 95% CI 1.152, 1.449; P < 0.001) and inpatient care service at a significantly higher rate (OR = 1.238, 95% CI 1.021, 1.501; P < 0.05) compared with those without depressive symptom. CONCLUSION This article discovered that depression acted as a mediation variable in the relationship between hearing loss and medical service utilization. This research provided possible interventions for reducing the burden of the healthcare system and society that older adults with hearing loss imposed.
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Affiliation(s)
- Liding Guan
- The Center for Social Security Studies of Wuhan University, Wuhan, 430072, China.
| | - Qing Liu
- The Center for Social Security Studies of Wuhan University, Wuhan, 430072, China.
| | - Deshan Chen
- The Center for Social Security Studies of Wuhan University, Wuhan, 430072, China.
| | - Chen Chen
- The Center for Social Security Studies of Wuhan University, Wuhan, 430072, China.
| | - Zengwen Wang
- The Center for Social Security Studies of Wuhan University, Wuhan, 430072, China.
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Bondesson E, Jöud A, Stigmar K, Ringqvist Å, Kraepelien M, Kaldo V, Wettermark B, Forsell Y, Petersson IF, Schelin ME. Utilization of healthcare and prescription medicines after non-pharmacological interventions for depression - A 3-year register follow-up of an RCT in primary care. Prev Med Rep 2022; 25:101658. [PMID: 35127347 PMCID: PMC8800057 DOI: 10.1016/j.pmedr.2021.101658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 11/29/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022] Open
Abstract
A 3-year register follow-up of an RCT for depression interventions was conducted. Healthcare utilization and dispensed medicines were used as register outcomes. The interventions had no effect on consultations for mental illness during follow-up. Both interventions are appropriate additions to mild-moderate depression care.
Depression is a common, recurrent disorder. There is a need for readily available treatments with few negative side effects, that demands little resources and that are effective both in the short- and long term. Our aim was to investigate the long-term effectiveness of two different interventions; physical exercise and internet-based cognitive behavioural therapy (internet-CBT), compared to usual care in patients with mild to moderate depression in a Swedish primary care setting. We performed a register-based 3-year follow-up study of participants in the randomized controlled trial REGASSA (n = 940) using healthcare utilization and dispensed medicines as outcomes. We found no difference between the three groups regarding proportion of participants consulting healthcare due to mental illness or pain during follow-up. Regarding number of consultations, there was no difference between the groups, except for consultations related to pain. For this outcome both treatment arms had significantly fewer consultations compared to usual care, during year 2–3, the risk ratio (RR) for physical exercise and internet-CBT was 0.64 (95% CI = 0.43–0.95) and 0.61 (95% CI = 0.41–0.90), respectively. A significantly lower proportion of patients in both treatment arms were dispensed hypnotics and sedatives year 2–3 compared to the usual care arm, RR for both physical exercise and internet-CBT was 0.72 (95% CI = 0.53–0.98). No other differences between the groups were found. In conclusion, considering long-term effects, both physical exercise and internet-CBT, being resource-efficient treatments, could be considered as appropriate additions for patients with mild to moderate depression in primary care settings. Trial registration: The original RCT was registered with the German Clinical Trial Register (DRKS study ID: DRKS00008745).
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Dean RL, Hurducas C, Hawton K, Spyridi S, Cowen PJ, Hollingsworth S, Marquardt T, Barnes A, Smith R, McShane R, Turner EH, Cipriani A. Ketamine and other glutamate receptor modulators for depression in adults with unipolar major depressive disorder. Cochrane Database Syst Rev 2021; 9:CD011612. [PMID: 34510411 PMCID: PMC8434915 DOI: 10.1002/14651858.cd011612.pub3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Many studies have recently been conducted to assess the antidepressant efficacy of glutamate modification in mood disorders. This is an update of a review first published in 2015 focusing on the use of glutamate receptor modulators in unipolar depression. OBJECTIVES To assess the effects - and review the acceptability and tolerability - of ketamine and other glutamate receptor modulators in alleviating the acute symptoms of depression in people with unipolar major depressive disorder. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase and PsycINFO all years to July 2020. We did not apply any restrictions to date, language or publication status. SELECTION CRITERIA Double- or single-blinded randomised controlled trials (RCTs) comparing ketamine, memantine, esketamine or other glutamate receptor modulators with placebo (pill or saline infusion), other active psychotropic drugs, or electroconvulsive therapy (ECT) in adults with unipolar major depression. DATA COLLECTION AND ANALYSIS Three review authors independently identified studies, assessed trial quality and extracted data. The primary outcomes were response rate (50% reduction on a standardised rating scale) and adverse events. We decided a priori to measure the efficacy outcomes at different time points and run sensitivity/subgroup analyses. Risk of bias was assessed using the Cochrane tool, and certainty of the evidence was assessed using GRADE. MAIN RESULTS Thirty-one new studies were identified for inclusion in this updated review. Overall, we included 64 studies (5299 participants) on ketamine (31 trials), esketamine (9), memantine (5), lanicemine (4), D-cycloserine (2), Org26576 (2), riluzole (2), atomoxetine (1), basimglurant (1), citicoline (1), CP-101,606 (1), decoglurant (1), MK-0657 (1), N-acetylcysteine (1), rapastinel (1), and sarcosine (1). Forty-eight studies were placebo-controlled, and 48 were two-arm studies. The majority of trials defined an inclusion criterion for the severity of depressive symptoms at baseline: 29 at least moderate depression; 17 severe depression; and five mild-to-moderate depression. Nineteen studies recruited only patients with treatment-resistant depression, defined as inadequate response to at least two antidepressants. The majority of studies investigating ketamine administered as a single dose, whilst all of the included esketamine studies used a multiple dose regimen (most frequently twice a week for four weeks). Most studies looking at ketamine used intravenous administration, whilst the majority of esketamine trials used intranasal routes. The evidence suggests that ketamine may result in an increase in response and remission compared with placebo at 24 hours odds ratio (OR) 3.94, 95% confidence interval (CI) 1.54 to 10.10; n = 185, studies = 7, very low-certainty evidence). Ketamine may reduce depression rating scale scores over placebo at 24 hours, but the evidence is very uncertain (standardised mean difference (SMD) -0.87, 95% CI -1.26 to -0.48; n = 231, studies = 8, very low-certainty evidence). There was no difference in the number of participants assigned to ketamine or placebo who dropped out for any reason (OR 1.25, 95% CI 0.19 to 8.28; n = 201, studies = 6, very low-certainty evidence). When compared with midazolam, the evidence showed that ketamine increases remission rates at 24 hours (OR 2.21, 95% CI 0.67 to 7.32; n = 122,studies = 2, low-certainty evidence). The evidence is very uncertain about the response efficacy of ketamine at 24 hours in comparison with midazolam, and its ability to reduce depression rating scale scores at the same time point (OR 2.48, 95% CI 1.00 to 6.18; n = 296, studies = 4,very low-certainty evidence). There was no difference in the number of participants who dropped out of studies for any reason between ketamine and placebo (OR 0.33, 95% CI 0.05 to 2.09; n = 72, studies = 1, low-certainty evidence). Esketamine treatment likely results in a large increase in participants achieving remission at 24 hours compared with placebo (OR 2.74, 95% CI 1.71 to 4.40; n = 894, studies = 5, moderate-certainty evidence). Esketamine probably results in decreases in depression rating scale scores at 24 hours compared with placebo (SMD -0.31, 95% CI -0.45 to -0.17; n = 824, studies = 4, moderate-certainty evidence). Our findings show that esketamine increased response rates, although this evidence is uncertain (OR 2.11, 95% CI 1.20 to 3.68; n = 1071, studies = 5, low-certainty evidence). There was no evidence that participants assigned to esketamine treatment dropped out of trials more frequently than those assigned to placebo for any reason (OR 1.58, 95% CI 0.92 to 2.73; n = 773, studies = 4,moderate-certainty evidence). We found very little evidence for the remaining glutamate receptor modulators. We rated the risk of bias as low or unclear for most domains, though lack of detail regarding masking of treatment in the studies reduced our certainty in the effect for all outcomes. AUTHORS' CONCLUSIONS Our findings show that ketamine and esketamine may be more efficacious than placebo at 24 hours. How these findings translate into clinical practice, however, is not entirely clear. The evidence for use of the remaining glutamate receptor modulators is limited as very few trials were included in the meta-analyses for each comparison and the majority of comparisons included only one study. Long term non-inferiority RCTs comparing repeated ketamine and esketamine, and rigorous real-world monitoring are needed to establish comprehensive data on safety and efficacy.
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Affiliation(s)
| | | | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Styliani Spyridi
- Department of Rehabilitation Sciences, Faculty of Health Sciences, Cyprus University of Technology, Lemesos, Cyprus
| | - Philip J Cowen
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | | | | | | | - Rupert McShane
- Oxford Health NHS Foundation Trust, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Erick H Turner
- Portland Veterans Affairs Medical Center, P3MHDC, Portland, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Andrea Cipriani
- Oxford Health NHS Foundation Trust, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
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Abstract
Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed medications for psychiatric disorders, yet they leave the majority of patients without full symptom relief. Therefore, a major research challenge is to identify novel targets for the improved treatment of these disorders. SSRIs act by blocking the serotonin transporter (SERT), the high-affinity, low-capacity, uptake-1 transporter for serotonin. Other classes of antidepressant work by blocking the norepinephrine or dopamine transporters (NET and DAT), the high-affinity, low-capacity uptake-1 transporters for norepinephrine and dopamine, or by blocking combinations of SERT, NET, and DAT. It has been proposed that uptake-2 transporters, which include organic cation transporters (OCTs) and the plasma membrane monoamine transporter (PMAT), undermine the therapeutic utility of uptake-1 acting antidepressants. Uptake-2 transporters for monoamines have low affinity for these neurotransmitters, but a high capacity to transport them. Thus, activity of these transporters may limit the increase of extracellular monoamines thought to be essential for ultimate therapeutic benefit. Here preclinical evidence supporting a role for OCT2, OCT3, and PMAT in behaviors relevant to psychiatric disorders is presented. Importantly, preclinical evidence revealing these transporters as targets for the development of novel therapeutics for psychiatric disorders is discussed.
