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Lebrat M, Megard R, Dananché C, Zimmer L, Plasse J, Franck N. Identification of factors associated with hospitalization in an outpatient population with mental health conditions: a case-control study. Front Psychiatry 2024; 15:1341160. [PMID: 38699458 PMCID: PMC11063375 DOI: 10.3389/fpsyt.2024.1341160] [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] [Received: 11/19/2023] [Accepted: 03/28/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction Addressing relevant determinants for preserved person-centered rehabilitation in mental health is still a major challenge. Little research focuses on factors associated with psychiatric hospitalization in exclusive outpatient settings. Some variables have been identified, but evidence across studies is inconsistent. This study aimed to identify and confirm factors associated with hospitalization in a specific outpatient population. Methods A retrospective monocentric case-control study with 617 adult outpatients (216 cases and 401 controls) from a French community-based care facility was conducted. Participants had an index outpatient consultation between June 2021 and February 2023. All cases, who were patients with a psychiatric hospitalization from the day after the index outpatient consultation and up to 1 year later, have been included. Controls have been randomly selected from the same facility and did not experience a psychiatric hospitalization in the 12 months following the index outpatient consultation. Data collection was performed from electronic medical records. Sociodemographic, psychiatric diagnosis, historical issues, lifestyle, and follow-up-related variables were collected retrospectively. Uni- and bivariate analyses were performed, followed by a multivariable logistic regression. Results Visit to a psychiatric emergency within a year (adjusted odds ratio (aOR): 13.02, 95% confidence interval (CI): 7.32-23.97), drug treatment discontinuation within a year (aOR: 6.43, 95% CI: 3.52-12.03), history of mental healthcare without consent (aOR: 5.48, 95% CI: 3.10-10.06), medical follow-up discontinuation within a year (aOR: 3.17, 95% CI: 1.70-5.95), history of attempted suicide (aOR: 2.50, 95% CI: 1.48-4.30) and unskilled job (aOR: 0.26, 95% CI: 0.10-0.65) are the independent variables found associated with hospitalization for followed up outpatients. Conclusions Public health policies and tools at the local and national levels should be adapted to target the identified individual determinants in order to prevent outpatients from being hospitalized.
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Affiliation(s)
- Matthieu Lebrat
- Pôle Centre Rive Gauche, CH Le Vinatier, Bron, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Rachel Megard
- Pôle Centre Rive Gauche, CH Le Vinatier, Bron, France
| | | | - Luc Zimmer
- Université Claude Bernard Lyon 1, Villeurbanne, France
- UMR 5992 CNRS, U1028 INSERM, Centre de Recherche en Neurosciences de Lyon, Bron, France
- Hospices Civils de Lyon, Lyon, France
| | - Julien Plasse
- UMR 5229 CNRS, Centre Ressource de Réhabilitation psychosociale, Le Vinatier, Bron, France
| | - Nicolas Franck
- Pôle Centre Rive Gauche, CH Le Vinatier, Bron, France
- Université Claude Bernard Lyon 1, Villeurbanne, France
- UMR 5229 CNRS, Centre Ressource de Réhabilitation psychosociale, Le Vinatier, Bron, France
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Brakemeier EL, Guhn A, Stapel S, Reinhard MA, Padberg F. [Inpatient psychotherapy of depressive disorders: options and challenges]. DER NERVENARZT 2023; 94:213-224. [PMID: 36853327 DOI: 10.1007/s00115-023-01448-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND The psychotherapy of depressive disorders has become established as a central component of inpatient treatment in psychiatric and psychosomatic hospitals and furthermore constitutes an important component of the residency training in Germany; however, the number of studies examining the effectiveness and efficacy is limited. METHODS This narrative review summarizes the current state of research on inpatient psychotherapy for depressive disorders. The results of meta-analyses as well as practice-based observational studies from routine treatment in Germany, disorder-specific special programs, and side effects of inpatient psychotherapy are summarized. RESULTS The number of studies on the efficacy of inpatient psychotherapy of depressive disorders is overall low. The main finding of the largest recent meta-analysis indicates that psychotherapy in clinics and other facilities has a significant effect on depressive symptoms, with small to moderate effect sizes in randomized controlled studies. The effects are mostly maintained even after 9-15 months follow-up. An observational study from routine treatment with a very large sample size reported large pre-post and pre-follow-up effect sizes. It additionally revealed factors that appear to be difficult to change during inpatient psychotherapy, negatively affect treatment success and could be specifically addressed in future trials. Special programs, such as inpatient Interpersonal Psychotherapy (IPT) and the inpatient Cognitive Behavioral Analysis System of Psychotherapy (CBASP) indicate acceptance and efficacy/effectiveness in an initial randomized controlled (IPT) study and in observational (CBASP) studies. Side effects of inpatient psychotherapy were reported by 60-94% of patients with depressive disorders, whereby a perceived dependence on the therapist or the therapeutic setting was identified as a frequent side effect. CONCLUSION Overall, the results of the narrative review reveal that inpatient psychotherapy appears to be meaningful and effective for many patients with depressive disorders. Specific side effects, cost-effectiveness, and the question of differential indications (what works for whom?) should be further investigated.
