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Pedro LMR, de Oliveira MF, Pereira MD, da Fonseca AD, Canavarro MC. Factors Associated with Prospective Acceptability and Preferences for Unified Transdiagnostic Cognitive-Behavioral Treatments and Group Therapy in the Portuguese General Population. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01391-1. [PMID: 38839662 DOI: 10.1007/s10488-024-01391-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/07/2024]
Abstract
Group transdiagnostic cognitive-behavioral therapy (CBT) offers a promising solution for limited mental health access in Portugal. Understanding barriers to patient adherence is crucial for successful implementation. This study aimed to characterize the prospective acceptability and preferences for unified transdiagnostic CBT and group therapy in the Portuguese general population and explore their correlates. A sample of 243 participants (18-88 years old), recruited online, completed an online survey collecting information on sociodemographic and clinical characteristics, acceptability of transdiagnostic CBT treatments, specifically of Unified Protocol (UP), acceptability of group therapy, therapeutic format preferences, beliefs about group therapy and help-seeking attitudes. Most participants were receptive to and perceived as useful both unified transdiagnostic CBT and group therapy. Overall, participants presented significantly more favorable attitudes than unfavorable attitudes toward unified transdiagnostic CBT and group therapy (p < .001). Multivariate analyses revealed that (1) favorable attitudes toward transdiagnostic treatments were negatively associated with being employed and positively associated with living in an urban area, and higher efficacy scores; (2) unfavorable attitudes toward transdiagnostic treatments were positively associated with being married/cohabitating and negatively associated with vulnerability scores; (3) being female, living in an urban area, and higher efficacy and myth scores emerged as positive predictors of favorable attitudes toward group therapy; and (4) efficacy and vulnerability scores and help-seeking propensity emerged as negative predictors of unfavorable attitudes toward group therapy. These findings highlight the importance of delineating strategies to increase knowledge and acceptance of unified transdiagnostic CBT and group therapy in the Portuguese population, addressing specific individual characteristics.
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Affiliation(s)
- Liliana Maria Rodrigues Pedro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra, 3000-115, Portugal.
| | | | - Marco Daniel Pereira
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra, 3000-115, Portugal
| | - Ana Dias da Fonseca
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra, 3000-115, Portugal
| | - Maria Cristina Canavarro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra, 3000-115, Portugal
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Vázquez Morejón AJ, Felipe González C, Muñoz Caracuel MA, Vázquez-Morejón R. Psychosocial factors associated with treatment preference in mental health. Int J Soc Psychiatry 2024; 70:818-827. [PMID: 38439521 DOI: 10.1177/00207640241236105] [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: 03/06/2024]
Abstract
BACKGROUND Studies examining the effects of incorporating patients' preferences into treatment outcomes highlight their impact on crucial aspects such as reduced dropout rates and enhanced effectiveness. Recognizing individuals' rights to participate in decisions about their treatments underscores the importance of studying treatment preferences and the factors influencing these choices. AIM This study aims to identify treatment preferences (psychological, pharmacological, or combined) among a sample of patients and to discern the psychosocial and clinical factors influencing these preferences. METHODS A total of 2,133 individuals receiving care at a community mental health unit completed assessments on anxious-depressive symptoms, social and occupational adjustment, and their treatment preference. Data analysis was conducted using SPSS, with descriptive statistics, Chi-square tests, and one-way ANOVA applied. RESULTS Preferences for treatments were distributed as follows: Combined (49.8%), psychological (33%), and pharmacological (10.6%). Factors such as diagnosis, severity of depressive and anxious symptoms, and functional impact were related to treatment preference with a moderate effect size. Meanwhile, various sociodemographic factors correlated with the selected treatment, though with a weak effect size. CONCLUSIONS There is a pronounced preference for combined treatments. The significance of psychological treatments is evident, as four out of five participants favored them in their choices. Addressing these preferences calls for an exploration within the broader context of prescription freedom in mental health.
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Affiliation(s)
- Antonio J Vázquez Morejón
- Hospital Universitario Virgen del Rocío, Seville, Andalucía, Spain
- University of Seville, Seville, Spain
| | | | | | - Raquel Vázquez-Morejón
- Grupo de Investigación Comportamientos Sociales y Salud, University of Seville, Seville, Spain
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3
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Wong VWH, Yiu EKL, Ng CH, Sarris J, Ho FYY. Unraveling the associations between unhealthy lifestyle behaviors and mental health in the general adult Chinese population: A cross-sectional study. J Affect Disord 2024; 349:583-595. [PMID: 38176449 DOI: 10.1016/j.jad.2023.12.079] [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: 07/08/2023] [Revised: 11/24/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND This study examined the cumulative risk of unhealthy lifestyle behaviors and the associations between overall lifestyle and common mental disorders (CMDs), insomnia, stress, health-related quality of life (HRQOL), and functional impairment. Additionally, the treatment preferences for managing CMDs and insomnia were examined. METHODS A survey was conducted on 1487 Chinese Hong Kong adults, assessing their lifestyle behaviors (i.e., diet and nutrition, substance use, physical activity, stress management, restorative sleep, social support, and environmental exposures), mental health-related outcomes, and treatment preferences via a vignette. RESULTS The findings revealed significant additive relationships between the number of 'worse' lifestyle domains and the risk of all outcomes. A healthier overall lifestyle was significantly associated with reduced risks of all outcomes (AORs = 0.88 to 0.93). Having healthier practices in diet and nutrition, substance use, stress management, restorative sleep, and social support domains were significantly associated with lower risks of all outcomes (AORs = 0.93 to 0.98), except that substance use was not significantly associated with stress. Physical activity was inversely associated with only depressive symptoms (AOR = 0.98), anxiety symptoms (AOR = 0.99), and stress (AOR = 0.99). Environmental exposures were not significantly associated with functional impairment but with all other outcomes (AORs = 0.98 to 0.99). Besides, lifestyle interventions (55 %) were significantly more preferred for managing CMDs and insomnia relative to psychotherapy (35.4 %) and pharmacotherapy (9.6 %). CONCLUSIONS Our findings underscore the importance of considering lifestyle factors when managing CMDs, insomnia, stress, HRQOL, and functional impairment, with a particular emphasis on adopting a multicomponent treatment approach.
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Affiliation(s)
| | - Eric Kwok-Lun Yiu
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, VIC, Australia
| | - Jerome Sarris
- Western Sydney University, NICM Health Research Institute, Westmead, NSW, Australia; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Fiona Yan-Yee Ho
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong.
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4
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Effectiveness of ACT-based intervention in compliance with the model for sustainable mental health: A cluster randomized control trial in a group of older adults. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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5
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Daniel KE, Blackstone SR, Tan JS, Merkel RL, Hauck FR, Allen CW. Integrated model of primary and mental healthcare for the refugee population served by an academic medical centre. Fam Med Community Health 2023; 11:fmch-2022-002038. [PMID: 37012045 PMCID: PMC10083854 DOI: 10.1136/fmch-2022-002038] [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: 10/31/2022] [Accepted: 02/26/2023] [Indexed: 04/05/2023] Open
Abstract
Refugees are at increased risk for developing mental health concerns due to high rates of trauma exposure and postmigration stressors. Moreover, barriers to accessing mental health services result in ongoing suffering within this population. Integrated care-which combines primary healthcare and mental healthcare into one cohesive, collaborative setting-may improve refugees' access to comprehensive physical and mental health services to ultimately better support this uniquely vulnerable population. Although integrated care models can increase access to care by colocating multidisciplinary services, establishing an effective integrated care model brings unique logistic (eg, managing office space, delineating roles between multiple providers, establishing open communication practices between specialty roles) and financial (eg, coordinating across department-specific billing procedures) challenges. We therefore describe the model of integrated primary and mental healthcare used in the International Family Medicine Clinic at the University of Virginia, which includes family medicine providers, behavioural health specialists and psychiatrists. Further, based on our 20-year history of providing these integrated services to refugees within an academic medical centre, we offer potential solutions for addressing common challenges (eg, granting specialty providers necessary privileges to access visit notes entered by other specialty providers, creating a culture where communication between providers is the norm, establishing a standard that all providers ought to be CC'ed on most visit notes). We hope that our model and the lessons we have learned along the way can help other institutions that are interested in developing similar integrated care systems to support refugees' mental and physical health.
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Affiliation(s)
- Katharine E Daniel
- Department of Psychology, University of Virginia, Charlottesville, Virginia, USA
- Department of Family Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Sarah R Blackstone
- Department of Family Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Joseph S Tan
- Department of Family Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Richard L Merkel
- Department of Psychiatry, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Fern R Hauck
- Department of Family Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Claudia W Allen
- Department of Family Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
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Strong JV, Plys E, Hartmann CW, Hinrichs KLM, McCullough M. Strategies for Implementing Group Mental Health Interventions in a VA Community Living Center. Clin Gerontol 2022; 45:1201-1213. [PMID: 32314668 DOI: 10.1080/07317115.2020.1756550] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: Group mental health interventions are difficult to implement into rehabilitation facilities, but no one has studied the specific barriers. This mixed-methods project systematically examined the implementation of a mental health (MH) group intervention in a VA community living center (CLC) for residents on subacute rehabilitation units, using the Promoting Action on Research Implementation in Health Services (PARIHS) implementation framework.Methods: We implemented a group MH intervention, tracking team referrals, attendance rates, and reasons for declining to participate. We conducted qualitative interviews with attendees.Results: Individual barriers to attendance included acute illness (n = 67, 20%), attitudes toward MH (n = 50; 15%), and perceived busyness (n = 19; 6%). Facility barriers included competing appointments (n = 69; 21%). Interviews demonstrated challenges to implementation, including stigma toward mental health (Theme: Challenges and Supports to Implementation). Attendees found the group relatable, and noted that both positive and negative group dynamics contributed to their experience (Themes: Content Relevance and Group Dynamics).Conclusions: The results provide insight into implementing a group MH treatment into the CLC setting, with implications for the MH care of older adults residing in CLCs.Clinical Implications: 1) Group leaders should consider matching attendees for ability levels (physical or cognitive). 2) At the facility level, leaders may take steps to address stigma toward MH by adopting approaches (e.g., music) or framing MH issues (e.g., use of language) in a way that is approachable. 3) Modifiable barriers at the individual and facility level could be addressed to encourage ease of implementation.