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18
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Spießl H. [Spravato or the Question: "How Much May an Antidepressant Cost?"]. PSYCHIATRISCHE PRAXIS 2021; 48:227-230. [PMID: 34261145 DOI: 10.1055/a-1500-9805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Bishop A, Younan R, Low J, Pilkington PD. Early maladaptive schemas and depression in adulthood: A systematic review and meta-analysis. Clin Psychol Psychother 2021; 29:111-130. [PMID: 34131990 DOI: 10.1002/cpp.2630] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/31/2021] [Accepted: 06/09/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Improved understanding of the specific cognitive risk factors associated with depression is needed to inform prevention and treatment approaches. Recent research has examined the relationship between early maladaptive schemas (EMSs) and depression, but the findings were yet to be integrated using meta-analytic methods. The aim of this review was to synthesize the evidence on the relationship between depression and EMS. METHOD A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, by searching the PsycINFO, PubMed and CINAHL databases. Included studies were peer-reviewed journal articles that examined the relationship between one or more EMS and depression in adulthood in participants aged 18 years or older. RESULTS A total of 51 studies were included (k = 743; pooled N = 17,830). All 18 EMSs were positively correlated with depression, with effect sizes ranging from small (r = .23 [.17, .29]; Entitlement) to large (r = .53 [.46, .60]; Social Isolation; r = .50, 95% CI [.45, .54]; Defectiveness/Shame). CONCLUSION The evidence suggests that individuals who feel like they do not belong, or that they are flawed, bad or unlovable, report higher levels of depression. However, most studies used cross-sectional designs, and further longitudinal research is needed to establish the direction of the relationship between EMS and depression. These findings can guide preventative and treatment approaches. Focusing treatment on the Social Isolation and Defectiveness/Shame EMS may aid in relieving depressive symptoms.
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Affiliation(s)
- Amy Bishop
- School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Rita Younan
- Schema Therapy Institute of Australia, Melbourne, Australia
| | - Jennifer Low
- School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Pamela D Pilkington
- School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
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20
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Tan XW, Abdin E, Tor PC. Accelerated transcranial magnetic stimulation (aTMS) to treat depression with treatment switching: study protocol of a pilot, randomized, delayed-start trial. Pilot Feasibility Stud 2021; 7:104. [PMID: 33952345 PMCID: PMC8097929 DOI: 10.1186/s40814-021-00845-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 04/28/2021] [Indexed: 12/28/2022] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) is a technique for stimulating brain activity using a transient magnetic field to induce an electrical current in the brain producing depolarization of focal groups of brain cells. TMS is a protocol approved by the U.S. Food and Drug Administration in routine clinical practice as a treatment for depression. A major limitation of rTMS is the large amount of time taken for a standard protocol (38 min a day for 20–30 working days). The optimal type and duration of TMS are still uncertain, as is the optimal strategy for continuing or changing the type of rTMS if there is a poor initial response. Objectives The trial aims to assess whether a 1-week compressed course of left dorsolateral prefrontal (L DLPFC) 5 Hz accelerated rTMS (aTMS) treatment is as effective as an established 4-week course of non-accelerated rTMS and if additional 5 Hz L DLPFC aTMS treatments will be efficacious in non-responders as compared to 1 Hz right DLPFC aTMS treatment. Methods A randomized, single-blind, delayed-start trial was planned to commence in Jan 2020. A total of 60 patients will be enrolled from the Institute of Mental Health Singapore within a 2-year period and randomized into the early or delayed-start phase of the trial. The primary outcome of the trial is the improvement of Montgomery-Asberg Depression Rating scale at the end of the active treatment phase. Discussion If this study protocol proves to be effective, the findings of this trial will be updated to the College of Psychiatrists, Academy of Medicine Singapore, as well as published in a peer-reviewed journal to enhance local and international TMS treatment guidelines. Trial registration ClinicalTrials.gov ID: NCT03941106
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Affiliation(s)
- Xiao Wei Tan
- Department of Mood and Anxiety, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, 539747, Singapore
| | - Phern Chern Tor
- Department of Mood and Anxiety, Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore. .,Neurostimulation Service, Institute of Mental Health, Singapore, 539747, Singapore. .,Duke-NUS Graduate Medical School, Singapore, 169857, Singapore.
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21
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'An Apple a Day'?: Psychiatrists, Psychologists and Psychotherapists Report Poor Literacy for Nutritional Medicine: International Survey Spanning 52 Countries. Nutrients 2021; 13:nu13030822. [PMID: 33801454 PMCID: PMC8000813 DOI: 10.3390/nu13030822] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/16/2021] [Accepted: 02/25/2021] [Indexed: 02/01/2023] Open
Abstract
Nutritional interventions have beneficial effects on certain psychiatric disorder symptomatology and common physical health comorbidities. However, studies evaluating nutritional literacy in mental health professionals (MHP) are scarce. This study aimed to assess the across 52 countries. Surveys were distributed via colleagues and professional societies. Data were collected regarding self-reported general nutrition knowledge, nutrition education, learning opportunities, and the tendency to recommend food supplements or prescribe specific diets in clinical practice. In total, 1056 subjects participated in the study: 354 psychiatrists, 511 psychologists, 44 psychotherapists, and 147 MHPs in-training. All participants believed the diet quality of individuals with mental disorders was poorer compared to the general population (p < 0.001). The majority of the psychiatrists (74.2%) and psychologists (66.3%) reported having no training in nutrition. Nevertheless, many of them used nutrition approaches, with 58.6% recommending supplements and 43.8% recommending specific diet strategies to their patients. Only 0.8% of participants rated their education regarding nutrition as 'very good.' Almost all (92.9%) stated they would like to expand their knowledge regarding 'Nutritional Psychiatry.' There is an urgent need to integrate nutrition education into MHP training, ideally in collaboration with nutrition experts to achieve best practice care.
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Bergmans RS, Rapp A, Kelly KM, Weiss D, Mezuk B. Understanding the relationship between type 2 diabetes and depression: lessons from genetically informative study designs. Diabet Med 2021; 38:e14399. [PMID: 32924175 PMCID: PMC8990216 DOI: 10.1111/dme.14399] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 08/19/2020] [Accepted: 09/03/2020] [Indexed: 12/11/2022]
Abstract
AIMS To conduct a systematic review in order to comprehensively synthesize the findings from a diverse range of genetically informative studies on comorbid depression and type 2 diabetes. METHODS Database searches (1 January 2008 to 1 June 2020) in PubMed and EMBASE were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Eligible reports employed any type of genetically informed design, including twin modelling, Mendelian randomization, genome-wide association studies, polygenetic risk scores, or linkage disequilibrium score regression. Searches generated 451 unique citations, and 16 manuscripts met the inclusion criteria. RESULTS The included studies addressed three aetiological models of the depression-diabetes relationship: uni- or bi-directional phenotypic causation; shared genetic liability; or gene-environment interaction. From these studies, there is modest evidence that type 2 diabetes is causally related to risk of developing depression, but much more limited evidence that depression is causally related to risk of diabetes. There is little evidence of shared genetic liability between depression and diabetes or of gene-environment interaction. CONCLUSIONS Findings from genetically informed studies are mixed but provide some support for the uni- or bi-directional phenotypic model of depression and type 2 diabetes. Future studies should also explore the hypothesis that this relationship may be influenced by shared environmental risk factors. Findings can inform multifaceted approaches to diabetes prevention and care that reflect how psychosocial factors contribute to type 2 diabetes risk and outcomes.
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Affiliation(s)
- R. S. Bergmans
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - A. Rapp
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - K. M. Kelly
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - D. Weiss
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Briana Mezuk
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
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23
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van Mierlo LA, Scheffers M, Koning I. The relative relation between body satisfaction, body investment, and depression among dutch emerging adults. J Affect Disord 2021; 278:252-258. [PMID: 32971318 DOI: 10.1016/j.jad.2020.09.034] [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: 01/30/2020] [Revised: 05/29/2020] [Accepted: 09/08/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Depression is one of the biggest global health problems, especially among emerging adults (18 to 25). A negative body image is a well-known risk factor for the development of depressive symptoms. However, little is known about how different aspects of body image relate to depressive symptoms. Therefore, the current study explores the relation between body satisfaction, body investment, and depressive symptoms, moderated by sex and physical activity, among a non-clinical sample of emerging adults. METHODS Cross-sectional data from 410 Dutch emerging adults (Mage = 21.95 years, SD = 1.98, 80.60% women) within a convenience sample was used within a hierarchical multiple regression analysis. RESULTS Results showed that a higher body satisfaction and more body investment were related to fewer depressive symptoms. This relation was somewhat stronger for body investment than for body satisfaction. Furthermore, the relation between lower body satisfaction and more depressive symptoms was stronger for participants with a lower level of physical activity. No other moderation effects were found. LIMITATIONS This results should be seen within the light of their limitations. This study used cross-sectional data and therefore no causal relations can be determined. Also, the sample was biased in which mostly highly educated females participated. CONCLUSIONS However, this research is unique for adding different concepts of body image in one model. The findings propose that interventions regarding depressive symptoms among emerging adults should focus, next to body satisfaction, on the emotional investment in the body and the enhancement of physical activity.
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Affiliation(s)
- Lieselot A van Mierlo
- Windesheim University of Applied Sciences, Campus 2, 8017 CA Zwolle, the Netherlands.
| | - Mia Scheffers
- Windesheim University of Applied Sciences, Campus 2, 8017 CA Zwolle, the Netherlands
| | - Ina Koning
- Utrecht University, Padualaan 14, 3584 CH Utrecht, the Netherlands
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24
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Etzelmueller A, Vis C, Karyotaki E, Baumeister H, Titov N, Berking M, Cuijpers P, Riper H, Ebert DD. Effects of Internet-Based Cognitive Behavioral Therapy in Routine Care for Adults in Treatment for Depression and Anxiety: Systematic Review and Meta-Analysis. J Med Internet Res 2020; 22:e18100. [PMID: 32865497 PMCID: PMC7490682 DOI: 10.2196/18100] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/06/2020] [Accepted: 06/03/2020] [Indexed: 01/23/2023] Open
Abstract
Background Although there is evidence for the efficacy of internet-based cognitive behavioral therapy (iCBT), the generalizability of results to routine care is limited. Objective This study systematically reviews effectiveness studies of guided iCBT interventions for the treatment of depression or anxiety. Methods The acceptability (uptake, participants’ characteristics, adherence, and satisfaction), effectiveness, and negative effects (deterioration) of nonrandomized pre-post designs conducted under routine care conditions were synthesized using systematic review and meta-analytic approaches. Results A total of 19 studies including 30 groups were included in the analysis. Despite high heterogeneity, individual effect sizes of investigated studies indicate clinically relevant changes, with effect sizes ranging from Hedges’ g=0.42-1.88, with a pooled effect of 1.78 for depression and 0.94 for anxiety studies. Uptake, participants’ characteristics, adherence, and satisfaction indicate a moderate to high acceptability of the interventions. The average deterioration across studies was 2.9%. Conclusions This study provides evidence supporting the acceptability and effectiveness of guided iCBT for the treatment of depression and anxiety in routine care. Given the high heterogeneity between interventions and contexts, health care providers should select interventions that have been proven in randomized controlled clinical trials. The successful application of iCBT may be an effective way of increasing health care in multiple contexts.