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Affiliation(s)
- Eva-Lotta Brakemeier
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Greifswald, Greifswald, Deutschland.
| | - Anne Guhn
- Charité - Universitätsmedizin Berlin, Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Berlin, Deutschland
| | | | - Matthias A Reinhard
- Klinik für Psychiatrie und Psychotherapie, LMU Klinikum, München, Deutschland
| | - Frank Padberg
- Klinik für Psychiatrie und Psychotherapie, LMU Klinikum, München, Deutschland
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T. Stahmeyer J, Märtens C, Eidt-Koch D, G. Kahl K, Zeidler J, Eberhard S. The State of Care for Persons With a Diagnosis of Depression. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:458-465. [PMID: 35506291 PMCID: PMC9639222 DOI: 10.3238/arztebl.m2022.0204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 01/21/2022] [Accepted: 04/14/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Depression is one of the most common mental illnesses. There are well-known deficiencies in the care of patients with depression, particularly at the interfaces between health service areas or sectors. The aim of this study was to analyze the characteristics and state of care of persons with a diagnosis of depression. METHODS The analysis was based on diagnosis and billing data obtained from a statutory health insurance carrier in Germany. Patients carrying a diagnosis of depression in 2018 (ICD-10 F32, F33, F34.1) were identified and studied with respect to their utilization of care services for depression. Sociodemographic characteristics and the degree of severity of depression were also taken into account. RESULTS More than 285 000 individuals with a diagnosis of depression were included in the analysis. Their mean age was 57.5 years, and 67.5% were female. About three-quarters had at least one comorbid mental disorder. Primary care physicians were involved in the treatment of depression for 82.8% of patients with severe depression; 41.1% of such patients had contact with a medical specialist, and 9.2% with a psychologist-psychotherapist. Antidepressants were prescribed for 60.3% of patients with severe depression, and 10.2% were receiving psychotherapeutic services in accordance with the psychotherapy directive. CONCLUSION Our findings point to existing deficiencies in the care of patients with depression, particularly in the establishment of the diagnosis and in the assessment of disease severity. These are essential matters for the initiation of guideline-oriented therapy and therefore deserve to be more strongly emphasized in continuing medical education.