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Affiliation(s)
- Jessica V Strong
- Psychology Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,New England GRECC, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Evan Plys
- Psychology Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Internal Medicine, University of Colorado Denver- Anschutz Medical Campus
| | - Christine W Hartmann
- Edith Norse Rogers VA Medical Center, Bedford, Massachusetts, USA.,Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
| | - Kate L M Hinrichs
- Psychology Service, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Megan McCullough
- Edith Norse Rogers VA Medical Center, Bedford, Massachusetts, USA.,Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, Massachusetts, USA
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7
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Strong JV, Plys E, Hinrichs KLM, Hartmann CW, McCullough M. Music for your mental health? The development and evaluation of a group mental health intervention in subacute rehabilitation. Aging Ment Health 2022; 26:950-957. [PMID: 34121525 DOI: 10.1080/13607863.2021.1935463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: Short-stay residents of nursing homes experience high rates of mental health (MH) distress compared to community dwelling counterparts, yet MH interventions are difficult to implement and sustain. We modified a music therapy framework to Effective Music in Psychotherapy. Using the modified model, we integrated music listening into MH group intervention and evaluated MH outcomes. This pilot study reports the development and evaluation of the Mental Health and Music Group for short-stay nursing homes residents.Method: The group was developed and refined to be non-sequential and non-cumulative, specific to the needs of short-stay nursing home residents. Pre-/post-session ratings examined affect, quality of life, and pain. Leaders monitored engagement across and between sessions. Qualitative interviews were conducted with a selection of attendees.Results: Findings indicated decreases in irritation and worry, and increases in mood, energy, and self-as-a-whole from pre- to post-session. There were no changes in pain, perception of physical health or life-as-a-whole, energetic, sad, or happy affect, or differences in engagement. Qualitative interviews demonstrated benefits of group modality and music to group cohesion and highlighted the relevance of music for mental health outcomes.Conclusion: The Mental Health and Music group was designed around a framework of Effective Music in Psychotherapy, for short-stay nursing home settings, and demonstrated promising results. Future research can solidify the interventions generalizeability to medical and rehabilitation settings addressing the specific population needs and preferences.Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2021.1935463 .
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Affiliation(s)
- Jessica V Strong
- VA Boston Healthcare System, Boston, MA, USA.,New England Geriatric Research Education and Clinical Center, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Department of Psychology, Faculty of Arts, University of Prince Edward Island, Charlottetown, Canada
| | - Evan Plys
- VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kate L M Hinrichs
- VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Christine W Hartmann
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System.,Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Megan McCullough
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System.,Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA, USA
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8
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Older adults’ mental health information preferences: a call for more balanced information to empower older adults’ mental health help-seeking. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x21001896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
A small minority of older adults seek psychological help when they need it. Barriers to mental health service use among older adults include low mental health literacy and reduced opportunities for shared decision-making in health care. There is a gap in the literature examining the mental health information preferences of older adults. The objectives of this study were to describe the information preferences and predictors of preferences among older adults. In total, 229 adults aged 50 years and older in central Canada responded to a questionnaire investigating socio-demographic, psycho-social and health-related characteristics, as well as mental health information preferences. Descriptive analysis quantified participants’ ratings of information preferences and hierarchical linear regression analysis determined predictors of their preferences. Older adults rated all mental health content items as very important. Most participants preferred detailed information (two to six pages) on all treatment options (psychological, pharmacological, combined and self-help). Older adults significantly preferred discussion with a heath-care provider and written information, in comparison to other formats. Older adults also significantly preferred to consult family, friends and heath-care professionals over other sources. Socio-demographic and psycho-social characteristics accounted for some of the variance in predicting older adults’ information preferences. Findings highlight older adults’ desire to be involved in decisions concerning mental health supports. Providing balanced information concerning mental health treatment may increase empowerment in mental health help-seeking.
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9
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Shepardson RL, Buckheit KA, Funderburk JS. Anxiety treatment preferences among veteran primary care patients: Demographic, mental health, and treatment-related correlates. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2021; 39:563-575. [PMID: 34472956 PMCID: PMC9358443 DOI: 10.1037/fsh0000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Anxiety symptoms are common, yet undertreated, among primary care patients. Accommodating patient treatment preferences improves engagement and retention. In contrast to depression, little is known about primary care patients' preferences for anxiety treatment. METHOD Participants were 144 veterans experiencing anxiety symptoms but not receiving psychotherapy who were recruited from primary care. Preferences for 11 anxiety treatment attributes (method; location; type; format; provider; frequency, length, and number of appointments; psychotherapy orientation; symptom focus; and topic/skill) and demographic, mental health (e.g., anxiety symptom severity), and treatment-related (e.g., psychotherapy history) variables were assessed via mailed survey. We used chi-square goodness of fit tests to identify patient preferences for each attribute and multivariate multinomial logistic regression models to explore demographic, mental health, and treatment-related correlates of treatment preferences. RESULTS Patient preferences were largely consistent with integrated primary care models, particularly Primary Care Behavioral Health, with a few exceptions. Patients preferred longer appointments (e.g., 45-60 minutes) and a longer duration of treatment (e.g., ≥13 appointments) than is typically offered in primary care. Several variables, particularly education level, perceived need for help, anxiety symptom severity, and attitudes toward psychotherapy, were repeatedly associated with preferences for various anxiety treatment attributes. DISCUSSION Results from this study suggest that patients tend to have distinct preferences for anxiety treatment in primary care that are largely consistent with common integrated primary care models. Results also identify several variables that may be associated with specific preferences, which may help match patients to their preferred type of care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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10
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Burrows T, Teasdale S, Rocks T, Whatnall M, Schindlmayr J, Plain J, Roberton M, Latimer G, Harris D, Forsyth A. Cost effectiveness of dietary interventions for individuals with mental disorders: A scoping review of experimental studies. Nutr Diet 2021; 79:291-302. [PMID: 34510689 DOI: 10.1111/1747-0080.12703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022]
Abstract
AIM This scoping review aimed to explore the extent of the evidence of experimental studies evaluating the cost effectiveness of dietary interventions in individuals with mental disorders. METHODS Five databases (CINAHL, EMBASE, MEDLINE, PsycINFO and Scopus) were searched to October 2020 for cost-analysis studies of interventions aiming to improve dietary intake in people with mental disorders. No restriction was placed on participant age, mental disorder type or intervention design. Results are presented narratively. RESULTS Of 2753 articles identified, 13 articles reporting on eight studies were included. Studies were RCTs (n = 5), cluster RCT (n = 1), cluster preference RCT (n = 1), and pre-post test (n = 1). Seven studies were in community settings (eg, outpatient clinics), and one study in the community housing setting. All studies were in adults, seven included male and female participants, and one included only females. Defined mental disorder diagnoses included serious/severe mental disorders (n = 3), major depression (n = 2), schizophrenia, schizoaffective disorder or first-episode psychosis (n = 1), any mental disorder (n = 1), and bulimia nervosa (n = 1). Five interventions were multi-behaviour, two were diet only and one was eating disorder treatment. Cost analyses included cost-utility (n = 3), cost-effectiveness (n = 1), cost-utility and cost-effectiveness (n = 3), and a costing study (n = 1). Two studies (25%) reported positive results in favour of cost effectiveness, and four studies reported a mix of positive and neutral results. CONCLUSIONS There is limited evidence evaluating the cost effectiveness of dietary interventions in individuals with mental disorders. Additional studies in various settings are needed to confirm cost effectiveness of different interventions.
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Affiliation(s)
- Tracy Burrows
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New South Wales, Australia
| | - Scott Teasdale
- School of Psychiatry, UNSW Sydney, Kensington, New South Wales, Australia
| | - Tetyana Rocks
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, Deakin University, Geelong, Victoria, Australia
| | - Megan Whatnall
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New South Wales, Australia
| | - Julia Schindlmayr
- Dietitians Australia, Deakin, Australian Capital Territory, Australia
| | - Janice Plain
- Macquarie Hospital, North Ryde, New South Wales, Australia
| | - Michelle Roberton
- Victorian Centre of Excellence in Eating Disorders, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Georgina Latimer
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University, Hawthorn, Victoria, Australia
| | - Deanne Harris
- Tamworth Rural Referral Hospital, Hunter New England Health, Tamworth, New South Wales, Australia
| | - Adrienne Forsyth
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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11
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Exploring older adults’ experiences seeking psychological services using the network episode model. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x20000719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractOlder adults’ mental health problems are a growing public health concern, especially because their rate of mental health service use is particularly low. Decades of mental health service utilisation models have been developed, yet key assumptions from these models focus primarily on factors that facilitate or inhibit access into the treatment system without taking into considering the dynamics of how individuals respond to their mental health problems and engage in service utilisation. More recently, dynamic models like the Network Episode Model (NEM-II) have been developed to challenge the underlying, rational choice assumption of traditional utilisation models. Given the multifaceted and complex nature of older adults’ mental health problems, the objective of this study was to examine whether the NEM-II is a helpful and appropriate model for understanding the dynamic process of how older adults navigate the mental health system, including factors that advanced and delayed help-seeking. Our qualitative analyses from 15 interviews with older adults revealed that their backgrounds, social supports and treatment systems influence, and are influenced by, their illness careers. Factors that delayed help-seeking included: a lack of support, ‘inappropriate’ referrals/advice from treatment professionals and poor mental health literacy. This research suggests the NEM-II is a helpful and appropriate theory for understanding older adults’ pathways to treatment, and has implications to enhance older adults’ access to psychological services.