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Affiliation(s)
- Anne Etzelmueller
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,GET.ON Institute GmbH, Hamburg, Germany.,Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Mental Health, Amsterdam, Netherlands
| | - Christiaan Vis
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Mental Health, Amsterdam, Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands.,Department of Global Health and Social Medicine, Harvard Medical School, USA, Boston, MA, United States
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Nickolai Titov
- eCentre Clinic Department of Psychology, Macquarie University, Sydney, Australia
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Mental Health, Amsterdam, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, Mental Health, Amsterdam, Netherlands.,Community Mental Health Centre GGZ inGeest, Amsterdam, Netherlands
| | - David Daniel Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,GET.ON Institute GmbH, Hamburg, Germany.,Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands
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Worrall C, Jongenelis M, Pettigrew S. Modifiable Protective and Risk Factors for Depressive Symptoms among Older Community-dwelling Adults: A Systematic Review. J Affect Disord 2020; 272:305-317. [PMID: 32553372 DOI: 10.1016/j.jad.2020.03.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 02/08/2020] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Caitlin Worrall
- School of Psychology, Curtin University, Kent St, Bentley, 6102, Western Australia, Australia.
| | - Michelle Jongenelis
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, 3010, Victoria, Australia.
| | - Simone Pettigrew
- The George Institute for Global Health, Australia, Level 5, 1 King St, Newtown, 2042, New South Wales, Australia.
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Alang S, McAlpine D. Treatment Modalities and Perceived Effectiveness of Treatment Among Adults With Depression. Health Serv Insights 2020; 13:1178632920918288. [PMID: 32425544 PMCID: PMC7218458 DOI: 10.1177/1178632920918288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/20/2020] [Indexed: 12/15/2022] Open
Abstract
Patient-reported outcomes of mental health treatment, such as perceived effectiveness, are important. They indicate whether treatment is perceived to reduce symptoms and minimize psychiatric disability. Outpatient treatment for depression typically includes medication or counseling, either alone or in combination. This study examines the relationship between treatment modality and perceived effectiveness of treatment. Using a sample of adults who received outpatient treatment for depression from the 2015-2016 National Survey on Drug Use and Health (N = 4169), logistic regressions estimated the odds of rating treatment as effective among persons who received medication only, counseling only, and a combination of medication and counseling. There were no differences in perceived effectiveness between counseling only and medication only. However, receiving both was associated with greater odds of rating treatment as effective. Poor self-rated health and severe mental illness were associated with lower perceived effectiveness of medication. Those with substance use problems had lower odds of rating counseling and both counseling and medication as effective. A combined treatment for depression may be perceived as better than single-modality treatment. Therefore, there might be benefits to increasing access to both forms of treatment for persons less likely to rate either single modality as effective.
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Affiliation(s)
- Sirry Alang
- Department of Sociology and Anthropology, and Program in Health, Medicine, and Society, Lehigh University, Bethlehem, PA, USA
| | - Donna McAlpine
- Division of Health Policy & Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Carpenter JS, Iorfino F, Cross S, Nichles A, Zmicerevska N, Crouse JJ, Palmer JR, Whitton AE, White D, Naismith SL, Guastella AJ, Hermens DF, Scott J, Scott EM, Hickie IB. Cohort profile: the Brain and Mind Centre Optymise cohort: tracking multidimensional outcomes in young people presenting for mental healthcare. BMJ Open 2020; 10:e030985. [PMID: 32229519 PMCID: PMC7170572 DOI: 10.1136/bmjopen-2019-030985] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The Brain and Mind Centre (BMC) Optymise cohort assesses multiple clinical and functional domains longitudinally in young people presenting for mental health care and treatment. Longitudinal tracking of this cohort will allow investigation of the relationships between multiple outcome domains across the course of care. Subsets of Optymise have completed detailed neuropsychological and neurobiological assessments, permitting investigation of associations between these measures and longitudinal course. PARTICIPANTS Young people (aged 12-30) presenting to clinics coordinated by the BMC were recruited to a research register (n=6743) progressively between June 2008 and July 2018. To date, 2767 individuals have been included in Optymise based on the availability of at least one detailed clinical assessment. MEASURES Trained researchers use a clinical research proforma to extract key data from clinical files to detail social and occupational functioning, clinical presentation, self-harm and suicidal thoughts and behaviours, alcohol and other substance use, physical health comorbidities, personal and family history of mental illness, and treatment utilisation at the following time points: baseline, 3, 6, 12, 24, 36, 48, and 60 months, and time last seen. FINDINGS TO DATE There is moderate to substantial agreement between raters for data collected via the proforma. While wide variations in individual illness course are clear, social and occupational outcomes suggest that the majority of cohort members show no improvement in functioning over time. Differential rates of longitudinal transition are reported between early and late stages of illness, with a number of baseline factors associated with these transitions. Furthermore, there are longitudinal associations between prior suicide attempts and inferior clinical and functional outcomes. FUTURE PLANS Future reports will detail the longitudinal course of each outcome domain and examine multidirectional relationships between these domains both cross-sectionally and longitudinally, and explore in subsets the associations between detailed neurobiological measures and clinical, social and functional outcomes.
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Affiliation(s)
- Joanne S Carpenter
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Frank Iorfino
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Shane Cross
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alissa Nichles
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Natalia Zmicerevska
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jacob J Crouse
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jake R Palmer
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Alexis E Whitton
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Django White
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sharon L Naismith
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Adam J Guastella
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Daniel F Hermens
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Jan Scott
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Academic Psychiatry, Newcastle University, Newcastle, United Kingdom
- Diderot University, Sorbonne City, Paris, France
| | - Elizabeth M Scott
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Ian B Hickie
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Murchland AR, Eng CW, Casey JA, Torres JM, Mayeda ER. Inequalities in elevated depressive symptoms in middle-aged and older adults by rural childhood residence: The important role of education. Int J Geriatr Psychiatry 2019; 34:1633-1641. [PMID: 31318472 PMCID: PMC7060021 DOI: 10.1002/gps.5176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 07/08/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To quantify inequalities in the prevalence of elevated depressive symptoms by rural childhood residence and the extent to which childhood socioeconomic conditions and educational attainment contribute to this disparity. METHODS We identified the prevalence of depressive symptoms among US-born adults ages 50 years and older in the 1998 to 2014 waves of the Health and Retirement Study (n = 16 022). We compared prevalence of elevated depressive symptoms (>4/8 symptoms) by rural versus nonrural childhood residence (self-report) and the extent to which own education mediated this disparity. We used generalized estimating equations and marginal standardization to calculate predicted probabilities of elevated depressive symptoms. RESULTS In age, race/ethnicity, and sex-adjusted models, rural childhood residence was associated with elevated depressive symptoms (OR = 1.20; 95% CI, 1.12-1.29; marginal predicted probability 10.5% for rural and 8.9% for nonrural childhood residence). Adjusting for US Census birth region and parental education attenuated this association (OR = 1.07; 95% CI, 0.99-1.15; marginal predicted probability 9.9% for rural and 9.3% for nonrural). After additional adjustment for own education, rural childhood residence was not associated with elevated depressive symptoms (OR = 0.94; 95% CI, 0.87-1.01; marginal predicted probability 9.2% for rural and 9.8% for nonrural). CONCLUSIONS Rural childhood residence was associated with elevated depressive symptoms in middle-aged and older adults; birth region, parental education, and own education appear to contribute to this disparity.
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Affiliation(s)
- Audrey R. Murchland
- University of California, San Francisco, Department of Epidemiology and Biostatistics
| | - Chloe W. Eng
- University of California, San Francisco, Department of Epidemiology and Biostatistics
| | - Joan A. Casey
- University of California, Berkeley School of Public Health, Division of Environmental Health Sciences
- Columbia Mailman School of Public Health, Department of Environmental Health Sciences
| | - Jacqueline M. Torres
- University of California, San Francisco, Department of Epidemiology and Biostatistics
| | - Elizabeth Rose Mayeda
- University of California, Los Angeles Fielding School of Public Health, Department of Epidemiology
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Desautels C, Savard J, Ivers H. Moderators of Cognitive Therapy and Bright Light Therapy Effects on Depressive Symptoms in Patients with Breast Cancer. Int J Behav Med 2019; 26:380-390. [PMID: 31264101 DOI: 10.1007/s12529-019-09802-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cognitive therapy (CT) and bright light therapy (BLT) have been found to be effective to treat depressive symptoms in breast cancer patients. No study has investigated the baseline patients' characteristics that are associated with better outcomes with CT vs. BLT in this population. This study aimed to assess, in breast cancer patients, the moderating role of eight clinical variables on the effects of CT and BLT on depressive symptoms. METHODS This is a secondary analysis of a randomized controlled trial conducted in 59 women who received an 8-week CT or BLT and completed questionnaires evaluating depression and possible moderating variables. RESULTS Patients benefited more from BLT when they had no prior history of major depressive disorder, higher depression scores on the Hospital Anxiety and Depression Scale (HADS-D) at baseline, a greater initial preference for BLT, and when they received BLT during spring or summer. Patients benefited more from CT when they had a lower initial preference for receiving CT, higher depression scores on the HADS-D, and seasonal depressive symptoms. CONCLUSIONS Although replication is needed, findings of this study suggest the existence of different profiles of patients more likely to benefit from CT and BLT. TRIAL REGISTRATION NCT01637103 https://clinicaltrials.gov/ct2/show/NCT01637103.
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Affiliation(s)
- Caroline Desautels
- School of Psychology, Université Laval, Québec, QC, Canada
- CHU de Québec - Université Laval Research Center, Québec, QC, Canada
- Université Laval Cancer Research Center, Québec, QC, Canada
| | - Josée Savard
- School of Psychology, Université Laval, Québec, QC, Canada.
- CHU de Québec - Université Laval Research Center, Québec, QC, Canada.
- Université Laval Cancer Research Center, Québec, QC, Canada.