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Affiliation(s)
- Jona T. Stahmeyer
- AOK Niedersachsen, F1-Division of Politics, Research, and Public Relations, Hannover,*Stabsbereich Versorgungsforschung AOK – Die Gesundheitskasse für Niedersachsen Hildesheimer Straße 273, 30519 Hannover, Germany
| | - Caroline Märtens
- AOK Niedersachsen, F1-Division of Politics, Research, and Public Relations, Hannover
| | - Daniela Eidt-Koch
- Ostfalia University of Applied Sciences, Faculty of Health and Health Care Sciences, Wolfsburg
| | - Kai G. Kahl
- Hannover Medical School, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover
| | - Jan Zeidler
- Leibniz University Hannover, Center for Health Economics Research Hannover (CHERH), Institute of Health Economics (IHE), Hannover
| | - Sveja Eberhard
- AOK Niedersachsen, F1-Division of Politics, Research, and Public Relations, Hannover
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Wiegand HF, Bröcker AL, Fehr M, Lohmann N, Maicher B, Röthke N, Rueb M, Wessels P, de Greck M, Pfennig A, Unterecker S, Tüscher O, Walter H, Falkai P, Lieb K, Hölzel LP, Adorjan K. Changes and Challenges in Inpatient Mental Health Care During the First Two High Incidence Phases of the COVID-19 Pandemic in Germany - Results From the COVID Ψ Psychiatry Survey. Front Psychiatry 2022; 13:855040. [PMID: 35573380 PMCID: PMC9091906 DOI: 10.3389/fpsyt.2022.855040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/15/2022] [Indexed: 01/14/2023] Open
Abstract
Psychiatric inpatient treatment, an important pillar of mental health care, is often of longer duration in Germany than in other countries. The COVID-19 pandemic called for infection prevention and control measures and thereby led to shifts in demand and inpatient capacities. The Germany-wide COVID Ψ Psychiatry Survey surveyed department heads of German psychiatric inpatient institutions. It assessed changes in utilization during the first two high incidence phases of the pandemic (spring 2020 and winter 2020/21) and also consequences for care, telemedicine experiences, hygiene measures, treatment of patients with mental illness and co-occuring SARS-CoV-2, and coercive measures in such patients. A total of n = 71 psychiatric departments (of 346 contacted) participated in the survey. The results showed a median decrease of inpatient treatment to 80% of 2019 levels and of day hospital treatment to 50% (first phase) and 70% (second phase). Reductions were mainly due to decreases in elective admissions, and emergency admissions remained unchanged or increased in 87% of departments. Utilization was reduced for affective, anxiety, personality, and addiction disorders but appeared roughly unaffected for psychotic disorders. A lack of integration of patients into their living environment, disease exacerbations, loss of contact, and suicide attempts were reported as problems resulting from reduced capacities and insufficient outpatient treatment alternatives. Almost all departments (96%) treated patients with severe mental illness and co-occurring SARS-CoV-2 infection. The majority established special wards and separate areas for (potentially) infectious patients. Telephone and video consultations were found to provide benefits in affective and anxiety disorders. Involuntary admissions of persons without mental illness because of infection protection law violations were reported by 6% of the hospitals. The survey showed high adaptability of psychiatric departments, which managed large capacity shifts and introduced new services for infectious patients, which include telemedicine services. However, the pandemic exacerbated some of the shortcomings of the German mental health system: Avoidable complications resulted from the lack of cooperation and integrated care sequences between in- and outpatient sectors and limited options for psychiatric hospitals to provide outpatient services. Preventive approaches to handle comparable pandemic situations in the future should focus on addressing these shortcomings.
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Affiliation(s)
- Hauke Felix Wiegand
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Anna-Lena Bröcker
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mandy Fehr
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Niklas Lohmann
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Birgit Maicher
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Nikolaus Röthke
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Mike Rueb
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Paula Wessels
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wurzburg, Wurzburg, Germany
| | - Moritz de Greck
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Frankfurt, Frankfurt, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - Stefan Unterecker
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wurzburg, Wurzburg, Germany
| | - Oliver Tüscher
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Lars Peer Hölzel
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Oberberg Parkklinik Schlangenbad, Wiesbaden Schlangenbad, Wiesbaden, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
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Treatment Patterns and Resource Utilization of Pregnant Women with Inflammatory Rheumatic Diseases or Psoriasis in Germany: A Claims Database Analysis. Rheumatol Ther 2021; 8:1565-1584. [PMID: 34427895 PMCID: PMC8572290 DOI: 10.1007/s40744-021-00347-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/05/2021] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Uncontrolled inflammatory disease activity can impact pregnancy outcomes and the health of the mother and child. This retrospective claims database analysis assessed treatment patterns before, during, and after pregnancy among women with inflammatory rheumatic disease (IRD; axial spondyloarthritis [axSpA], psoriatic arthritis [PsA], and rheumatoid arthritis [RA]) or psoriasis (PSO) in Germany. METHODS Data were extracted from the BARMER sickness fund (2013-2017). Pregnant women (18-45 years) with documented IRD or PSO diagnoses were compared with age-matched controls from the same database for the analysis of patient characteristics, healthcare resource utilization, and pharmacological treatment during pregnancy. Reported measures included the proportion of women with pharmacological prescriptions or hospitalization/new prescription of corticosteroids or biologics in the 180 days before pregnancy, during pregnancy, and 180 days after delivery. Pre-specified prescription categories (such as disease-specific drugs [not including biologics]) were identified by anatomical therapeutic chemical classification codes. Extrapolated values to the German statutory health insurance population are reported. RESULTS Overall, 2702 pregnant women with IRD (axSpA: 1063; PsA: 660; RA: 979) and 6527 with PSO were identified. The proportion of women with IRD receiving prescriptions for disease-specific drugs reduced during pregnancy and remained stable after delivery (before: 15.0%; during: 9.0%; after: 9.7%). The proportion of women with PSO receiving prescriptions for disease-specific drugs was low (before: 0.6%; during: 0.3%; after: 0.1%). The proportion of women with hospitalization/new prescription of corticosteroids or biologics decreased during pregnancy, compared with pre-pregnancy, and increased after delivery in women with IRD (before: 9.0%; during: 5.1%; after: 11.1%) and PSO (before: 3.5%; during: 1.9%; after: 2.7%). CONCLUSIONS A reduction in pharmacological treatment during pregnancy was observed for women with IRD in Germany. Many women with IRD did not return to pre-pregnancy treatments after delivery, despite signs of disease exacerbation, such as hospitalization and initiation of treatment with corticosteroids/biologics, in this period.