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Osma J, Suso-Ribera C, Peris-Baquero Ó, Gil-Lacruz M, Pérez-Ayerra L, Ferreres-Galan V, Torres-Alfosea MÁ, López-Escriche M, Domínguez O. What format of treatment do patients with emotional disorders prefer and why? Implications for public mental health settings and policies. PLoS One 2019; 14:e0218117. [PMID: 31181100 PMCID: PMC6557569 DOI: 10.1371/journal.pone.0218117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/25/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We analyzed the preference of three psychological intervention formats-individual, group, and online-in a sample of 267 patients with a primary diagnosis of emotional disorder in Spanish public mental health settings. METHOD We studied patients' preferences considering sociodemographic characteristics, diagnoses, history of psychological treatments, number of sessions, and satisfaction with past interventions. RESULTS Most participants (85.4%) preferred psychological treatment in an individual format, 14.2% in group, and 0.4% online. When comparing the people who chose individual and group treatment, no demographic or clinical differences were found. The arguments against group format were the lack of privacy and expression difficulties. Regarding online format, these included being considered impersonal and ineffective. CONCLUSION The rejection of group and online psychotherapy formats allows us to define the actions we should carry out in public mental health settings to improve the acceptance of more cost-effective therapy formats.
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Affiliation(s)
- Jorge Osma
- Departamento de psicología y sociología, Universidad de Zaragoza, Teruel, Spain
- Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, Spain
| | - Carlos Suso-Ribera
- Departamento de psicología básica, clínica y psicobiología, Universitat Jaume I, Castellón, Spain
| | | | - Marta Gil-Lacruz
- Departamento de psicología y sociología, Universidad de Zaragoza, Teruel, Spain
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Bevilacqua K, Schneider S, Rasul R, Taioli E, Schwartz RM. Engagement in linkage to mental health care program in the Rockaways after Hurricane Sandy. JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 47:743-756. [PMID: 30597560 PMCID: PMC6590356 DOI: 10.1002/jcop.22150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/15/2018] [Accepted: 12/11/2018] [Indexed: 06/09/2023]
Abstract
The Rockaways area of New York City was especially devastated by Hurricane Sandy. This study examined participant characteristics associated with acceptance of a linkage to and attendance at appointments for mental health difficulties (MHD). Participants (N = 1,011) completed questionnaires to assess mental health symptoms. Participants who met screening criteria (n = 442) were offered linkage to care. Individuals who had a higher mental health symptom burden (MHSB; i.e., those who screened in on more than one criteria vs. only one criterion) had 2.68 greater odds of accepting services (95% confidence interval [1.68, 4.26]). MHSB was not associated with attending a first appointment (p = 0.80). Female gender and Hispanic ethnicity were also associated with acceptance of linkage to care, though not attendance. Reducing stigma around MHD associated with natural disasters and increasing knowledge about the mental health care system could promote help-seeking behavior among survivors.
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Affiliation(s)
- Kristin Bevilacqua
- Department of Occupational MedicineEpidemiology and Prevention, Northwell Health
- Joint Center for Disaster HealthTrauma and Resilience
| | - Samantha Schneider
- Department of Occupational MedicineEpidemiology and Prevention, Northwell Health
- Joint Center for Disaster HealthTrauma and Resilience
| | - Rehana Rasul
- Department of Occupational MedicineEpidemiology and Prevention, Northwell Health
- Joint Center for Disaster HealthTrauma and Resilience
- Department of BiostatisticsNorthwell Health
| | - Emanuela Taioli
- Joint Center for Disaster HealthTrauma and Resilience
- Institute of Translational Epidemiology, Department of Population Health Science and PolicyThe Icahn School of Medicine at Mount Sinai
| | - Rebecca M. Schwartz
- Department of Occupational MedicineEpidemiology and Prevention, Northwell Health
- Joint Center for Disaster HealthTrauma and Resilience
- Institute of Translational Epidemiology, Department of Population Health Science and PolicyThe Icahn School of Medicine at Mount Sinai
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
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Jones EC, Liebel SW, Hallowell ES, Sweet LH. Insula thickness asymmetry relates to risk of major depressive disorder in middle-aged to older adults. Psychiatry Res Neuroimaging 2019; 283:113-117. [PMID: 30598360 PMCID: PMC6379126 DOI: 10.1016/j.pscychresns.2018.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 12/19/2018] [Accepted: 12/20/2018] [Indexed: 11/22/2022]
Abstract
A growing body of research implicates the insula as a critical brain structure in major depressive disorder (MDD), emotional salience, and interoception. Despite a high prevalence of depressive symptoms among middle-aged to older adults and the elevated risks that they confer towards poor outcomes like deteriorating health and suicidality, only limited research has examined the role of the insula in this population. The present study investigates associations between insula thickness and risk of developing MDD in middle-aged to older adults. A composite measure of MDD risk was quantified based upon current Beck Depression Inventory-II scores, current antidepressant medication use, and self-reported history of depression. Linear regressions were performed to analyze the relationships between insula thickness and MDD risk. Linear regression established that left-right insula thickness difference and left insula thickness significantly predicted MDD risk; however, right insula thickness did not. These findings provide evidence of the importance of insula thickness in middle-aged to older adults at elevated risk for MDD, while highlighting the left insula as an area of particular interest.
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Affiliation(s)
- Erin C Jones
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA 30602, USA.
| | - Spencer W Liebel
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA 30602, USA
| | - Emily S Hallowell
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA 30602, USA
| | - Lawrence H Sweet
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA 30602, USA
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15
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Witlox M, Kraaij V, Garnefski N, de Waal MWM, Smit F, Hoencamp E, Gussekloo J, Bohlmeijer ET, Spinhoven P. An Internet-based Acceptance and Commitment Therapy intervention for older adults with anxiety complaints: study protocol for a cluster randomized controlled trial. Trials 2018; 19:502. [PMID: 30223873 PMCID: PMC6142346 DOI: 10.1186/s13063-018-2731-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 06/08/2018] [Indexed: 12/02/2022] Open
Abstract
Background Anxiety is among the most prevalent and disabling mental health problems in older adults. Few older adults with mild to moderately severe anxiety symptoms receive adequate interventions, putting them at risk for developing anxiety disorders, depression, and various somatic problems. Effective, low-threshold interventions should be developed. Blended care, in which a web-based intervention is combined with a limited amount of face-to-face contacts with a mental healthcare counselor at the general practice, is a promising option. The online self-help intervention “Living to the Full”—an Acceptance and Commitment Therapy (ACT) intervention—has been proven to reduce depression and anxiety in several patient groups, but has not yet been investigated in older adults. The aim of this study is to evaluate the (cost-)effectiveness of a blended form of “Living to the Full” in reducing anxiety symptoms in adults aged 55 to 75 years. Furthermore, moderators and mediators of the treatment effect are investigated. Methods/design The (cost-)effectiveness of the ACT intervention will be investigated in a cluster single-blind randomized controlled trial (RCT). The blended intervention will be compared to treatment-as-usual. Thirty-six mental health counselors working at general practices in the Netherlands will be randomized to deliver blended care or treatment as usual. A total of 240 participants (aged 55–75 years) with mild to moderately severe anxiety complaints (defined as a total score of 5–15 on the GAD-7) will be recruited. There are four measurements consisting of online questionnaires (primary outcome: GAD-7) and a telephone interview: before the start of the intervention; directly following the intervention (14 weeks after baseline); and six and twelve months after baseline. Possible mediator variables will be assessed multiple times basis during the intervention. Discussion This RCT will evaluate the effectiveness of a blended ACT intervention for older adults with anxiety symptoms. If the intervention is shown to be effective, it will be implemented, thereby improving the accessibility and quality of preventive interventions for older adults with anxiety problems. Trial registration Netherlands Trial Register, NTR6270. Registered on 21 March 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2731-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maartje Witlox
- Institute of Psychology, Leiden University, Leiden, The Netherlands.
| | - Vivivan Kraaij
- Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Nadia Garnefski
- Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Margot W M de Waal
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Filip Smit
- Netherlands Institute of Mental Health and Addiction, Trimbos, Utrecht, The Netherlands
| | - Erik Hoencamp
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care and Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Ernst T Bohlmeijer
- Department of Psychology Health and Technology, University of Twente, Twente, The Netherlands
| | - Philip Spinhoven
- Institute of Psychology, Leiden University, Leiden, The Netherlands
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16
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Rodenburg-Vandenbussche S, Carlier IVE, van Vliet IM, van Hemert AM, Stiggelbout AM, Zitman FG. Clinical and sociodemographic associations with treatment selection in major depression. Gen Hosp Psychiatry 2018; 54:18-24. [PMID: 30048764 DOI: 10.1016/j.genhosppsych.2018.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/19/2018] [Accepted: 06/22/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate treatment selection in a naturalistic sample of MDD outpatients and the factors influencing treatment selection in specialized psychiatric care. METHOD Multinomial Logistic Regression analysis investigated associations between treatment selection and patients' sociodemographic and clinical characteristics, using retrospective chart review data and Routine Outcome Monitoring (ROM) data of MDD outpatients. RESULTS Of the patients included for analyses (N = 263), 34% received psychotherapy, 32% received an antidepressant (AD) and 35% received a combination. Men were more likely than women to receive AD with reference to psychotherapy (ORAD = 5.57, 95% CI 2.38-13.00). Patients with severe depression and patients with AD use upon referral, prescribed by their general practitioner, were more likely to receive AD (ORsevere depression = 5.34, 95% CI 1.70-16.78/ORAD GP = 9.26, 95% CI 2.53-33.90) or combined treatment (ORsevere depression = 6.32, 95% CI 1.86-21.49/ORAD GP = 22.36, 95% CI 5.89-83.59) with respect to psychotherapy. More severe patients with AD upon referral received combined treatment less often compared to psychotherapy (OR = 0.14, 95% CI 0.03-0.68). CONCLUSION AD prescriptions in primary care, severity and gender influenced treatment selection for depressive disorders in secondary psychiatric care. Other factors such as the accessibility of treatment and patient preferences may have played a role in treatment selection in this setting and need further investigation.