- Centre de recherche du CHU de Québec - L'Hôtel-Dieu de Québec, 11 Côte du Palais, Québec, Québec, G1R 2J6, Canada.
| | - Hans Ivers
- School of Psychology, Université Laval, Québec, QC, Canada
- CHU de Québec - Université Laval Research Center, Québec, QC, Canada
- Université Laval Cancer Research Center, Québec, QC, Canada
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McMickens CL, Clayton A, Rosenthal MS, Wallace L, Howell HB, Bell G, Smith MV. A Qualitative Exploration of Mothers' Experiences Receiving Mental Health Services in a Supermarket Setting. Matern Child Health J 2019; 23:479-485. [PMID: 30694441 DOI: 10.1007/s10995-018-2646-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objectives Innovative mental health care delivery models have been proposed as a method to address disparities in access and utilization. The aim of this study is to characterize patients' perspectives and experiences of participating in one such innovative delivery model, group cognitive behavioral therapy within a supermarket setting. Methods In this qualitative study, 16 mothers were interviewed to explore their experiences and perspectives of receiving group-based cognitive behavioral therapy in a supermarket setting, as part of their participation in an academic-community research collaborative whose mission is to address mental health needs within low-resourced communities. Data from semi-structured interviews were analyzed using inductive coding. Results Five themes related to receiving mental health services in a supermarket setting emerged from the data: (1) Participants reported a convergence of life stressors and their introduction to supermarket-based services; (2) Participants perceived the supermarket setting as convenient; (3) Participants perceived the supermarket setting as less stigmatizing; (4) Participants perceived services in the supermarket as an acceptable form of mental health treatment; and (5) Participants described the program staff as an influential component of their treatment experience. Conclusions Understanding patient experiences of various service delivery models is critical to improving access to treatment and addressing disparities in mental health service utilization and outcomes. This study supports the use of innovative delivery models to increase access to mental health services in low-resourced communities.
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Affiliation(s)
- Courtney L McMickens
- Department of Psychiatry, Boston University School of Medicine, Doctors Office Building, 720 Harrison Ave, Suite 915, Office 904, Boston, MA, 02118, USA.
| | - Ashley Clayton
- School of Public Health, Yale School of Medicine, 60 College Street, P.O. Box 208034, New Haven, CT, 06520-8034, USA.,MOMS Partnership, Department of Psychiatry, Yale School of Medicine, Temple Medical Center, 40 Temple Street, Ste 6B, New Haven, CT, 06510, USA.,Department of Psychiatry, Yale University School of Medicine, Temple Medical Center, 40 Temple Street, Suite 6B, New Haven, CT, 06510, USA
| | - Marjorie S Rosenthal
- Department of Pediatrics, Yale School of Medicine, P.O. Box 208064, New Haven, CT, 06520-8064, USA.,RWJF Clinical Scholars Program, Yale School of Medicine, 333 Cedar Street, SHM IE-61, P.O. Box 208088, New Haven, CT, 06520-8088, USA
| | - Lori Wallace
- MOMS Partnership, Department of Psychiatry, Yale School of Medicine, Temple Medical Center, 40 Temple Street, Ste 6B, New Haven, CT, 06510, USA.,Department of Psychiatry, Yale University School of Medicine, Temple Medical Center, 40 Temple Street, Suite 6B, New Haven, CT, 06510, USA
| | - Heather B Howell
- MOMS Partnership, Department of Psychiatry, Yale School of Medicine, Temple Medical Center, 40 Temple Street, Ste 6B, New Haven, CT, 06510, USA.,Department of Psychiatry, Yale University School of Medicine, Temple Medical Center, 40 Temple Street, Suite 6B, New Haven, CT, 06510, USA
| | - Gweniver Bell
- MOMS Partnership, Department of Psychiatry, Yale School of Medicine, Temple Medical Center, 40 Temple Street, Ste 6B, New Haven, CT, 06510, USA
| | - Megan V Smith
- School of Public Health, Yale School of Medicine, 60 College Street, P.O. Box 208034, New Haven, CT, 06520-8034, USA.,MOMS Partnership, Department of Psychiatry, Yale School of Medicine, Temple Medical Center, 40 Temple Street, Ste 6B, New Haven, CT, 06510, USA.,Yale Child Study Center, Yale School of Medicine, 230 South Frontage Rd., New Haven, CT, 06519, USA.,Department of Psychiatry, Yale University School of Medicine, Temple Medical Center, 40 Temple Street, Suite 6B, New Haven, CT, 06510, USA
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Schousboe JT, Vo TN, Kats AM, Langsetmo L, Diem SJ, Taylor BC, Strotmeyer ES, Ensrud KE. Depressive Symptoms and Total Healthcare Costs: Roles of Functional Limitations and Multimorbidity. J Am Geriatr Soc 2019; 67:1596-1603. [PMID: 30903701 DOI: 10.1111/jgs.15881] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/01/2019] [Accepted: 02/18/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Depressive symptoms can be both a cause and a consequence of functional limitations and medical conditions. Our objectives were to determine the association of depressive symptoms with subsequent total healthcare costs in older women after accounting for functional limitations and multimorbidity. DESIGN Prospective cohort study (Study of Osteoporotic Fractures [SOF]). SETTING Four US sites. PARTICIPANTS A total of 2508 community-dwelling women (mean age = 79.4 years) participating in the SOF year 10 (Y10) examination linked with their Medicare claims data. MEASUREMENTS At Y10, depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS) and functional limitations were assessed by number (range = 0-5) of impairments in performing instrumental activities of daily living. Multimorbidity was ascertained by the Elixhauser method using claims data for the 12 months preceding the Y10 examination. Total direct healthcare costs, outpatient costs, acute hospital stays, and skilled nursing facility during the 12 months following the Y10 examination were ascertained from claims data. RESULTS Annualized mean (SD) total healthcare costs were $4654 ($9075) in those with little or no depressive symptoms (GDS score = 0-1), $7871 ($14 534) in those with mild depressive symptoms (GDS score = 2-5), and $9010 ($15 578) in those with moderate to severe depressive symptoms (GDS score = 6 or more). After adjustment for age, site, self-reported functional limitations, and multimorbidity, the magnitudes of these incremental costs were partially attenuated (cost ratio = 1.34 [95% confidence interval {CI} = 1.14-1.59] for those with mild depressive symptoms, and cost ratio = 1.29 [95% CI = 0.99-1.69] for those with moderate to severe depressive symptoms vs women with little or no depressive symptoms). CONCLUSION Depressive symptoms were associated with higher subsequent healthcare costs attributable, in part, to greater functional limitations and multimorbidity among those with symptoms. Importantly, even mild depressive symptoms were associated with higher healthcare costs. J Am Geriatr Soc 67:1596-1603, 2019.
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Affiliation(s)
- John T Schousboe
- Department of Rheumatology, Park Nicollet Clinic and HealthPartners Institute, HealthPartners Inc, Bloomington, Minnesota.,Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota
| | - Tien N Vo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Allyson M Kats
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Lisa Langsetmo
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Susan J Diem
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Center for Care Delivery and Outcomes Research, Veterans Administration Health Care System, Minneapolis, Minnesota
| | - Brent C Taylor
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Center for Care Delivery and Outcomes Research, Veterans Administration Health Care System, Minneapolis, Minnesota
| | - Elsa S Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kristine E Ensrud
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.,Department of Medicine, University of Minnesota, Minneapolis, Minnesota.,Center for Care Delivery and Outcomes Research, Veterans Administration Health Care System, Minneapolis, Minnesota
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Yamabe K, Liebert R, Flores N, Pashos CL. Health-related quality of life outcomes, economic burden, and associated costs among diagnosed and undiagnosed depression patients in Japan. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:233-243. [PMID: 30881068 PMCID: PMC6419602 DOI: 10.2147/ceor.s179901] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Depression is associated with substantial health and economic burden. This study examined the impact of diagnosed and undiagnosed depression on health-related outcomes and costs among Japanese adults. Methods A retrospective, observational study was conducted using 2012-2014 Japan National Health and Wellness Survey (N=83,504) data. Differences between respondents diagnosed with depression (n=2,843) and undiagnosed with depression (weighted n=2,717) and controls without depression (weighted n=2,801) in health-related quality of life, impairment to work productivity and daily activities (Work Productivity and Activity Impairment Questionnaire), health care resource utilization, and annual costs were evaluated. Propensity score weighting and weighted generalized linear models were used to compare groups on the outcome variables, after adjusting for covariates. Results Overall, respondents with undiagnosed depression had significantly better outcomes than those diagnosed with depression, but significantly worse outcomes than controls (for all, P<0.001). The mean Mental Component Summary scores were lower in the diagnosed group when compared with undiagnosed respondents and controls (33.2 vs 34.5 vs 48.6). Similar findings were obtained for mean Physical Component Summary (49.2 vs 49.5 vs 52.8) and health state utility scores (0.61 vs 0.62 vs 0.76). Additionally, the diagnosed group reported greater absenteeism (13.1 vs 6.6 vs 2.5%), presenteeism (41.4 vs 38.1 vs 18.8%), overall work productivity impairment (47.2 vs 41.1 vs 20.2%), and activity impairment (48.4 vs 43.3 vs 21.1%) than the undiagnosed and control groups, respectively. Consistently, patients with diagnosed depression had higher annual per patient direct (1.6-fold) and indirect costs (1.1-fold) than those in the undiagnosed depression group. Conclusion Diagnosed depression was associated with lower health-related quality of life and greater impairment in work productivity and daily activities, higher health care resource utilization, and higher costs, compared with undiagnosed respondents and controls. These study findings suggest a need for greater awareness of depression symptoms among Japanese adults, which is needed to facilitate proper diagnosis and treatment.
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Affiliation(s)
- Kaoru Yamabe
- Healthcare Policy and Access, Takeda Pharmaceutical Company Limited, Nihonbashi, Chuouku, Tokyo 103-8668, Japan,
| | - Ryan Liebert
- Health Outcomes Research, Kantar Health, New York, NY 10010, USA
| | - Natalia Flores
- Health Outcomes Research, Kantar Health, New York, NY 10010, USA
| | - Chris L Pashos
- Global Outcomes & Epidemiology Research, Data Sciences Institute, Takeda Pharmaceuticals International, Inc., Cambridge, MA 02139, USA
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Prediction of prolonged treatment course for depressive and anxiety disorders in an outpatient setting: The Leiden routine outcome monitoring study. J Affect Disord 2019; 247:81-87. [PMID: 30658244 DOI: 10.1016/j.jad.2018.12.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/04/2018] [Accepted: 12/16/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this study was to improve clinical identification of patients with a prolonged treatment course for depressive and anxiety disorders early in treatment. METHOD We conducted a cohort study in 1.225 adult patients with a depressive or anxiety disorders in psychiatric specialty care setting between 2007 and 2011, with at least two Brief Symptom Inventory (BSI) assessments within 6 months. With logistic regression, we modelled baseline age, gender, ethnicity, education, marital status, housing situation, employment status, psychiatric comorbidity and both baseline and 1st follow-up BSI scores to predict prolonged treatment course (>2 years). Based on the regression coefficients, we present an easy to use risk prediction score. RESULTS BSI at 1st follow-up proved to be a strong predictor for both depressive and anxiety disorders (OR = 2.17 (CI95% 1.73-2.74); OR = 2.52 (CI95% 1.86-3.23)). The final risk prediction score included BSI 1st follow-up and comorbid axis II disorder for depressive disorder, for anxiety disorders BSI 1st follow-up and age were included. For depressive disorders, for 28% of the patients with the highest scores, the positive predictive value for a prolonged treatment course was60% (sensitivity 0.38, specificity 0.81). For anxiety disorders, for 35% of the patients with the highest scores, the positive predictive value for a prolonged treatment course was 52% (sensitivity 0.55, specificity 0.75). CONCLUSIONS A high level of symptoms at 2-6 months of follow-up is a strong predictor for prolonged treatment course. This facilitates early identification of patients at risk of a prolonged course of treatment; in a relatively easy way by a self-assessed symptom severity.