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Wiegand HF, Hölzel LP. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:57-58. [PMID: 33759750 DOI: 10.3238/arztebl.m2021.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Baur W. Breaking Down Barriers in Outpatient Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:57. [PMID: 33759748 DOI: 10.3238/arztebl.m2021.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wittner G. Alarming Figures for Severe and Moderate-to-Severe Depression. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:57. [PMID: 33759749 DOI: 10.3238/arztebl.m2021.0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hrynyschyn R, Dockweiler C. Effectiveness of Smartphone-Based Cognitive Behavioral Therapy Among Patients With Major Depression: Systematic Review of Health Implications. JMIR Mhealth Uhealth 2021; 9:e24703. [PMID: 33565989 PMCID: PMC7904402 DOI: 10.2196/24703] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/26/2020] [Accepted: 12/09/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Depression is often associated with rapid changes in mood and quality of life that persist for a period of 2 weeks. Despite medical innovations, there are problems in the provision of care. Long waiting times for treatment and high recurrence rates of depression cause enormous costs for health care systems. At the same time, comprehensive limitations in physical, psychological, and social dimensions are observed for patients with depression, which significantly reduce their quality of life. In addition to patient-specific limitations, undersupply and inappropriate health care have been determined. For this reason, new forms of care are discussed. Smartphone-based therapy is considered to have great potential due to its reach and easy accessibility. Low socioeconomic groups, which are always difficult to reach for public health interventions, can now be accessed due to the high dispersion of smartphones. There is still little information about the impact and mechanisms of smartphone-based therapy on depression. In a systematic literature review, the health implications of smartphone-based therapy were presented in comparison with standard care. OBJECTIVE The objective of this review was to identify and summarize the existing evidence regarding smartphone-based cognitive behavioral therapy for patients with depression and to present the health implications of smartphone-based cognitive behavioral therapy of considered endpoints. METHODS A systematic literature review was conducted to identify relevant studies by means of inclusion and exclusion criteria. For this purpose, the PubMed and Psyndex databases were systematically searched using a search syntax. The endpoints of depressive symptoms, depression-related anxiety, self-efficacy or self-esteem, and quality of life were analyzed. Identified studies were evaluated for study quality and risk of bias. After applying the inclusion and exclusion criteria, 8 studies were identified. RESULTS The studies examined in this review reported contradictory results regarding the investigated endpoints. In addition, due to clinical and methodological heterogeneity, it was difficult to derive evident results. All included studies reported effects on depressive symptoms. The other investigated endpoints were only reported by isolated studies. Only 50% (4/8) of the studies reported effects on depression-related anxiety, self-efficacy or self-esteem, and quality of life. CONCLUSIONS No clear implications of smartphone-based cognitive behavioral therapy could be established. Evidence for the treatment of depression using smartphone-based cognitive behavioral therapy is limited. Additional research projects are needed to demonstrate the effects of smartphone-based cognitive behavioral therapy in the context of evidence-based medicine and to enable its translation into standard care. Participatory technology development might help to address current problems in mobile health intervention studies.
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Affiliation(s)
- Robert Hrynyschyn
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Health and Nursing Science, Berlin, Germany
| | - Christoph Dockweiler
- Centre for ePublic Health Research, School of Public Health, Bielefeld University, Bielefeld, Germany
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