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Affiliation(s)
| | - I V E Carlier
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| | - I M van Vliet
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| | - A M van Hemert
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
| | - A M Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - F G Zitman
- Department of Psychiatry, Leiden University Medical Centre, Leiden, the Netherlands
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17
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Shepardson RL, Buchholz LJ, Weisberg RB, Funderburk JS. Psychological interventions for anxiety in adult primary care patients: A review and recommendations for future research. J Anxiety Disord 2018; 54:71-86. [PMID: 29427898 PMCID: PMC7909724 DOI: 10.1016/j.janxdis.2017.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/07/2017] [Accepted: 12/23/2017] [Indexed: 10/18/2022]
Abstract
Anxiety symptoms are prevalent in primary care, yet treatment rates are low. The integration of behavioral health providers into primary care via the Primary Care Behavioral Health (PCBH) model offers a promising way to improve treatment options by adding a team member with the necessary skillset to deliver evidence-based psychological interventions for anxiety. We conducted a narrative review of psychological interventions for anxiety applied within adult primary care settings (k = 44) to update the literature and evaluate the fit of existing interventions with the PCBH model. The majority of studies were randomized controlled trials (RCTs; 70.5%). Most interventions utilized cognitive-behavioral therapy (68.2%) and were delivered individually, face-to-face (52.3%). Overall, 65.9% of interventions (58.6% of RCTs, 91.7% of pre-post) were effective in reducing anxiety symptoms, and 83.3% maintained the gains at follow-up. Although it is encouraging that most interventions significantly reduced anxiety, their longer formats (i.e., number and duration of sessions) and narrow symptom targets make translation into practice difficult. Methodological limitations of the research included homogenous samples, failure to report key procedural details, pre-post designs, and restrictive eligibility criteria. We offer recommendations to guide future research to improve the likelihood of successful translation of anxiety interventions into clinical practice.
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Affiliation(s)
- Robyn L Shepardson
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, United States; Department of Psychology, Syracuse University, Syracuse, NY, United States.
| | - Laura J Buchholz
- Center for Integrated Healthcare, VA Western New York Healthcare System at Buffalo, Buffalo, NY, United States; Department of Psychology, University at Buffalo/State University of New York, Buffalo, NY, United States; Department of Psychology, University of Tampa, Tampa, FL, United States.
| | - Risa B Weisberg
- VA Boston Healthcare System, Boston, MA, United States; Boston University School of Medicine, Boston, MA, United States; Alpert Medical School of Brown University, Providence, RI, United States.
| | - Jennifer S Funderburk
- Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, United States; Department of Psychology, Syracuse University, Syracuse, NY, United States; Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, United States.
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18
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Comparison of Stepped Care Delivery Against a Single, Empirically Validated Cognitive-Behavioral Therapy Program for Youth With Anxiety: A Randomized Clinical Trial. J Am Acad Child Adolesc Psychiatry 2017; 56:841-848. [PMID: 28942806 DOI: 10.1016/j.jaac.2017.08.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 07/16/2017] [Accepted: 08/03/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Stepped care is embraced as an ideal model of service delivery but is minimally evaluated. The aim of this study was to evaluate the efficacy of cognitive-behavioral therapy (CBT) for child anxiety delivered via a stepped-care framework compared against a single, empirically validated program. METHOD A total of 281 youth with anxiety disorders (6-17 years of age) were randomly allocated to receive either empirically validated treatment or stepped care involving the following: (1) low intensity; (2) standard CBT; and (3) individually tailored treatment. Therapist qualifications increased at each step. RESULTS Interventions did not differ significantly on any outcome measures. Total therapist time per child was significantly shorter to deliver stepped care (774 minutes) compared with best practice (897 minutes). Within stepped care, the first 2 steps returned the strongest treatment gains. CONCLUSION Stepped care and a single empirically validated program for youth with anxiety produced similar efficacy, but stepped care required slightly less therapist time. Restricting stepped care to only steps 1 and 2 would have led to considerable time saving with modest loss in efficacy. Clinical trial registration information-A Randomised Controlled Trial of Standard Care Versus Stepped Care for Children and Adolescents With Anxiety Disorders; http://anzctr.org.au/; ACTRN12612000351819.
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19
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Demetriadou E, Kokkinou M, Metaxas G, Kyriakides E, Kyprianou T. Psychological support for families of ICU patients: longitudinal documentation of the service. PSYCHOL HEALTH MED 2017; 22:736-743. [DOI: 10.1080/13548506.2016.1231922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Variation in referral and access to new psychological therapy services by age: an empirical quantitative study. Br J Gen Pract 2017; 67:e453-e459. [PMID: 28583944 DOI: 10.3399/bjgp17x691361] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/23/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Older people with common mental health problems (CMHPs) are known to have reduced rates of referral to psychological therapy. AIM To assess referral rates to the Improving Access to Psychological Therapies (IAPT) services, contact with a therapist, and clinical outcome by age. DESIGN AND SETTING Empirical research study using patient episodes of care from South West of England IAPT services. METHOD By analysing 82 513 episodes of care (2010-2011), referral rates and clinical improvement were compared with both total population and estimated prevalence in each age group using IAPT data. Probable recovery of those completing treatment was calculated for each group. RESULTS Estimated prevalence of CMHPs peaks in 45-49-year-olds (20.59% of population). The proportions of patients identified with CMHPs being referred peaks at 20-24 years (22.95%) and reduces with increase in age thereafter to 6.00% for 70-74-year-olds. Once referred, the proportion of those attending first treatment increases with age between 20 years (57.34%) and 64 years (76.97%). In addition, the percentage of those having a clinical improvement gradually increases from the age of 18 years (12.94%) to 69 years (20.74%). CONCLUSION Younger adults are more readily referred to IAPT services. However, as a proportion of those referred, probabilities of attending once, attending more than once, and clinical improvement increase with age. It is uncertain whether optimum levels of referral have been reached for young adults. It is important to establish whether changes to service configuration, treatment options, and GP behaviour can increase referrals for middle-aged and older adults.
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21
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Rothenberg LS, Ganz DA, Wenger NS. Possible Legal Barriers for PCP Access to Mental Health Treatment Records. J Behav Health Serv Res 2017; 43:319-29. [PMID: 25870028 DOI: 10.1007/s11414-015-9458-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Provider and payer groups have endorsed the goal of improving the integration of primary care and behavioral health across a variety of programs and settings. There is an interest in sharing patients' medical information, a goal that is permissible within HIPAA, but there are concerns about more restrictive state medical privacy laws. This article assesses whether a substantial number of state medical privacy laws are, or could be interpreted to be, more restrictive than HIPAA. Preliminary investigation found that in almost one third of the states (including large-population states such as Florida, Georgia, Massachusetts, New York, and Texas), primary care physicians (PCPs) may have difficulty accessing mental health treatment records without the patient's (or his/her guardian/conservator's) written consent. If a comprehensive legal analysis supports this conclusion, then those advocating integration of behavioral and primary care may need to consider seeking appropriate state legislative solutions.
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Affiliation(s)
- Leslie S Rothenberg
- , 16751 Edgar Street, Pacific Palisades, CA, 90272-3226, USA. .,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA. .,The RAND Corporation, Santa Monica, CA, USA.
| | - David A Ganz
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,The RAND Corporation, Santa Monica, CA, USA.,Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Neil S Wenger
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,The RAND Corporation, Santa Monica, CA, USA.,UCLA Health Ethics Center, Los Angeles, CA, USA
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22
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El-Gabalawy R, Mackenzie CS, Sareen J. Mental health service use among older Canadians with anxiety and comorbid physical conditions. Aging Ment Health 2017; 20:627-36. [PMID: 25897560 DOI: 10.1080/13607863.2015.1033678] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objective of this study was to understand the relationship between mental health service use and comorbid any anxiety and commonly occurring physical conditions (i.e., arthritis, cardiovascular disease, and gastrointestinal disease) in a national sample of older Canadians. METHODS The sample consisted of older adults aged 55 years and older from the Canadian Community Health Survey 1.2 (N = 12,792). Trained lay interviewers assessed mental disorders based on Diagnostic and Statistical Manual of Mental Disorders - 4th Edition (DSM-IV) criteria. Physical conditions were based on self-reported diagnoses by health professionals. Past-year mental health service use was categorized into whether services were utilized in the general or specialty sectors. Crosstabulations and multiple logistic regressions examined the effects of both anxiety and physical conditions on mental health service use within the general and specialty mental health sectors. RESULTS Adjusted logistic regressions indicated that there was no effect of anxiety among older adults with gastrointestinal disease on mental health service use. Conversely, in adjusted regressions, having a comorbid anxiety disorder with cardiovascular disease or arthritis was associated with increased odds of service use from the general sector in comparison to cardiovascular disease and arthritis, respectively, alone. Additionally, older adults with comorbid any anxiety disorder and gastrointestinal disease in comparison to anxiety alone had lower rates of seeking mental health services; however, these effects were no longer significant in an adjusted model. CONCLUSION Comorbidity between gastrointestinal conditions and anxiety was associated with unmet mental health service needs. This may be conceptualized in the context overlapping symptomatology in gastrointestinal conditions and anxiety.