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Hohl R, Deslandes AC, Mármora CHC. The Effect of Single-Dose Massage Session on Autonomic Activity, Mood, and Affective Responses in Major Depressive Disorder. J Holist Nurs 2019; 37:312-321. [PMID: 30810079 DOI: 10.1177/0898010119832493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Massage therapy (MT) is a holistic procedure that includes hand pressure (HP), therapeutic communication (TC), and attentive care (AC); together, these procedures could decrease symptoms of depression. Purpose: To study the influence of TC and AC during MT. Methods: Within-subject experimental design with counterbalancing order of treatment. Comparison analysis of the effect of a typical Swedish massage session (SM) with a "sham" massage (ShM; without HP) on the heart rate variability (HRV) mood and affective responses of patients with major depressive disorder (N = 11). During the ShM, clay stones were randomly placed on the body, and the patients were informed about the (sham) therapeutic effect of stones. Findings: A main effect of time showed that after intervention, both SM and ShM increased the HRV (high-frequency power; F[1, 10] = 7.58, p = .02) and reduced scores for anxiety (F[1, 10] = 37.57, p < .001), other feelings (F[1, 10] = 22.64, p = .001), and physical sedation (F[1, 10] = 10.72, p = .008). The SM was associated with more positive affective responses than ShM (qualitative analysis). Conclusions: AC and TC included in MT session improved mood and HRV in the absence of HP. Additional effect on affective responses was observed owing to the HP.
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Nutraceuticals for major depressive disorder- more is not merrier: An 8-week double-blind, randomised, controlled trial. J Affect Disord 2019; 245:1007-1015. [PMID: 30699842 DOI: 10.1016/j.jad.2018.11.092] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/18/2018] [Accepted: 11/12/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND One of the most pressing questions in "Nutritional Psychiatry" is whether using combinations of different nutraceuticals with putative antidepressant activity may provide an enhanced synergistic antidepressant effect. METHODS A phase II/III, Australian multi-site, 8-week, double-blind, RCT involving 158 outpatients with a DSM-5 diagnosis of MDD. The intervention consisted of a nutraceutical combination: S-adenosyl methionine; Folinic acid; Omega-3 fatty acids; 5-HTP, Zinc picolinate, and relevant co-factors versus placebo. The primary outcome was change in MADRS score. Hypothesis-driven analyses of potential moderators of response involving key SNPs, and BDNF were also conducted. RESULTS Placebo was superior to the nutraceutical combination in reducing MADRS score (differential reduction -1.75 points), however a mixed linear model revealed a non-significant Group X Time interaction (p = 0.33). Response rates were 40% for the active intervention and 51% for the placebo; remission rates were 34% and 43% for active and placebo groups, respectively. No significant differences were found between groups on any other secondary depression, anxiety, psychosocial, or sleep outcome measures. Key SNPs and BDNF did not significantly moderate response. No significant differences occurred between groups for total adverse effects, aside from more nausea in the active group. LIMITATIONS Very high placebo response rates suggest a placebo run-in design may have been valuable. INTERPRETATION The adoption of a nutraceutical 'shotgun' approach to treating MDD was not supported, and appeared to be less effective than adding placebo to treatment as usual.
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Benderly M, Kalter-Leibovici O, Weitzman D, Blieden L, Buber J, Dadashev A, Mazor-Dray E, Lorber A, Nir A, Yalonetsky S, Razon Y, Chodick G, Hirsch R. Depression and anxiety are associated with high health care utilization and mortality among adults with congenital heart disease. Int J Cardiol 2019; 276:81-86. [DOI: 10.1016/j.ijcard.2018.09.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/31/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
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Klein NS, Wijnen BFM, Lokkerbol J, Buskens E, Elgersma HJ, van Rijsbergen GD, Slofstra C, Ormel J, Dekker J, de Jong PJ, Nolen WA, Schene AH, Hollon SD, Burger H, Bockting CLH. Cost-effectiveness, cost-utility and the budget impact of antidepressants versus preventive cognitive therapy with or without tapering of antidepressants. BJPsych Open 2019; 5:e12. [PMID: 30762507 PMCID: PMC6381417 DOI: 10.1192/bjo.2018.81] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND As depression has a recurrent course, relapse and recurrence prevention is essential.AimsIn our randomised controlled trial (registered with the Nederlands trial register, identifier: NTR1907), we found that adding preventive cognitive therapy (PCT) to maintenance antidepressants (PCT+AD) yielded substantial protective effects versus antidepressants only in individuals with recurrent depression. Antidepressants were not superior to PCT while tapering antidepressants (PCT/-AD). To inform decision-makers on treatment allocation, we present the corresponding cost-effectiveness, cost-utility and budget impact. METHOD Data were analysed (n = 289) using a societal perspective with 24-months of follow-up, with depression-free days and quality-adjusted life years (QALYs) as health outcomes. Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were derived to provide information about cost-effectiveness. The budget impact was examined with a health economic simulation model. RESULTS Mean total costs over 24 months were €6814, €10 264 and €13 282 for AD+PCT, antidepressants only and PCT/-AD, respectively. Compared with antidepressants only, PCT+AD resulted in significant improvements in depression-free days but not QALYs. Health gains did not significantly favour antidepressants only versus PCT/-AD. High probabilities were found that PCT+AD versus antidepressants only and antidepressants only versus PCT/-AD were dominant with low willingness-to-pay thresholds. The budget impact analysis showed decreased societal costs for PCT+AD versus antidepressants only and for antidepressants only versus PCT/-AD. CONCLUSIONS Adding PCT to antidepressants is cost-effective over 24 months and PCT with guided tapering of antidepressants in long-term users might result in extra costs. Future studies examining costs and effects of antidepressants versus psychological interventions over a longer period may identify a break-even point where PCT/-AD will become cost-effective.Declaration of interestC.L.H.B. is co-editor of PLOS One and receives no honorarium for this role. She is also co-developer of the Dutch multidisciplinary clinical guideline for anxiety and depression, for which she receives no remuneration. She is a member of the scientific advisory board of the National Insure Institute, for which she receives an honorarium, although this role has no direct relation to this study. C.L.H.B. has presented keynote addresses at conferences, such as the European Psychiatry Association and the European Conference Association, for which she sometimes receives an honorarium. She has presented clinical training workshops, some including a fee. She receives royalties from her books and co-edited books and she developed preventive cognitive therapy on the basis of the cognitive model of A. T. Beck. W.A.N. has received grants from the Netherlands Organisation for Health Research and Development and the European Union and honoraria and speakers' fees from Lundbeck and Aristo Pharma, and has served as a consultant for Daleco Pharma.
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Affiliation(s)
- Nicola S Klein
- PhD Candidate,Department of Clinical Psychology and Experimental Psychopathology,University of Groningen;and Psychologist, Top Referent Traumacentrum,GGZ Drenthe,the Netherlands
| | - Ben F M Wijnen
- Health Economist,Center of Economic Evaluation,Trimbos Institute (Netherlands Institute of Mental Health and Addiction);and Postdoctoral Researcher,Department of Health Services Research,Maastricht University,Care and Public Health Research Institute CAPHRI,the Netherlands
| | - Joran Lokkerbol
- Director, Center of Economic Evaluation,Trimbos Institute (Netherlands Institute of Mental Health and Addiction),the Netherlands;and Harkness Fellow in Health Care Policy and Practice,Department of Health Care Policy,Harvard Medical School,USA
| | - Erik Buskens
- Professor of Health Technology Assessment,Faculty of Economics and Business,University Medical Center Groningen, University of Groningen,the Netherlands
| | - Hermien J Elgersma
- PhD Candidate,Department of Clinical Psychology and Experimental Psychopathology,University of Groningen;and Clinical Psychologist,Accare,the Netherlands
| | - Gerard D van Rijsbergen
- Health Care Psychologist,Department of Early Detection and Intervention in Psychosis,GGZ Drenthe,the Netherlands
| | - Christien Slofstra
- Senior Researcher,Lentis Psychiatric Institute,Lentis Research,the Netherlands
| | - Johan Ormel
- Professor of Psychiatric Epidemiology,University Center for Psychiatry and Interdisciplinary Center Psychiatric Epidemiology,University of Groningen, University Medical Center Groningen,the Netherlands
| | - Jack Dekker
- Professor, Department of Clinical, Neuro and Developmental Psychology,Vrije Universiteit;and Head of Research Department,Arkin Mental Health Institute,the Netherlands
| | - Peter J de Jong
- Professor of Experimental Psychopathology,Chair of Department of Clinical Psychology and Experimental Psychopathology,University of Groningen,the Netherlands
| | - Willem A Nolen
- Emeritus Professor,Department of Psychiatry,University of Groningen, University Medical Center Groningen,the Netherlands
| | - Aart H Schene
- Professor of Psychiatry,Head of the Department of Psychiatry,Radboud University Medical Center;and Principal Investigator,Donders Institute for Brain,Cognition and Behavior,Radboud University,the Netherlands
| | - Steven D Hollon
- Professor of Psychology, Department of Psychology,Vanderbilt University,USA
| | - Huibert Burger
- Associate Professor of Clinical Epidemiology,Department of General Practice,University of Groningen, University Medical Center Groningen;and Associate Professor of Clinical Epidemiology,Amsterdam UMC, location AMC,Department of Psychiatry,University of Amsterdam,the Netherlands
| | - Claudi L H Bockting
- Professor of Clinical Psychology in Psychiatry,Amsterdam UMC, location AMC,Department of Psychiatry,University of Amsterdam,the Netherlands
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Wu Y, Mai N, Zhong X, Wen Y, Zhou Y, Li H, Shang D, Hu L, Chen X, Chen B, Zhang M, Ning Y. Kynurenine pathway changes in late-life depression with memory deficit. Psychiatry Res 2018; 269:45-49. [PMID: 30145300 DOI: 10.1016/j.psychres.2018.08.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 06/21/2018] [Accepted: 08/13/2018] [Indexed: 01/11/2023]
Abstract
Kynurenine pathway (KP) activation is associated with many neuropsychiatric diseases, such as major depressive disorder (MDD) and Alzheimer's disease (AD). Investigations conducted on MDD seldom shed light on KP changes in late-life depression (LLD), though memory deficit (MD) in patients with LLD is a predictable sign of AD. Thus, we aimed to investigate whether tryptophan (TRP) metabolism and kynurenine (KYN) metabolism were imbalanced in patients with LLD with MD and in patients with LLD without MD. We explored KP characteristics between LLD with MD and LLD without MD groups. We investigated 85 patients with LLD and MD, 71 patients with LLD without MD, and 129 healthy controls (HCs). Serum concentrations of TRP, KYN, and kynurenic acid (KYNA) were detected by liquid chromatography-tandem mass spectrometry. Cognition performance was assessed by the Mini-Mental State Examination (MMSE). Language ability was assessed by the Boston Naming Test (BNT). Depressive symptoms were assessed by the 17-item Hamilton Depression Scale (HAMD-17). Lower TRP and KYNA levels, a lower KYNA/KYN ratio and a higher KYN/TRP ratio were found in patients with LLD and MD compared to those in HC. Low levels of TRP and KYN, in the absence of a changed KYN/TRP ratio, were found in patients with LLD without MD. The KYNA/TRP ratio and MMSE, BNT, and HAMD-17 scores were associated with the presence of LLD. MMSE scores and a trend for the KYN/TRP ratio were associated with the presence of MD in patients with LLD. Aside from MMSE scores, there was a trend toward an association between the KYN/TRP ratio and the presence of MD in patients with LLD. In conclusion, profound shifts in TRP metabolism and KYN metabolism were found in patients with LLD and MD but not in patients with LLD without MD.