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Affiliation(s)
- Renée El-Gabalawy
- a Department of Psychology , University of Manitoba , Winnipeg , Canada
| | - Corey S Mackenzie
- a Department of Psychology , University of Manitoba , Winnipeg , Canada
| | - Jitender Sareen
- a Department of Psychology , University of Manitoba , Winnipeg , Canada.,b Department of Psychiatry , University of Manitoba , Winnipeg , Canada.,c Department of Community Health Sciences , University of Manitoba , Winnipeg , Canada
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Likelihood of Attending Treatment for Anxiety Among Veteran Primary Care Patients: Patient Preferences for Treatment Attributes. J Clin Psychol Med Settings 2016; 23:225-39. [DOI: 10.1007/s10880-016-9462-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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24
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Ortoleva Bucher C, Dubuc N, von Gunten A, Morin D. Du soin pratiqué au quotidien au consensus d’experts : état de l’évidence sur les interventions infirmières et leur priorisation selon le profil clinique des personnes âgées hospitalisées pour des symptômes comportementaux et psychologiques de la démence. Rech Soins Infirm 2016. [DOI: 10.3917/rsi.124.0075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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25
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Otero P, Smit F, Cuijpers P, DeRubeis RJ, Torres Á, Vázquez FL. Differential response to depression prevention among a sample of informal caregivers: Moderator analysis of longer-term follow-up trial data. Psychiatry Res 2015; 230:271-8. [PMID: 26456895 DOI: 10.1016/j.psychres.2015.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 06/11/2015] [Accepted: 09/02/2015] [Indexed: 10/23/2022]
Abstract
Depression is one of the most common mental disorders in caregivers. Therefore, preventive interventions for this population are needed, especially for caregivers with subclinical symptoms of depression. However, no study to date has identified the characteristics of caregivers that help to predict who will or will not benefit from such a preventive intervention. This study aimed to identify moderators of response to intervention comparing problem solving and usual care in indicated prevention of depression among informal caregivers. A randomized controlled trial was conducted involving 173 participants who were allocated to the problem-solving intervention (n=89) or the usual-care control-group (n=84), with 12-months follow-up. Socio-demographic, care-related and clinical variables at baseline were analyzed as potential moderators of intervention response at 12-months follow-up. Age and emotional distress emerged as significant moderators. Those caregivers younger than 65 years and with higher emotional distress at baseline were more likely to benefit from the intervention than from usual care. Simultaneous consideration of multiple moderators found that intervention was indicated for 95.4% of the sample. Considering these moderators in clinical decision-making could contribute to matching treatments and health service users in a more personalized and effective way.
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Affiliation(s)
- Patricia Otero
- Unit of Depressive Disorders, Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Campus Vida, 15782 Santiago de Compostela, Spain.
| | - Filip Smit
- Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands; Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands; Department of Epidemiology and Biostatics, EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology and EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
| | - Robert J DeRubeis
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Ángela Torres
- Department of Psychiatry, Radiology and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Fernando L Vázquez
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, Spain
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Goetter EM, Bui E, Ojserkis RA, Zakarian RJ, Brendel RW, Simon NM. A Systematic Review of Dropout From Psychotherapy for Posttraumatic Stress Disorder Among Iraq and Afghanistan Combat Veterans. J Trauma Stress 2015; 28:401-9. [PMID: 26375387 DOI: 10.1002/jts.22038] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A significant number of veterans of the conflicts in Iraq and Afghanistan have posttraumatic stress disorder (PTSD), yet underutilization of mental health treatment remains a significant problem. The purpose of this review was to summarize rates of dropout from outpatient, psychosocial PTSD interventions provided to U.S. Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF), and Operation New Dawn (OND) veterans with combat-related PTSD. There were 788 articles that were identified which yielded 20 studies involving 1,191 individuals eligible for the review. The dropout rates in individual studies ranged from 5.0% to 78.2%, and the overall pooled dropout rate was 36%, 95% CI [26.20, 43.90]. The dropout rate differed marginally by study type (routine clinical care settings had higher dropout rates than clinical trials) and treatment format (group treatment had higher dropout rates than individual treatment), but not by whether comorbid substance dependence was excluded, by treatment modality (telemedicine vs. in-person treatment), or treatment type (exposure therapy vs. nonexposure therapy). Dropout is a critical aspect of the problem of underutilization of care among OEF/OIF/OND veterans with combat-related PTSD. Innovative strategies to enhance treatment retention are needed.
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Affiliation(s)
- Elizabeth M Goetter
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Eric Bui
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca A Ojserkis
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca J Zakarian
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca Weintraub Brendel
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Naomi M Simon
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
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Polenick CA, Flora SR. Behavioral activation for depression in older adults: theoretical and practical considerations. THE BEHAVIOR ANALYST 2015; 36:35-55. [PMID: 25729131 DOI: 10.1007/bf03392291] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Late-life depression (LLD) is a major public health concern that can have devastating effects on older individuals and their families. Behavioral theories predict that decreases in response-contingent positive reinforcement and increases in negatively reinforced avoidance behaviors, often accompanied by aversive life events, result in the selection and maintenance of depression. Based on these theories, behavioral activation treatments for depression are designed to facilitate structured increases in enjoyable activities that increase opportunities for contact with positive reinforcement. We discuss the applicability of behavioral models for LLD, and we briefly review current behavioral activation interventions for LLD with an emphasis on implications for future behavior-analytic research. Behavioral activation has been demonstrated to be effective in reducing depression and increasing healthy behavior in older adults. Potential challenges and considerations for future research are discussed. We suggest that applied behavior analysts and clinical behavior analysts are particularly well suited to improve and expand on the knowledge base and practical application of behavioral activation interventions with this population.
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Ki M, Paik JW, Choi KS, Ryu SH, Han C, Lee K, Ham BJ, Chang HS, Won ES, Jun TY, Lee MS. Delays in depression treatment among Korean population. Asia Pac Psychiatry 2014; 6:414-24. [PMID: 25103868 DOI: 10.1111/appy.12140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 04/24/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Delays in mental health service utilization for patients with depression have been observed globally. To elucidate some aspects of delays, age-related associations with a series of variables representing different stages of mental health service use were studied concurrently. METHODS A total of 1,433 patients with depression participated in a nationwide Korean Depressive Patient Survey through the collaboration of 70 psychiatric clinics and hospitals. Using logistic and Poisson regression, we investigated whether there is variation in the associations by age. RESULTS Patients with depression in South Korea spent 3.4 years on average before starting a first depression treatment after the onset of depression, and 58% of them entered depression treatment in the first year of onset. Early onset appeared to lower the chance of "early depression treatment": e.g., adjusted odds ratio (OR)s for onset age of 40-54, 25-39 and <25 versus ≥55 were 0.65 (95% CI = 0.44, 0.94), 0.36 (95% CI = 0.16, 0.81) and 0.18 (95% CI = 0.06, 0.48), respectively. In contrast, favorable associations of early onset with "self-recognition as depression" and "number of nonpsychiatric clinics attended" before visiting psychiatrist were found. Younger cohorts were associated with more positive attitudes toward all mental health utilization measures. DISCUSSION Delays in depression treatment are lengthy in South Korea. Those with early onset are more likely to have delayed depression treatment but are more willing to seek help from a psychiatrist once they sought for the treatment.
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Affiliation(s)
- Myung Ki
- School of Medicine, Department of Preventive Medicine, Eulji University, Daejeon, Korea
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van der Aa HPA, Hoeben M, Rainey L, van Rens GHMB, Vreeken HL, van Nispen RMA. Why visually impaired older adults often do not receive mental health services: the patient's perspective. Qual Life Res 2014; 24:969-78. [PMID: 25398494 DOI: 10.1007/s11136-014-0835-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Older adults with a visual impairment are particularly vulnerable for increased depression and anxiety symptoms; however, they tend to underutilise mental health services. The present study aims to characterise the perceived need for and barriers to use mental health services in visually impaired older adults based on Andersen's behavioural model. METHODS A cross-sectional study in 871 visually impaired older adults (mean age 73 years) from outpatient low vision rehabilitation services was conducted. A multinomial logistic regression analysis was performed to assess potential-related factors to perceived need for mental health services, measured with the Perceived Need for Care Questionnaire (PNCQ). RESULTS About 35 % of the population had subthreshold depression and/or anxiety, and 13 % had a mood and/or anxiety disorder according to the DSM-IV. Almost 34 % of the participants with an actual disorder did not receive mental health services, even though 57 % perceived to be in need of these services. Participants who had more severe depression and/or anxiety, comorbid depression and anxiety, no history of major depressive disorder, a lower perceived health status and a younger age were more likely to be in need of mental health services. Barriers to receive these services were lack of knowledge and self-reliance. CONCLUSIONS Findings support the implementation of counselling methods, instead of medication, and patient empowerment to reduce an unmet need of mental health services in visually impaired older adults, for which extensive research is warranted.
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Affiliation(s)
- Hilde P A van der Aa
- Department of Ophthalmology, VU University Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands,
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Shtompel N, Whiteman K, Ruggiano N. Negative feelings and help seeking among older adults with chronic conditions. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2014; 57:810-824. [PMID: 24873974 DOI: 10.1080/01634372.2014.898008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Older adults with chronic conditions are at greater risk of negative affect, though few studies have focused on older adults' perspectives on how chronic conditions affect their mental well-being. This study involved in-depth interviews that explored how older adults describe their feelings about chronic conditions, the context within which they experience these feelings, and their experiences with help-seeking for negative feelings. Participants reported that older adults experience a range of negative feelings related to their conditions and are only comfortable talking to people who understand their everyday experiences with managing chronic conditions. The findings have implications for health self-management.
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Affiliation(s)
- Natalia Shtompel
- a School of Social Work , Florida International University , Miami , Florida , USA
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Muir-Cochrane E, O'Kane D, Barkway P, Oster C, Fuller J. Service provision for older people with mental health problems in a rural area of Australia. Aging Ment Health 2014; 18:759-66. [PMID: 24499436 DOI: 10.1080/13607863.2013.878307] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Unmet mental health care needs of older people (aged 65 and over) have been identified as a serious problem internationally, particularly in rural areas. In this study we explored the views of health and social care providers of the barriers to effective mental health care for older people in a rural region in Australia. METHOD Semi-structured interviews were conducted with 19 participants from 13 organisations providing care and support to older people in a rural region of Australia. A framework analysis approach was used to thematically analyse the data. RESULTS Two main themes were identified: 'Recognising the Problem' and 'Service Availability and Access'. In particular the participants identified the impact of the attitudes of older people and health professionals, as well as service inadequacies and gaps in services, on the provision of mental health care to older people in a rural region. CONCLUSION This study supports previous work on intrinsic and extrinsic barriers to older people with mental health problems accessing mental health services. The study also offers new insight into the difficulties that arise from the separation of physical and mental health systems for older people with multiple needs, and the impact of living in a rural region on unmet mental health care needs of older people.
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Affiliation(s)
- Eimear Muir-Cochrane
- a Faculty of Health Sciences, School of Nursing and Midwifery , Flinders University , Adelaide , Australia
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Hendriks GJ, Kampman M, Keijsers GPJ, Hoogduin CAL, Voshaar RCO. Cognitive-behavioral therapy for panic disorder with agoraphobia in older people: a comparison with younger patients. Depress Anxiety 2014; 31:669-77. [PMID: 24867666 DOI: 10.1002/da.22274] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 03/19/2014] [Accepted: 03/24/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Older adults with panic disorder and agoraphobia (PDA) are underdiagnosed and undertreated, while studies of cognitive-behavioral therapy (CBT) are lacking. This study compares the effectiveness of CBT for PDA in younger and older adults. METHODS A total of 172 patients with PDA (DSM-IV) received manualized CBT. Primary outcome measures were avoidance behavior (Mobility Inventory Avoidance scale) and agoraphobic cognitions (Agoraphobic Cognitions Questionnaire), with values of the younger (18-60 years) and older (≥ 60 years) patients being compared using mixed linear models adjusted for baseline inequalities, and predictive effects of chronological age, age at PDA onset and duration of illness (DOI) being examined using multiple linear regressions. RESULTS Attrition rates were 2/31 (6%) for the over-60s and 31/141 (22%) for the under-60s group (χ(2) = 3.43, df = 1, P = .06). Patients in both age groups improved on all outcome measures with moderate-to-large effect sizes. Avoidance behavior had improved significantly more in the 60+ group (F = 4.52, df = 1,134, P = .035), with agoraphobic cognitions showing no age-related differences. Baseline severity of agoraphobic avoidance and agoraphobic cognitions were the most salient predictors of outcome (range standardized betas 0.59 through 0.76, all P-values < .001). Apart from a superior reduction of agoraphobic avoidance in the 60+ participants (β = -0.30, P = .037), chronological age was not related to outcome, while in the older patients higher chronological age, late-onset type and short DOI were linked to superior improvement of agoraphobic avoidance. CONCLUSIONS CBT appears feasible for 60+ PDA-patients, yielding outcomes that are similar and sometimes even superior to those obtained in younger patients.
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Affiliation(s)
- Gert-Jan Hendriks
- Institute of Integrated Mental Health Care "Pro Persona," Centre for Anxiety Disorders "Overwaal,", Lent, The Netherlands; Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands; Department of Psychiatry, Radboud University Medical Centre, Radboud University Nijmegen, Nijmegen, The Netherlands
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Stanley MA, Wilson NL, Amspoker AB, Kraus-Schuman C, Wagener PD, Calleo JS, Cully JA, Teng E, Rhoades HM, Williams S, Masozera N, Horsfield M, Kunik ME. Lay providers can deliver effective cognitive behavior therapy for older adults with generalized anxiety disorder: a randomized trial. Depress Anxiety 2014; 31:391-401. [PMID: 24577847 DOI: 10.1002/da.22239] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/27/2013] [Accepted: 01/07/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The Institute of Medicine recommends developing a broader workforce of mental health providers, including nontraditional providers, to expand services for older adults. Cognitive behavior therapy (CBT) is effective for late-life generalized anxiety disorder (GAD), but no study has examined outcomes with delivery by lay providers working under the supervision of licensed providers. The current study examined the effects of CBT delivered by lay, bachelor-level providers (BLP) relative to Ph.D.-level expert providers (PLP), and usual care (UC) in older adults with GAD. METHODS Participants were 223 older adults (mean age, 66.9 years) with GAD recruited from primary care clinics at two sites and assigned randomly to BLP (n = 76), PLP (n = 74), or UC (n = 73). Assessments occurred at baseline and 6 months. CBT in BLP and PLP included core and elective modules (3 months: skills training; 3 months: skills review) delivered in person and by telephone, according to patient choice. RESULTS CBT in both BLP and PLP groups significantly improved GAD severity (GAD Severity Scale), anxiety (Spielberger State-Trait Anxiety Inventory; Structured Interview Guide for the Hamilton Anxiety Scale), depression (Patient Health Questionnaire), insomnia (Insomnia Severity Index), and mental health quality of life (Short-Form-12), relative to UC. Response rates defined by 20% reduction from pre- to posttreatment in at least three of four primary outcomes were higher for study completers in BLP and PLP relative to UC (BLP: 38.5%; PLP: 40.0%; UC: 19.1%). CONCLUSION Lay providers, working under the supervision of licensed providers, can deliver effective CBT.
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Affiliation(s)
- Melinda A Stanley
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, Texas; Baylor College of Medicine, Houston, Texas; South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, Texas
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Mackenzie CS, Erickson J, Deane FP, Wright M. Changes in attitudes toward seeking mental health services: a 40-year cross-temporal meta-analysis. Clin Psychol Rev 2013; 34:99-106. [PMID: 24486521 DOI: 10.1016/j.cpr.2013.12.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 11/27/2013] [Accepted: 12/03/2013] [Indexed: 11/27/2022]
Abstract
Although rates of treatment seeking for mental health problems are increasing, this increase is driven primarily by antidepressant medication use, and a majority of individuals with mental health problems remain untreated. Helpseeking attitudes are thought to be a key barrier to mental health service use, although little is known about whether such attitudes have changed over time. Research on this topic is mixed with respect to whether helpseeking attitudes have become more or less positive. The aim of the current study was to help clarify this issue using a cross-temporal meta-analysis of scores on Fischer and Turner's (1970) helpseeking attitude measure among university students (N=6796) from 1968 to 2008. Results indicated that attitudes have become increasingly negative over time, r(44)=-0.53, p<0.01, with even stronger negative results when the data are weighted (w) for sample size and study variance, r(44)=-0.63, p<.001. This disconcerting finding may reflect the greater emphasis of Fischer and Turner's scale toward helpseeking for psychotherapy. Such attitudes may be increasingly negative as a result of the unintended negative effects of efforts in recent decades to reduce stigma and market biological therapies by medicalizing mental health problems.
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Affiliation(s)
- Corey S Mackenzie
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Julie Erickson
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Frank P Deane
- School of Psychology, University of Wollongong, New South Wales, Australia
| | - Michelle Wright
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
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Abstract
OBJECTIVES To measure patient satisfaction with psychiatric outpatient care in a university hospital setting. We wished to ascertain whether there was an association between increased patient satisfaction and background factors such as demographic details, diagnosis and patient preference for outpatient treatment in a hospital or a community setting. METHODS We conducted a cross-sectional survey of individuals' satisfaction levels with their outpatient treatment. Outpatients were invited to complete the Client Satisfaction Questionnaire-8 (CSQ-8), a well validated self-report instrument, along with some additional questions on their attitudes to the service. RESULTS One hundred and sixty-two respondents had a mean total CSQ-8 score of 26.7 (s.d. = 4.6) indicating a moderate to high level of satisfaction with outpatient care. Ninety percent of patients were satisfied with their psychiatric outpatient care. There were no significant sociodemographic or clinical associations with satisfaction levels identified. Sixty one percent of patients were in favour of retaining outpatient care in the university hospital. CONCLUSIONS This study demonstrates high satisfaction levels with psychiatric outpatient care in a university hospital setting. The majority of patients expressed a preference for maintaining outpatient care in the general hospital setting, rather than transferring to a stand-alone mental health facility in a suburban setting.