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Affiliation(s)
- Yujie Wu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, Guangdong, China
| | - Naikeng Mai
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, Guangdong, China
| | - Xiaomei Zhong
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, Guangdong, China
| | - Yuguan Wen
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, Guangdong, China
| | - Yanling Zhou
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, Guangdong, China
| | - Haiyan Li
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, Guangdong, China
| | - Dewei Shang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, Guangdong, China
| | - Lijun Hu
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, Guangdong, China
| | - Xinru Chen
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, Guangdong, China
| | - Ben Chen
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, Guangdong, China
| | - Min Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, Guangdong, China
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), No. 36, Mingxin Road, Liwan District, Guangzhou, Guangdong, China.
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Kim MH, Banerjee S, Zhao Y, Wang F, Zhang Y, Zhu Y, DeFerio J, Evans L, Park SM, Pathak J. Association networks in a matched case-control design - Co-occurrence patterns of preexisting chronic medical conditions in patients with major depression versus their matched controls. J Biomed Inform 2018; 87:88-95. [PMID: 30300713 PMCID: PMC6262847 DOI: 10.1016/j.jbi.2018.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 09/25/2018] [Accepted: 09/28/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE We present a method for comparing association networks in a matched case-control design, which provides a high-level comparison of co-occurrence patterns of features after adjusting for confounding factors. We demonstrate this approach by examining the differential distribution of chronic medical conditions in patients with major depressive disorder (MDD) compared to the distribution of these conditions in their matched controls. MATERIALS AND METHODS Newly diagnosed MDD patients were matched to controls based on their demographic characteristics, socioeconomic status, place of residence, and healthcare service utilization in the Korean National Health Insurance Service's National Sample Cohort. Differences in the networks of chronic medical conditions in newly diagnosed MDD cases treated with antidepressants, and their matched controls, were prioritized with a permutation test accounting for the false discovery rate. Sensitivity analyses for the associations between prioritized pairs of chronic medical conditions and new MDD diagnosis were performed with regression modeling. RESULTS By comparing the association networks of chronic medical conditions in newly diagnosed depression patients and their matched controls, five pairs of such conditions were prioritized among 105 possible pairs after controlling the false discovery rate at 5%. In sensitivity analyses using regression modeling, four out of the five prioritized pairs were statistically significant for the interaction terms. CONCLUSION Association networks in a matched case-control design can provide a high-level comparison of comorbid features after adjusting for confounding factors, thereby supplementing traditional clinical study approaches. We demonstrate the differential co-occurrence pattern of chronic medical conditions in patients with MDD and prioritize the chronic conditions that have statistically significant interactions in regression models for depression.
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Affiliation(s)
- Min-Hyung Kim
- Division of Health Informatics, Department of Health Policy and Research, Weill Cornell Medical College of Cornell University, NY, USA
| | - Samprit Banerjee
- Division of Biostatistics and Epidemiology, Department of Health Policy and Research, Weill Cornell Medical College of Cornell University, NY, USA
| | - Yize Zhao
- Division of Biostatistics and Epidemiology, Department of Health Policy and Research, Weill Cornell Medical College of Cornell University, NY, USA
| | - Fei Wang
- Division of Health Informatics, Department of Health Policy and Research, Weill Cornell Medical College of Cornell University, NY, USA
| | - Yiye Zhang
- Division of Health Informatics, Department of Health Policy and Research, Weill Cornell Medical College of Cornell University, NY, USA
| | - Yongjun Zhu
- Department of Library and Information Science, Sungkyungkwan University, Seoul, Republic of Korea
| | - Joseph DeFerio
- Division of Health Informatics, Department of Health Policy and Research, Weill Cornell Medical College of Cornell University, NY, USA
| | - Lauren Evans
- Division of Biostatistics and Epidemiology, Department of Health Policy and Research, Weill Cornell Medical College of Cornell University, NY, USA
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Jyotishman Pathak
- Division of Health Informatics, Department of Health Policy and Research, Weill Cornell Medical College of Cornell University, NY, USA.
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Richards D, Duffy D, Burke J, Anderson M, Connell S, Timulak L. Supported Internet-Delivered Cognitive Behavior Treatment for Adults with Severe Depressive Symptoms: A Secondary Analysis. JMIR Ment Health 2018; 5:e10204. [PMID: 30279154 PMCID: PMC6231851 DOI: 10.2196/10204] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/12/2018] [Accepted: 08/28/2018] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Depression is a highly prevalent mental health issue that exacts significant economic, societal, personal, and interpersonal costs. Innovative internet-delivered interventions have been designed to increase accessibility to and cost-effectiveness of treatments. These treatments have mainly targeted mild to moderate levels of depression. The increased risk associated with severe depression, particularly of suicidal ideation often results in this population being excluded from research studies. As a result, the effectiveness of internet-delivered cognitive behavioral therapy (iCBT) in more severely depressed cohorts is less researched. OBJECTIVE The aim of this study is to examine the effect of iCBT on symptoms of severe depression, comorbid symptoms of anxiety, and levels of work and social functioning. METHODS Retrospective consent was provided by participants with elevated scores (>28 severe depression symptoms) on the Beck Depression Inventory (BDI-II) who accessed an iCBT intervention (Space from Depression) with support for up to 8 weeks. Data were collected at baseline, posttreatment, and 3-month follow-up on the primary outcome (BDI-II), and secondary outcomes (the Generalized Anxiety Disorder-7 and the Work and Social Adjustment Scale). RESULTS A significant change was observed on all measures between pre- and postmeasurement and maintained at 3-month follow-up. Clinical improvement was observed for participants on the BDI-II from pre- to postmeasurement, and suicidal ideation also reduced from pre- to postmeasurement. CONCLUSIONS Users of Space from Depression with symptoms of severe depression were found to have decreased symptoms of depression and anxiety and increased levels of work and social functioning. The intervention also demonstrated its potential to decrease suicidal ideation. Further investigation is required to determine why some individuals improve, and others do not. iCBT may have the potential to be used as an adjunct treatment for severe depression symptoms, but participants may require further treatment if they receive iCBT as a standalone intervention. Although promising, further research incorporating control groups is needed to support the utility of Space from Depression for use in or as an adjunct to treatment for severe depression.
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Affiliation(s)
- Derek Richards
- Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland.,E-Mental Health Group, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Daniel Duffy
- Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland.,E-Mental Health Group, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - John Burke
- Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Melissa Anderson
- Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland
| | - Sarah Connell
- Clinical Research & Innovation, SilverCloud Health, Dublin, Ireland.,E-Mental Health Group, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Ladislav Timulak
- E-Mental Health Group, School of Psychology, Trinity College Dublin, Dublin, Ireland
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Aronow H, Fila S, Martinez B, Sosna T. Depression and Coleman Care Transitions Intervention. SOCIAL WORK IN HEALTH CARE 2018; 57:750-761. [PMID: 30015601 DOI: 10.1080/00981389.2018.1496514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Coleman Care Transitions Intervention (CTI) is a "Patient Activation Model." Depression can be a barrier to activation and may challenge CTI. This study addressed whether CTI coaches modified the intervention for older adults who screened positive for depression. Over 4,500 clients in a Centers for Medicare and Medicaid Services demonstration completed screening for depression with the PHQ-9; one in five screened positive (score = 9+). Our findings suggest that coaches modified CTI and played a more directive role for clients who screened positive for depression, resulting in similar 30-day readmission rates among patients who screened positive for depression risk and those who did not. That finding stands in contrast to the widely reported higher readmission rates among people screening positive for depression.