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Kales HC, Nease D, Sirey JA, Zivin K, Kim HM, Kavanagh J, Lynn S, Chiang C, Neighbors HW, Valenstein M, Blow FC. Racial differences in adherence to antidepressant treatment in later life. Am J Geriatr Psychiatry 2013; 21:999-1009. [PMID: 23602306 PMCID: PMC3573214 DOI: 10.1016/j.jagp.2013.01.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 04/03/2012] [Accepted: 04/20/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Although antidepressants are an effective treatment for later-life depression, older patients often choose not to initiate or to discontinue medication treatment prematurely. Although racial differences in depression treatment preferences have been reported, little is known about racial differences in antidepressant medication adherence among older patients. DESIGN Prospective, observational study comparing antidepressant adherence for older African American and white primary care patients. PARTICIPANTS A total of 188 subjects age 60 and older, diagnosed with clinically significant depression with a new recommendation for antidepressant treatment by their primary care physician. MEASUREMENT Study participants were assessed at study entry and at the 4-month follow-up (encompassing the acute treatment phase). Depression medication adherence was based on a well-validated self-report measure. RESULTS At the 4-month follow-up, 61.2% of subjects reported that they were adherent to their antidepressant medication. In unadjusted and two of the three adjusted analyses, African American subjects (n = 82) had significantly lower rates of 4-month antidepressant adherence than white subjects (n = 106). African American women had the lowest adherence rates (44.4%) followed by African American men (56.8%), white men (65.3%), and white women (73.7%). In logistic regression models controlling for demographic, illness, and functional status variables, significant differences persisted between African American women and white women in reported 4-month antidepressant adherence (OR: 3.58, 95% CI: 1.27-10.07, Wald χ(2) = 2.42, df = 1, p <0.02). CONCLUSIONS The results demonstrate racial and gender differences in antidepressant adherence in older adults. Depression treatment interventions for older adults should take into account the potential impact of race and gender on adherence to prescribed medications.
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Affiliation(s)
- Helen C. Kales
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Department of Veterans Affairs, HSR&D Center for Clinical Care Management, and Serious Mental Illness Treatment, Resource and Evaluation Center (SMITREC), Ann Arbor, Michigan
| | - Donald Nease
- Department of Family Medicine, University of Colorado, Aurora, Colorado
| | - Jo Anne Sirey
- Weill Cornell Medical College, Cornell University, White Plains, New York
| | - Kara Zivin
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Department of Veterans Affairs, HSR&D Center for Clinical Care Management, and Serious Mental Illness Treatment, Resource and Evaluation Center (SMITREC), Ann Arbor, Michigan
| | - Hyungjin Myra Kim
- Department of Veterans Affairs, HSR&D Center for Clinical Care Management, and Serious Mental Illness Treatment, Resource and Evaluation Center (SMITREC), Ann Arbor, Michigan,Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan
| | - Janet Kavanagh
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Shana Lynn
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Claire Chiang
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Department of Veterans Affairs, HSR&D Center for Clinical Care Management, and Serious Mental Illness Treatment, Resource and Evaluation Center (SMITREC), Ann Arbor, Michigan
| | - Harold W. Neighbors
- Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, Michigan,Program for Research on Black Americans, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Marcia Valenstein
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Department of Veterans Affairs, HSR&D Center for Clinical Care Management, and Serious Mental Illness Treatment, Resource and Evaluation Center (SMITREC), Ann Arbor, Michigan
| | - Frederic C. Blow
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan,Department of Veterans Affairs, HSR&D Center for Clinical Care Management, and Serious Mental Illness Treatment, Resource and Evaluation Center (SMITREC), Ann Arbor, Michigan
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Kneebone I, Walker-Samuel N, Swanston J, Otto E. Relaxation training after stroke: potential to reduce anxiety. Disabil Rehabil 2013; 36:771-4. [PMID: 23841562 DOI: 10.3109/09638288.2013.808275] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To consider the feasibility of setting up a relaxation group to treat symptoms of post stroke anxiety in an in-patient post-acute setting; and to explore the effectiveness of relaxation training in reducing self-reported tension. METHOD A relaxation group protocol was developed in consultation with a multidisciplinary team and a user group. Over a period of 24 months, 55 stroke patients attended group autogenic relaxation training on a rehabilitation ward. Attendance ranged between one and eleven sessions. Self-reported tension was assessed pre and post relaxation training using the Tension Rating Circles (TRCs). RESULTS The TRCs identified a significant reduction in self-reported tension from pre to post training, irrespective of the number of sessions attended; z = -3.656, p < 0.001, r = -0.67, for those who attended multiple sessions, z = -2.758, p < 0.01, r = -0.6 for those who attended a single session. DISCUSSION The routine use of relaxation techniques in treating anxiety in patients undergoing post-stroke rehabilitation shows potential. Self-reported tension decreased after attendance at relaxation training. The TRCs proved acceptable to group members, but should be validated against standard anxiety measures. Further exploration of the application of relaxation techniques in clinical practice is desirable. Implications for Rehabilitation Anxiety is prevalent after stroke and likely affects rehabilitation outcomes. Relaxation training is a well proven treatment for anxiety in the non-stroke population. A significant within session reduction in tension, a hallmark symptom of anxiety, was evidenced via group relaxation training delivered in a post-acute, in-patient stroke unit setting. Relaxation training a shows promise as a treatment for anxiety after stroke.
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Affiliation(s)
- Ian Kneebone
- University of Western Sydney, School of Social Sciences and Psychology , Penrith , Australia
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Abstract
To increase the sustainability of cognitive behavior therapy (CBT) in primary care for late-life anxiety, we incorporated nonexpert counselors, options for telephone meetings, and integration with primary care clinicians. This open trial examines the feasibility, satisfaction, and clinical outcomes of CBT delivered by experienced and nonexperienced counselors for older adults with generalized anxiety disorder (GAD). Clinical outcomes assessed worry (Penn State Worry Questionnaire), GAD (Generalized Anxiety Disorder Severity Scale), and anxiety (Beck Anxiety Inventory and Structured Interview Guide for Hamilton Anxiety Scale). After 3 months of treatment, Cohen's d effect sizes for worry and anxiety ranged from 0.48 to 0.78. Patients treated by experienced and nonexperienced counselors had similar reductions in worry and anxiety, although treatment outcomes were more improved on the Beck Anxiety Inventory for experienced therapists. Preliminary results suggest that adapted CBT can effectively reduce worry. The piloted modifications can provide acceptable and feasible evidence-based care.
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Holvast F, Verhaak PFM, Dekker JH, de Waal MWM, van Marwijk HWJ, Penninx BWJH, Comijs H. Determinants of receiving mental health care for depression in older adults. J Affect Disord 2012; 143:69-74. [PMID: 22871525 DOI: 10.1016/j.jad.2012.05.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 05/26/2012] [Accepted: 05/27/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Major Depressive Disorder (MDD) is common among elderly people. However, it appears that only a minority receives treatment. This study aims to identify and analyse the factors that determine whether elderly people with depressive disorders have contact with health care professionals for mental problems. METHOD Cross-sectional analysis of cohort data collected in the Netherlands Study of Depression in Older persons (NESDO) and the Netherlands Study of Depression and Anxiety (NESDA) among 167 respondents aged ≥55 with a depressive disorder as indicated by the CIDI. Contacts for mental health problems during the past six months (TiC-P), and indicators of predisposing, enabling, and objective need factors were assessed by interview. RESULTS Of the total sample, 70% had contact for mental health problems, almost entirely within primary care (62%). The odds of having contact increased with advancing age; for respondents born in the Netherlands; for those who felt less lonely; and for those with a higher household income. LIMITATIONS Our study is based on base-line interviews and thus has a cross-sectional character. Therefore, causal conclusions cannot be drawn. Furthermore, we studied the respondents' perception whether mental health care was received. CONCLUSIONS The contact rate for mental health problems is high. Health care professionals should be aware that having contact is not associated with a higher objective need, but rather with increasing age, being Dutch-born, being less lonely and having a higher household income.
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Affiliation(s)
- Floor Holvast
- Department of General Practice, University Medical Center Groningen, A. Deusinglaan 1, 9713 AV Groningen, Netherlands.
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Hong PY, Lishner DA, Gum AM, Huss EA. How Will I Judge You for Spending Money on Treatment? The Effect of Perceived Treatment Seeking Behavior on Negative Evaluation of those with Depression. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2012. [DOI: 10.1521/jscp.2012.31.8.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Response to an unsolicited intervention offer to persons aged ≥ 75 years after screening positive for depressive symptoms: a qualitative study. Int Psychogeriatr 2012; 24:270-7. [PMID: 21846427 DOI: 10.1017/s1041610211001530] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Screening can increase detection of clinically relevant depressive symptoms, but screen-positive persons are not necessarily willing to accept a subsequent unsolicited treatment offer. Our objective was to explore limiting and motivating factors in accepting an offer to join a "coping with depression" course, and perceived needs among persons aged ≥75 years who screened positive for depressive symptoms in general practice. METHODS In a randomized controlled trial, in which 101 persons who had screened positive for depressive symptoms were offered a "coping with depression" course, a sample of 23 persons were interviewed, of whom five (22%) accepted the treatment offer. Interview transcripts were coded independently by two researchers. RESULTS All five individuals who accepted a place on the course felt depressed and/or lonely and had positive expectations about the course. The main reasons for declining to join the course were: not feeling depressed, or having negative thoughts about the course effect, concerns about group participation, or about being too old to change and learn new things. Although perceived needs to relieve depressive symptoms largely matched the elements of the course, most of those who had been screened were not (yet) prepared to accept an intervention offer. Many expressed the need to discuss this treatment decision with their general practitioner. CONCLUSIONS Although the unsolicited treatment offer closely matched the perceived needs of people screening positive for depressive symptoms, only those who combined feelings of being depressed or lonely with positive expectations about the offered course accepted it. Treatment should perhaps be more individually tailored to the patient's motivational stage towards change, a process in which general practitioners can play an important role.