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Affiliation(s)
- Harriet Aronow
- a Department of Nursing Research , Cedars-Sinai Medical Center , Los Angeles , USA
| | - Susan Fila
- b Santa Monica College , Department of Health and Wellbeing Services , Los Angeles , CA , USA
| | - Bibiana Martinez
- a Department of Nursing Research , Cedars-Sinai Medical Center , Los Angeles , USA
| | - Todd Sosna
- c Jewish Family Service of Los Angeles , Los Angeles , USA
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Stasik-O'Brien SM, Brock RL, Chmielewski M, Naragon-Gainey K, Koffel E, McDade-Montez E, O'Hara MW, Watson D. Clinical Utility of the Inventory of Depression and Anxiety Symptoms (IDAS). Assessment 2018; 26:944-960. [PMID: 30043620 DOI: 10.1177/1073191118790036] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Depressive and anxiety disorders are severe and disabling conditions that result in substantial cost and global societal burden. Accurate and efficient identification is thus vital to proper diagnosis and treatment of these disorders. The Inventory of Depression and Anxiety Symptoms (IDAS) is a reliable and well-validated measure that provides dimensional assessment of both mood and anxiety disorder symptoms. The current study examined the clinical utility of the IDAS by establishing diagnostic cutoff scores and severity ranges using a large mixed sample (N = 5,750). Results indicated that the IDAS scales are good to excellent predictors of their associated Structured Clinical Interview for DSM-IV diagnoses. These findings were replicated using Diagnostic and Statistical Manual of Mental Disorders-Fifth edition (DSM-5) criteria assessed via the Mini-International Neuropsychiatric Interview. We provide three cutoff scores for each scale that can be used differentially depending on the goal of their use: screening, efficiency, or diagnosis confirmation. The identified severity ranges allow users to characterize individuals as mild, moderate, or severe, providing clinical information beyond diagnostic status. Finally, the 10-item IDAS Dysphoria scale and 20-item General Depression scale demonstrate strong ability to predict internalizing diagnoses and may represent an efficient way to screen for the presence of internalizing psychopathology.
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Affiliation(s)
| | | | | | | | - Erin Koffel
- 5 Minneapolis VA Health Care System, Minneapolis, MN, USA
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Yang M, Loeb DF, Sprowell AJ, Trinkley KE. Design and Implementation of a Depression Registry for Primary Care. Am J Med Qual 2018; 34:59-66. [PMID: 30008227 DOI: 10.1177/1062860618787056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Registries are fundamental to the success of population health initiatives to improve care and outcomes for patients, including those with depression. The purpose of this article is to describe the design and clinical implementation of a depression registry as part of a collaborative care for depression intervention at 2 large academic outpatient internal medicine practices. The primary objective of the registry was to identify and track patients with depression and monitor antidepressant therapy. Secondary objectives of the registry were to assist in addressing pay-for-performance and value-based reimbursement metrics for depression screening and remission. The registry design and variables for inclusion in the registry were defined with input from clinicians, institutional leadership, and data analysts. For implementation, specific clinical workflows were established and responsible team roles were designated.
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Affiliation(s)
- Michael Yang
- 1 University of Colorado School of Medicine, Aurora, CO
| | - Danielle F Loeb
- 2 University of Colorado School of Medicine, Division of General Internal Medicine, Aurora, CO
| | | | - Katy E Trinkley
- 2 University of Colorado School of Medicine, Division of General Internal Medicine, Aurora, CO.,3 University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO
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Ludvigsson M, Bernfort L, Marcusson J, Wressle E, Milberg A. Direct Costs of Very Old Persons with Subsyndromal Depression: A 5-Year Prospective Study. Am J Geriatr Psychiatry 2018; 26:741-751. [PMID: 29673895 DOI: 10.1016/j.jagp.2018.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study aimed to compare, over a 5-year period, the prospective direct healthcare costs and service utilization of persons with subsyndromal depression (SSD) and non-depressive persons (ND), in a population of very old persons. A second aim was to develop a model that predicts direct healthcare costs in very old persons with SSD. DESIGN AND SETTING A prospective population-based study was undertaken on 85-year-old persons in Sweden. MEASUREMENTS Depressiveness was screened with the Geriatric Depression Scale at baseline and at 1-year follow-up, and the results were classified into ND, SSD, and syndromal depression. Data on individual healthcare costs and service use from a 5-year period were derived from national database registers. Direct costs were compared between categories using Mann-Whitney U tests, and a prediction model was identified with linear regression. RESULTS For persons with SSD, the direct healthcare costs per month of survival exceeded those of persons with ND by a ratio 1.45 (€634 versus €436), a difference that was significant even after controlling for somatic multimorbidity. The final regression model consisted of five independent variables predicting direct healthcare costs: male sex, activities of daily living functions, loneliness, presence of SSD, and somatic multimorbidity. CONCLUSIONS SSD among very old persons is associated with increased direct healthcare costs independently of somatic multimorbidity. The associations between SSD, somatic multimorbidity, and healthcare costs in the very old need to be analyzed further in order to better guide allocation of resources in health policy.
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Affiliation(s)
- Mikael Ludvigsson
- Division of Geriatric Medicine, Linköping University, Norrköping, Sweden.
| | - Lars Bernfort
- Department of Clinical and Experimental Medicine, Division of Health Care Analysis, Linköping University, Norrköping, Sweden
| | - Jan Marcusson
- Division of Geriatric Medicine, Linköping University, Norrköping, Sweden
| | - Ewa Wressle
- Division of Geriatric Medicine, Linköping University, Norrköping, Sweden
| | - Anna Milberg
- Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Norrköping, Sweden; Department of Advanced Home Care, Linköping University, Linköping, Sweden
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Kronish IM, Hampsey M, Falzon L, Konrad B, Davidson KW. Personalized (N-of-1) Trials for Depression: A Systematic Review. J Clin Psychopharmacol 2018; 38:218-225. [PMID: 29596148 PMCID: PMC5904006 DOI: 10.1097/jcp.0000000000000864] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE/BACKGROUND Personalized (N-of-1) trials are single-patient, crossover-design trials that may be useful for personalizing the selection of depression treatments. We conducted a systematic review of published N-of-1 trials for depression to determine the feasibility and suitability of this methodology for personalizing depression care. METHODS/PROCEDURES Electronic databases were searched from database inception through October 2016. Studies were selected if they enrolled depressed patients, included a within-subject crossover design, and systematically assessed depressive symptoms during the N-of-1 trial. FINDINGS/RESULTS Five eligible studies reporting on 47 depressed patients (range, 1-18 patients) were identified. Two studies were conducted among adults with treatment-resistant depression, 1 study among depressed inpatients, and 2 studies among patients from special populations (geriatric nursing home, human immunodeficiency virus-associated encephalopathy). All studies evaluated the effects of pharmacologic treatments (methylphenidate, D-amphetamine, ketamine, and sulpiride). Three studies compared an off-label treatment with placebo, 1 study compared 2 off-label treatments, and 1 study compared escalating doses of an off-label treatment with placebo. All 4 studies with more than 1 participant demonstrated heterogeneous treatment effects. All studies produced data that could personalize treatment selection for individual patients. No studies reported on recruitment challenges, compliance with self-tracking, or satisfaction with participation. IMPLICATIONS/CONCLUSIONS The feasibility of N-of-1 trials for depression was demonstrated for a limited number of second-line pharmacologic treatments in treatment-resistant patients or in patients with comorbidities that would have excluded them from conventional randomized controlled trials. Additional research is needed to determine whether N-of-1 trials are suitable for improving the selection of depression treatments in clinical practice.
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Affiliation(s)
- Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168 St. New York, NY 10032
| | - Meghan Hampsey
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168 St. New York, NY 10032
| | - Louise Falzon
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168 St. New York, NY 10032
| | - Beatrice Konrad
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168 St. New York, NY 10032
| | - Karina W. Davidson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168 St. New York, NY 10032
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Fleurkens P, van Minnen A, Becker ES, van Oostrom I, Speckens A, Rinck M, Vrijsen JN. Automatic approach-avoidance tendencies as a candidate intermediate phenotype for depression: Associations with childhood trauma and the 5-HTTLPR transporter polymorphism. PLoS One 2018; 13:e0193787. [PMID: 29547643 PMCID: PMC5856265 DOI: 10.1371/journal.pone.0193787] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 02/17/2018] [Indexed: 12/13/2022] Open
Abstract
Depression risk genes in combination with childhood events have been associated with biased processing as an intermediate phenotype for depression. The aim of the present conceptual replication study was to investigate the role of biased automatic approach-avoidance tendencies as a candidate intermediate phenotype for depression, in the context of genes (5-HTTLPR polymorphism) and childhood trauma. A naturalistic remitted depressed patients sample (N = 209) performed an Approach-Avoidance Task (AAT) with facial expressions (angry, sad, happy and neutral). Childhood trauma was assessed with a questionnaire. Genotype groups were created based on allele frequency: LaLa versus S/Lg-carriers. The latter is associated with depression risk. We found that remitted S/Lg-carriers who experienced childhood trauma automatically avoided sad facial expressions relatively more than LaLa homozygotes with childhood trauma. Remitted LaLa-carriers who had not experienced childhood trauma, avoided sad faces relatively more than LaLa homozygotes with childhood trauma. We did not find a main effect of childhood trauma, nor differential avoidance of any of the other facial expressions. Although tentative, the results suggest that automatic approach-avoidance tendencies for disorder-congruent materials may be a fitting intermediate phenotype for depression. The specific pattern of tendencies, and the relation to depression, may depend on the genetic risk profile and childhood trauma, but replication is needed before firm conclusions can be drawn.
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Affiliation(s)
- Pascal Fleurkens
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
- * E-mail:
| | - Agnes van Minnen
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
- Psychotrauma Expertise Centrum (PSYTREC), Bilthoven, The Netherlands
| | - Eni S. Becker
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Iris van Oostrom
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Anne Speckens
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mike Rinck
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Janna N. Vrijsen
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
- Pro Persona: Institution for Integrated Mental Health Care, Nijmegen, The Netherlands
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47
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Smirnova D, Cumming P, Sloeva E, Kuvshinova N, Romanov D, Nosachev G. Language Patterns Discriminate Mild Depression From Normal Sadness and Euthymic State. Front Psychiatry 2018; 9:105. [PMID: 29692740 PMCID: PMC5902561 DOI: 10.3389/fpsyt.2018.00105] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/15/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Deviations from typical word use have been previously reported in clinical depression, but language patterns of mild depression (MD), as distinct from normal sadness (NS) and euthymic state, are unknown. In this study, we aimed to apply the linguistic approach as an additional diagnostic key for understanding clinical variability along the continuum of affective states. METHODS We studied 402 written reports from 124 Russian-speaking patients and 77 healthy controls (HC), including 35 cases of NS, using hand-coding procedures. The focus of our psycholinguistic methods was on lexico-semantic [e.g., rhetorical figures (metaphors, similes)], syntactic [e.g., predominant sentence type (single-clause and multi-clause)], and lexico-grammatical [e.g., pronouns (indefinite, personal)] variables. Statistical evaluations included Cohen's kappa for inter-rater reliability measures, a non-parametric approach (Mann-Whitney U-test and Pearson chi-square test), one-way ANOVA for between-group differences, Spearman's and point-biserial correlations to analyze relationships between linguistic and gender variables, discriminant analysis (Wilks' λ) of linguistic variables in relation to the affective diagnostic types, all using SPSS-22 (significant, p < 0.05). RESULTS In MD, as compared with healthy individuals, written responses were longer, demonstrated descriptive rather than analytic style, showed signs of spoken and figurative language, single-clause sentences domination over multi-clause, atypical word order, increased use of personal and indefinite pronouns, and verb use in continuous/imperfective and past tenses. In NS, as compared with HC, we found greater use of lexical repetitions, omission of words, and verbs in continuous and present tenses. MD was significantly differentiated from NS and euthymic state by linguistic variables [98.6%; Wilks' λ(40) = 0.009; p < 0.001; r = 0.992]. The highest predictors in discrimination between MD, NS, and euthymic state groups were the variables of word order (typical/atypical) (r = -0.405), ellipses (omission of words) (r = 0.583), colloquialisms (informal words/phrases) (r = 0.534), verb tense (past/present/future) (r = -0.460), verbs form (continuous/perfect) (r = 0.345), amount of reflexive (e.g., myself)/personal (r = 0.344), and negative (e.g., nobody)/indefinite (r = 0.451) pronouns. The most significant between-group differences were observed in MD as compared with both NS and euthymic state. CONCLUSION MD is characterized by patterns of atypical language use distinguishing depression from NS and euthymic state, which points to a potential role of linguistic indicators in diagnosing affective states.