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Hendriks GJ, Keijsers GPJ, Kampman M, Hoogduin CAL, Oude Voshaar RC. Predictors of outcome of pharmacological and psychological treatment of late-life panic disorder with agoraphobia. Int J Geriatr Psychiatry 2012; 27:146-50. [PMID: 21452176 DOI: 10.1002/gps.2700] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 12/24/2010] [Accepted: 01/18/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study aims to evaluate the differential predictive values of age, age of onset and duration of illness on paroxetine and cognitive-behavioural therapy (CBT) outcome in late-life panic disorder with agoraphobia. METHOD Patients 60 years and older with a confirmed diagnosis of panic disorder with agoraphobia (n = 49) were randomly assigned to paroxetine (40 mg/day) treatment, individual CBT or a waiting-list control condition. Multiple regression analyses were conducted per treatment arm with post-treatment avoidance behaviour and agoraphobic cognitions as the dependent variables. RESULTS Higher age at onset and shorter duration of illness were predictors of superior outcomes following CBT, although these variables did not influence the treatment effects of paroxetine. CONCLUSIONS In late-life agoraphobic panic disorder, chronological age has no impact on treatment modality outcome. In older patients with a late disease onset or shorter duration of illness, CBT is to be preferred over paroxetine, whereas paroxetine might be the treatment of choice for older people with an early onset and short duration of illness.
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Abstract
OBJECTIVES While psychosocial interventions for late-life anxiety show positive outcomes, treatment effects are not as robust as in younger adults. To date, the reach of research has been limited to academic and primary care settings, with homogeneous samples. This review examines recently funded and ongoing late-life anxiety research that uses innovative approaches to reach unique patient populations and tailor treatment content and delivery options to meet the unique needs of older adults. METHOD A systematic search was conducted using electronic databases of funded clinical trials to identify ongoing psychosocial intervention studies targeting older adults with anxiety. The principal investigators (PIs) of the studies were contacted for study details and preliminary data, if available. In some cases, the PIs of identified studies acted as referral sources in identifying additional studies. RESULTS Eleven studies met inclusion criteria and represented three areas of innovation: new patient groups, novel treatment procedures, and new treatment-delivery options. Studies and their associated theoretical bases are discussed, along with preliminary results reported in published papers or conference presentations. CONCLUSION Psychosocial intervention trials currently in progress represent promising new strategies to facilitate engagement and improve outcomes among unique subsets of older adults with anxiety. Continued investigation of evidence-based treatments for geriatric anxiety will allow greater understanding of how best to tailor the interventions to fit the needs of older adults.
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Affiliation(s)
- Srijana Shrestha
- VA HSR&D Center of Excellence, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, T, USA
| | - Suzanne Robertson
- VA HSR&D Center of Excellence, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Melinda A. Stanley
- VA HSR&D Center of Excellence, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, T, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center, USA
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Correlates of perceived need for and use of mental health services by older adults in the collaborative psychiatric epidemiology surveys. Am J Geriatr Psychiatry 2010; 18:1103-15. [PMID: 20808105 PMCID: PMC2992082 DOI: 10.1097/jgp.0b013e3181dd1c06] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Older adults are especially unlikely to seek mental health services, but little is known about whether their perceptions of need for help contribute to this problem. The objectives of this study were to compare perceived need across the lifespan and to examine sociodemographic and mental health correlates of whether older adults sought professional help, perceived the need for help without seeking it, and sought help from specialty mental health professionals. METHODS The authors examined help-seeking and perceived need with the Collaborative Psychiatric Epidemiology Surveys, focusing on 3,017 adults aged 55 years and older. Logistic regressions predicted help-seeking and perceived need from sociodemographic factors, past-year psychiatric disorders, and past-year suicidal behaviors. Individuals who perceived the need for help without receiving it also reported barriers to help-seeking. RESULTS Levels of perceived need were highest among 25-44 year olds and lowest among adults aged 65 years and older. Among older adults with psychiatric disorders, 47.1% did not perceive a need for professional help. Diagnoses and suicidal behaviors were strong predictors of whether individuals perceived need, whereas among those who perceived the need for help, only older age was positively associated with help-seeking. Few factors clearly distinguished those who did and did not seek help from specialty mental health professionals with the exception of having three or more psychiatric diagnoses. Finally, the most common barrier to help-seeking was a desire to handle problems on one's own. CONCLUSIONS A lack of perceived need for mental health services and self-sufficiency beliefs are significant barriers to older adults' use of mental health services.
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A randomized controlled study of paroxetine and cognitive-behavioural therapy for late-life panic disorder. Acta Psychiatr Scand 2010; 122:11-9. [PMID: 19958308 DOI: 10.1111/j.1600-0447.2009.01517.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine the effectiveness of paroxetine and cognitive-behavioural therapy (CBT) in elderly patients suffering from panic disorder with or without agoraphobia (PD(A)). METHOD Forty-nine patients aged 60+ years with confirmed PD(A) were randomly assigned to 40 mg paroxetine, individual CBT, or to a 14-week waiting list. Outcomes, with avoidance behaviour and agoraphobic cognitions being the primary measures, were assessed at baseline and at weeks 8, 14 (conclusion CBT/waiting list), and at week 26 (treated patients only) and analysed using mixed models. RESULTS All outcome measures showed that the patients having received CBT and those treated with paroxetine had significantly better improvement compared with those in the waiting-list condition. With one patient (1/20, 5%) in the CBT and three (3/14, 17.6%) in the paroxetine condition dropping out, attrition rates were low. CONCLUSION Patients with late-life panic disorder respond well to both paroxetine and CBT. Although promising, the outcomes warrant replication in larger study groups.
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Gum AM, Ayalon L, Greenberg JM, Palko B, Ruffo E, Areán PA. Preferences for Professional Assistance for Distress in a Diverse Sample of Older Adults. Clin Gerontol 2010; 33:136-151. [PMID: 22611301 PMCID: PMC3355520 DOI: 10.1080/07317110903551901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Older adults (N=140; 68.6% minority) participating in community health screenings reported their use and preferences for various professionals and services to deal with distress. Race/ethnicity was recorded based on self-report. A third of participants had discussed distress with some professional within the past year. Compared to Whites, Asian and Black elders were less likely to see a mental health professional or receive counseling in the past year. Almost all participants (89.3%) were willing to discuss distress with some professional; most preferred medical (37.9%) or religious professionals (21.4%). Fewer Asians expressed willingness across most professionals and services. Findings support efforts to integrate mental health with other services, and suggest the need for additional strategies to enhance willingness to use mental health services, especially for Asian elders.
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Affiliation(s)
- Amber M Gum
- Department of Aging and Mental Health, Florida Mental Health Institute, University of South Florida
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Munir F, Khan HTA, Yarker J, Haslam C, Long H, Bains M, Kalawsky K. Self-management of health-behaviors among older and younger workers with chronic illness. PATIENT EDUCATION AND COUNSELING 2009; 77:109-115. [PMID: 19356885 DOI: 10.1016/j.pec.2009.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Revised: 01/15/2009] [Accepted: 02/21/2009] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To examine the self-management of health behaviors carried out by older (aged 50-69 years) and younger workers (aged 20-49 years) with a chronic illness. METHODS Questionnaire data was collected from 759 employees with a diagnosed chronic illness. Four categories of self-managing health behaviors were examined: using prescribed medication, monitoring and responding to symptoms, managing an appropriate diet and exercising. RESULTS The majority of participants (56-97%) reported being advised to carry out health behaviors at home and at work. Controlling for confounding factors, medication use was associated with younger and older workers. Managing an appropriate diet was associated with younger workers with asthma, musculoskeletal pain or diabetes. Exercising was associated with younger workers with asthma and with older workers with heart disease, arthritis and rheumatism or diabetes. CONCLUSIONS The findings indicate that there are differences in diet and exercise activities among younger and older workers. PRACTICE IMPLICATIONS To increase self-management in health behaviors at work, improved communication and understanding between the different health professions and the patient/employee is required so that different tailored approaches can be effectively targeted both by age and within the context of the working environment, to those managing asthma, heart disease, diabetes and arthritis and rheumatism.
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Affiliation(s)
- Fehmidah Munir
- Department of Human Sciences, Brockington Building, Loughborough University, Leicestershire, UK.
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Oltedal S, Garratt A, Johannessen JO. Psychiatric outpatients' experiences with specialized health care delivery. A Norwegian national survey. J Ment Health 2009. [DOI: 10.1080/09638230701279832] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Use of Health Services for Psychological Distress Symptoms among Community-Dwelling Older Adults. Can J Aging 2009; 28:51-61. [DOI: 10.1017/s0714980809090011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Abstract
OBJECTIVES Older adults with mental health problems are especially unlikely to seek professional mental health services. It is not clear, however, whether their help-seeking attitudes and treatment beliefs contribute to this problem. The objectives of this study were to compare older adults' attitudes and beliefs to younger adults' and to examine the influence of age on these variables after controlling for other demographic variables, prior help-seeking, and mental disorders. METHODS The authors analyzed cross-sectional data from Part 2 of the National Comorbidity Survey Replication. This dataset includes 5,692 community-dwelling adults, including 1,341 adults who were 55 years of age and older. Participants responded to three questions assessing attitudes toward seeking professional mental health services and one question examining beliefs about the percentage of people with serious mental health concerns who benefit from professional help. The authors used logistic regression to predict positive versus negative attitudes and beliefs from age, gender, education, and race/ethnicity, as well as prior help seeking and mood and/or anxiety disorder diagnosis. RESULTS Overall, more than 80% of participants exhibited positive help-seeking attitudes and more than 70% reported positive treatment beliefs. In contrast to the modest effect of age on beliefs, adults 55-74 years of age were approximately two to three times more likely to report positive help-seeking attitudes than younger adults. CONCLUSIONS Older adults' positive attitudes and treatment beliefs are unlikely barriers to their use of mental health services. This finding, which is consistent with recent positive views of aging, suggests that enabling resources and need factors are more likely explanations for older adults' low rates of mental health service use.
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