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Affiliation(s)
- Daria Smirnova
- Department of Psychiatry, Addictology, Psychotherapy and Clinical Psychology, Samara State Medical University, Samara, Russia.,Centre for Clinical Research in Neuropsychiatry, University of Western Australia, Perth, WA, Australia
| | - Paul Cumming
- School of Psychology and Counselling, Queensland University of Technology, QIMR Berghofer Institute, Brisbane, QLD, Australia
| | - Elena Sloeva
- Department of Pedagogy, Psychology and Psycholinguistics, Samara State Medical University, Samara, Russia
| | - Natalia Kuvshinova
- Department of Pedagogy, Psychology and Psycholinguistics, Samara State Medical University, Samara, Russia
| | - Dmitry Romanov
- Department of Psychiatry, Addictology, Psychotherapy and Clinical Psychology, Samara State Medical University, Samara, Russia
| | - Gennadii Nosachev
- Department of Psychiatry, Addictology, Psychotherapy and Clinical Psychology, Samara State Medical University, Samara, Russia
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48
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Manoliu A, Bosch OG, Brakowski J, Brühl AB, Seifritz E. The potential impact of biochemical mediators on telomere attrition in major depressive disorder and implications for future study designs: A narrative review. J Affect Disord 2018; 225:630-646. [PMID: 28889049 DOI: 10.1016/j.jad.2017.08.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/30/2017] [Accepted: 08/10/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) has been proposed to represent a "disease of premature aging", which is associated with certain biomarkers of cellular ageing and numerous other age-related diseases. Over the last decade, telomere length (TL) arose as a surrogate for cellular aging. Recent data suggests that TL might be reduced in patients with MDD, however, results are still inconclusive. This might be explained by the lack of assessment of potential biochemical mediators that are directly associated with telomere shortening and frequently observed in patients with MDD. METHODS A narrative review was performed. The PubMed database was searched for relevant studies. RESULTS We identified four major mediators, which are recurrently reported in patients with MDD and are associated with reduced TL: inflammation/oxidative stress, dysregulation of the hypothalamic-pituitary-adrenal axis, metabolic dysbalance including insulin resistance, and decreased brain-derived neurotrophic factor. These mediators are also mutually associated and were not systematically assessed in current studies investigating TL and MDD, which might explain inconclusive findings across current literature. Finally, we discuss possible ways to assess those mediators and potential implications of such approaches for future research. LIMITATIONS The majority of identified studies had cross-sectional designs and used heterogeneous methods to assess TL and associated relevant biochemical mediators. CONCLUSIONS A better understanding of the complex interactions between biochemical mediators, somatic comorbidities and shortened telomeres in patients with MDD might further specify the pathophysiology-based conceptualization and, based on that, personalized treatment of MDD.
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Affiliation(s)
- Andrei Manoliu
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, CH-8032 Zurich, Switzerland.
| | - Oliver G Bosch
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, CH-8032 Zurich, Switzerland
| | - Janis Brakowski
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, CH-8032 Zurich, Switzerland
| | - Annette B Brühl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, CH-8032 Zurich, Switzerland; Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Lenggstrasse 31, CH-8032 Zurich, Switzerland
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49
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Simons CJP, Drukker M, Evers S, van Mastrigt GAPG, Höhn P, Kramer I, Peeters F, Delespaul P, Menne-Lothmann C, Hartmann JA, van Os J, Wichers M. Economic evaluation of an experience sampling method intervention in depression compared with treatment as usual using data from a randomized controlled trial. BMC Psychiatry 2017; 17:415. [PMID: 29284448 PMCID: PMC5747107 DOI: 10.1186/s12888-017-1577-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 12/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Experience sampling, a method for real-time self-monitoring of affective experiences, holds opportunities for person-tailored treatment. By focussing on dynamic patterns of positive affect, experience sampling method interventions (ESM-I) accommodate strategies to enhance personalized treatment of depression-at potentially low-costs. This study aimed to investigate the cost-effectiveness of an experience sampling method intervention in patients with depression, from a societal perspective. METHODS Participants were recruited between January 2010 and February 2012 from out-patient mental health care facilities in or near the Dutch cities of Eindhoven and Maastricht, and through local advertisements. Out-patients diagnosed with major depression (n = 101) receiving pharmacotherapy were randomized into: (i) ESM-I consisting of six weeks of ESM combined with weekly feedback regarding the individual's positive affective experiences, (ii) six weeks of ESM without feedback, or (iii) treatment as usual only. Alongside this randomised controlled trial, an economic evaluation was conducted consisting of a cost-effectiveness and a cost-utility analysis, using Hamilton Depression Rating Scale (HDRS) and quality adjusted life years (QALYs) as outcome, with willingness-to-pay threshold for a QALY set at €50,000 (based on Dutch guidelines for moderate severe to severe illnesses). RESULTS The economic evaluation showed that ESM-I is an optimal strategy only when willingness to pay is around €3000 per unit HDRS and around €40,500 per QALY. ESM-I was the least favourable treatment when willingness to pay was lower than €30,000 per QALY. However, at the €50,000 willingness-to-pay threshold, ESM-I was, with a 46% probability, the most favourable treatment (base-case analysis). Sensitivity analyses confirmed the robustness of these results. CONCLUSIONS We may tentatively conclude that ESM-I is a cost-effective add-on intervention to pharmacotherapy in outpatients with major depression. TRIAL REGISTRATION Netherlands Trial register, NTR1974 .
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Affiliation(s)
- Claudia J. P. Simons
- 0000 0004 0480 1382grid.412966.eDepartment of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands ,GGzE, Institute for Mental Health Care Eindhoven and De Kempen, Eindhoven, The Netherlands
| | - Marjan Drukker
- 0000 0004 0480 1382grid.412966.eDepartment of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Silvia Evers
- 0000 0001 0481 6099grid.5012.6Department of Health Services Research, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands ,0000 0001 0835 8259grid.416017.5Trimbos Institute, Netherlands Institute of Mental Health and Addiction Department of Public Mental Health, Utrecht, The Netherlands
| | - Ghislaine A. P. G. van Mastrigt
- 0000 0001 0481 6099grid.5012.6Department of Health Services Research, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Petra Höhn
- 0000 0004 0480 1382grid.412966.eDepartment of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ingrid Kramer
- 0000 0004 0480 1382grid.412966.eDepartment of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands ,GGzE, Institute for Mental Health Care Eindhoven and De Kempen, Eindhoven, The Netherlands
| | - Frenk Peeters
- 0000 0004 0480 1382grid.412966.eDepartment of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Philippe Delespaul
- 0000 0004 0480 1382grid.412966.eDepartment of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands ,Mondriaan Mental Health Trust South Limburg, Heerlen, The Netherlands
| | - Claudia Menne-Lothmann
- 0000 0004 0480 1382grid.412966.eDepartment of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jessica A. Hartmann
- 0000 0001 2179 088Xgrid.1008.9Orygen, the National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Jim van Os
- 0000 0004 0480 1382grid.412966.eDepartment of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands ,0000000090126352grid.7692.aDepartment Psychiatry, Brain Centre Rudolf Magnus, Utrecht University Medical Centre, Utrecht, the Netherlands ,0000 0001 2322 6764grid.13097.3cKing’s College London, King’s Health Partners Department of Psychosis Studies; Institute of Psychiatry, London, UK
| | - Marieke Wichers
- 0000 0000 9558 4598grid.4494.dInterdisciplinary Center Psychopathology and Emotion regulation (ICPE), Department of Psychiatry, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
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50
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Aggarwal S, Kataria D, Prasad S. A comparative study of quality of life and marital satisfaction in patients with depression and their spouses. Asian J Psychiatr 2017; 30:65-70. [PMID: 28802799 DOI: 10.1016/j.ajp.2017.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/05/2017] [Accepted: 08/05/2017] [Indexed: 12/28/2022]
Abstract
Spouses of patients suffering from depression experience various forms of burden. Present study assesses and compares the marital satisfaction and quality of life (QOL) of the patients and their spouses. Further it assesses these variables in terms of illness severity, duration of untreated illness (DUI) and other demographic parameters especially gender. In this cross sectional study, 50 patients diagnosed with Depressive Disorder along with their spouses were recruited. Both groups were assessed separately for marital satisfaction and QOL along with demographic details followed by appropriate statistical analysis. A high level of marital distress found amongst both patients and their spouses whereas only patients reported poor QOL. Increasing DUI worsens both marital satisfaction and QOL in spouses with no effects on patients. Illness severity worsens QOL in both groups with no effect on marital satisfaction. Gender was not found to have any impact on either of the groups. Small sample size and cross sectional study design were main limitations. Early and faster intervention will be helpful in patient's prognosis, and also the perception and QOL of spouses. A better treatment response may be expected if focus is at improvement in QOL rather than only symptom control. Further work will be needed with a larger population and in a longitudinal study design. Future research also needs to focus upon establishment of better norms for the DUI for depressive disorder.
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Affiliation(s)
- Shruti Aggarwal
- Department of Psychiatry and De-addiction, Lady Hardinge Medical College and Smt. SK Hospital, New Delhi, India.
| | - Dinesh Kataria
- Department of Psychiatry and De-addiction, Lady Hardinge Medical College and Smt. SK Hospital, New Delhi, India.
| | - Shiv Prasad
- Department of Psychiatry and De-addiction, Lady Hardinge Medical College and Smt. SK Hospital, New Delhi, India.
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